Letter to the editor |
Reply: Mirror exchange of donor gametes should also accommodate scientific research
Department of Philosophy, Ghent University, Blandijnberg 2, B-9000 Ghent, Belgium
To whom correspondence should be addressed at: E-mail: guido.pennings{at}ugent.be
Sir,
The letter by Heng and Tong raises a very interesting point: should patients entering the mirror donation system have the option to donate their gametes for scientific research? This question could be extended to all present donor systems, such as embryo sharing, in which some remuneration is given. My answer is focused on two points: the internal logic of the mirror gamete donation system and the balance between benefits and risks for women who donate oocytes.
Mirror gamete donation will only work to a satisfying extent if the discrepancy between the number of oocyte donors and the number of sperm donors is not too large. Every additional donor obviously helps to diminish the shortage, but if donors have to wait too long before receiving gametes in return, the benefit (i.e. reduction of waiting time) is lost. It might indeed be expected that a number of patients will prefer to direct their gametes to research or, in the future, stem cell therapy because such use would not generate a genetic link. I mentioned in my article that people who refuse to be identified in a country where donor identifiability is imposed by law cannot participate (Pennings, 2005
). This group could theoretically be included if the option of research were offered. However, the benefit in the mirror donation system is the reduction of waiting time. This reduction is the result of the fact that more people become contributors. If they donate for research, there are no extra gametes available for the pool and, consequently, no reduction of waiting time.
Beside the argument that the system will only function properly if there is a reasonable balance between oocyte and sperm donors, there is the psychological advantage of direct reciprocity. The partner knows what he or she has to give and what he/she will get in return. Heng and Tong correctly state that donation to scientific research can also be seen as a reciprocal contribution to society. However, this also applies to blood donation. Should we then allow blood donors to receive priority for oocytes or sperm? The mirror donation system is designed the way it is because we do not want body material but gametes, and we do not want gametes for research but gametes for reproduction.
The second point concerns the question whether progress in scientific research is sufficient to justify the risk and effort involved in oocyte donation. The difference in investment between embryo and sperm donors also plays in this context. Few people will object when men donate sperm for research. However, donation of embryos for research is a lot more contentious. Some authors object to this idea, especially when this is considered in the context of somatic cell nuclear transfer (SCNT). They would like to see much more caution in approaching women for altruistic donation for stem cell research (Magnus and Cho, 2005). One main concern is linked to the risk of exploitation, especially of poor women, when payment is provided (Dickenson, 2004). This is not applicable in this system, since there is no payment involved. A second reason is that the effort (health risk, discomfort, time investment, psychological burden, etc.) of the oocyte donation is not compensated by benefits. Stem cell research is a long-term project of which the results in terms of therapeutic applications in humans remain uncertain. The oocytes donated by one woman would at best contribute to a small increase in knowledge. From the experiment to therapy is still a long way to go. It is reasonable not to subject women to the risk of ovarian hyperstimulation syndrome purely for research purposes. As Heng and Tong themselves suggest, oocyte donation for research should be restricted to women who need IVF for infertility and donate surplus oocytes for research. However, this option is not applicable here, since women in mirror gamete donation are not infertile. In short, reproduction (for themselves or for others) justifies the risks for the health of the woman but scientific research does not.
In the long run, it would be more useful and efficient if other sources of oocytes are explored to obtain oocytes for research. These alternatives (such as fetal oocytes, cadaveric oocytes and stem cell-derived gametes) all presuppose in vitro maturation, but since the clinical trials on SCNT are still a long way off, we can use this time to improve this technique. If indeed many oocytes are needed for research (although nobody really knows at the moment), these other sources would moreover immediately give a large amount of starting material.
References
Dickenson D (2004) The threatened trade in human ova. Nat Rev Genet 5,167.
Magnus D and Cho MK (2005) Issues in oocyte donation for stem cell research. Science 308,1747–1748.
Pennings G (2005) Gamete donation in a system of need-adjusted reciprocity. Hum Reprod 20,2990–2993.
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