Eggs, Ethics and Cash: What about Singapore?

What is the price for a woman's egg? Is it more or less than a man's sperm? Is an egg worth more than the $30 paid to the donor of a pint of blood? Is it worth more than a kidney, for which the official price is zero?

Some of the questions that are being discussed by the California stem cell agency as it develops rules for securing eggs for its taxpayer-funded research.

Prop. 71 prohibits paying women to provide eggs, beyond direct expenses. But the agency is trying determine whether eggs can be used that come from sources outside of California that may involve some sort of additional payment. The Center for Policy and Genetics says that many members of the CIRM's Standards Working Group have "advocated seizing on a potential loophole in Prop. 71," asserting that "compensation for egg providers would be legal as long as the funds for these payments came from a source other than the CIRM."

The topic of cash-for-eggs came up at the group's meeting in December. The meeting received no coverage in the media but was attended by a staffer from the Center. The Korean scandal, which involved payments of $1,400 for a human eggs, was discussed during the meeting, although the flap was in its early stages.

The transcript of the meeting shows a free-ranging and loose discussion of some of the considerations involving the use of human eggs. Often in such discussions, the beginning question is phrased as "should we pay women to donate their eggs?" Rarely is it phrased as "should women be allowed to sell their eggs?" The different starting points could lead to different conclusions.

Here is a semi-random sampling of some of the partial comments from members of the Standards Group as carried in the transcript of the meeting.

Ann Kiessling, director of the Bedford Stem Cell Research Association and associate professor of surgery at Harvard Medical School

"I think that in the consenting process itself, you cannot establish guidelines for people in Singapore or other parts of the world who may actually view this as a way for women to get together and actually create a small business to donate eggs. I don't think that should be absolutely prevented. What you want to prevent is having somebody go through this procedure who was not fully informed and not doing it of their own free will."

Zach Hall, president of CIRM

"The question is do we want to exclude cell lines that are made by well-meaning, thoughtful, responsible people who happen to come to a different conclusion for whatever reasons than we do on this particular issue?"

Kiessling, again

"Lots and lots of women are going to be willing to do this because they're going to be willing to do it. It's going to be a select group. You are not going to recruit people who can't afford to take off two weeks to do it... Plenty of women...are going to volunteer to donate eggs because women do things like that. That's not the issue. The problem is whether you ought to accept lines from other parts of the world or other parts of the country that have different guidelines."

Marcy Feit, president of ValleyCare Health Systems

"(Say)there's a cell bank in Singapore. What assurances do we have that even if we get paperwork that says informed consent was given, how do we validate the process of informed consent? Many times cultures work under different understandings of processes than we do. And so I think we have to give really careful consideration to lines that were derived before our standards were set in. And I'm not saying I have the answer of how we're going to go about that because I hear the plea from the scientists that you really want to include as many lines as possible that are usable for research. But given that, the attack on CIRM would be vicious internationally if we accepted one cell line that wasn't properly handled in another country. So to validate that process, to really understand, as much discussion as we had this morning regarding protecting women, and we know what we want, how do we validate that with cell lines that were created prior to this understanding this morning?"

The discussion turned to the value of eggs in dollars and cents.

Kevin Eggan, assistant professor of molecular and cellular biology at Harvard and a founding member of the Stowers Medical Institute

"The problem here is that...eggs somehow lie somewhere between blood and sperm
and a kidney. "

Robert Taylor, associate professor of medicine at Emory University

"So I'm having trouble following this argument. So the liver donor gets nothing.The kidney donor gets nothing. The sperm donor get $75 or something like that.The blood donor who has probably a slightly higher risk of injury than the sperm donor, which I would say is probably relatively minimal risk last time I thought about it, gets compensated to the tune of $30. I'm just -- I'm starting to -- so cost and risk clearly are either dissociated or inversely related. I can't figure this."

The topic of eggs and ethics is expected to be revisited later this month at a two-day meeting of the Standards Working Group.