Eggs for Sale: How Much Is too Much?

Andrea Gurmankin's (2001) pilot data suggest that many egg-donation agencies offer limited, perhaps even disingenuous risk information during preliminary phone calls from prospective egg donors responding to campus newspaper ads. She also makes a reasonable case that, while this is not illegal, it might influence some of these potential donors to behave differently had they gotten more detailed risk information up front.

Egg donation brims with difficult issues of informed consent, conflicting physician responsibilities, appropriate recruitment procedures, and the impact of financial incentives upon donors. The author's concern about the impact of misinformation upon donors and how this might interact with large recruitment fees is commendable, and her pilot data provide useful pointers to further studies. Her policy recommendations, however, have little to do with the actual data she has collected, and the implication that her suggestions somehow flow from that data is misleading.

The author makes four basic policy proposals:

1. That medically trained personnel be required to receive initial calls from egg donors;
2. That a standard information packet be provided all donors;
3. That third party screeners be used; and
4. That donor fees be reduced.

It is difficult to see, however, why the modest and unsurprising conclusion of her small pilot study, namely that "some oocyte donor programs are providing incomplete and inaccurate information to prospective oocyte donors in preliminary phone inquiries," warrant these actions.

It is important to look at the author's proposed policies within the framework of practices that are commonplace throughout medicine and other realms of society. The first suggestion—that medically trained personnel should answer preliminary phone calls—strikes me as the kind of regulatory micromanagement that creates significant overhead without accomplishing much. Ads are placed routinely for cosmetic surgery, hi-tech screening tests, weight-loss treatments, blood donation, and infertility treatment. All these procedures involve some risk, and rarely do medical personnel field initial phone inquiries for any of them. Nor should they. Not only would it be a highly inefficient use of trained medical professionals, it would convey the false impression that these are not essentially sales pitches. It is unreasonable to assume that someone responding to an ad offering tens of thousands of dollars for oocyte donation—especially an educated young woman at a premier academic institution—is entirely naive about the motivations of those placing that ad.

In the various situations where patients are solicited, regulators rightly trust that people have enough sense to know that they need to be careful, and informed-consent laws ensure that those who are not will at least get detailed risk information before they undergo a procedure. I agree that it would be desirable to ensure that prospective egg donors receive good risk information early in their recruitment process. Given the narrow scope of the pilot data, however, it is not clear how serious a problem the author has identified, whether the first phone call is the best place for donors to receive such risk information, or why they should be handled differently from people contemplating other elective medical procedures. Surely, an infertile couple inquiring about the possibilities of IVF and yearning for a child is no less vulnerable than a young, intelligent college student being offered money to donate eggs. Before designing a solution for this potential problem for egg donors, we at least need a better perspective on the entire recruitment process.

The author also suggests providing donors with standard information packets. This is a good idea, but it stands on its own merit. Such a packet would be useful to prospective donors no matter how much risk information most agencies were providing. The information would be cheap and easy to distribute and would insure access to up-to-date authoritative information about the procedure. The author's own failure to include potential psychosocial risks in her pilot study shows just how easy it is to neglect some risk factors...