Am J Obstet Gynecol. 2015 Mar 26. pii: S0002-9378(15)00327-0. doi: 10.1016/j.ajog.2015.03.046. [Epub ahead of print]

Kamakahi vs. ASRM and the future of compensation for human eggs.

Klitzman R1, Sauer MV2.

Author information

• 1Professor of Clinical Psychiatry, Director, Masters of Bioethics Program, Columbia University. Electronic address: rlk2@columbia.edu.
• 2Professor Obstetrics & Gynecology, Chief, Division of Reproductive Endocrinology, Columbia University, College of Physicians & Surgeons.

Abstract

A recent lawsuit, alleging that the American Society for Reproductive Medicine (ASRM) engages in price fixing by capping the amount of compensation paid for human oocytes, has several critical ethical and policy implications that have received relatively little attention. ASRM has argued that ceilings on donor compensation prevent enticement, exploitation, and oocyte commodification. Critics counter that low donor compensation decreases supply, since fewer women are then interested in donating, which then increases prices for the service that physicians - not donors - accrue; and that ethical goals can be better achieved through enhanced informed consent, hiring egg donor advocates and better counseling and screening. Yet if compensation caps are removed, questions emerge concerning what the oocyte market would then look like. Informed consent is an imperfect process. Beyond the legal and economic questions of whether ASRM violates the Sherman Anti-trust Act also lie crucial questions of whether human eggs should be viewed as other products. We argue that human eggs differ from other, factory-produced goods, and should command moral respect. Although eggs (or embryos) are not equivalent to human beings, they deserve special consideration, because of their potential for human life, and thus have a different moral status. ASRM's current guidelines appear to address, even if imperfectly, ethical challenges related to egg procurement for infertility treatment. Given public concerns about oocyte commodification and ASRM's wariness of government regulations, existing guidelines may represent a compromise - aiding patients who seek eggs, while simultaneously trying to avoid undue influence, exploitation and eugenics. Though the ultimate outcome of this lawsuit remains unclear, policy makers, providers, lawyers, judges and others should attend seriously to these issues. Alternatives to current ASRM guidelines may be possible - e.g., raising the current caps to, say, $12,000 or $15,000, potentially increasing donation, while still avoiding certain ethical difficulties - and warrant close consideration. These complex conflictingethical issues deserve more attention than they have received, since they affect key aspects of clinical practice and the lives of countless patients.