The value of bodily material: Acquiring and allocating human gametes

Medical Law Review

Volumn 20, Issue 4, 2012, Pages 576-603

  Pattinson, Shaun D ^a  

^a DURHAM UNIVERSITY   (United Kingdom)

Author keywords

Gamete donation; Human fertilisation and embryology authority; National donation system

Indexed keywords

ARTICLE; DONOR; FEMALE; FERTILIZATION; GOVERNMENT REGULATION; HUMAN; LEGAL ASPECT; MALE; MOTIVATION; NATIONAL HEALTH SERVICE; OOCYTE; SPERMATOZOON; TRANSPLANTATION; UNITED KINGDOM;

FEMALE; FERTILIZATION; GOVERNMENT REGULATION; GREAT BRITAIN; HUMANS; MALE; MOTIVATION; OVUM; SPERMATOZOA; STATE MEDICINE; TISSUE AND ORGAN PROCUREMENT; TISSUE DONORS;

EID: 84869988446     PISSN: 09670742     EISSN: 14643790     Source Type: Journal    
DOI: 10.1093/medlaw/fws005     Document Type: Article

References (135)

1. Waiting times of 3-5 years have been reported for donor eggs for use in infertility treatment: see HFEA, A Review of the HFEA's Sperm and Egg Donation Policies-2011 (2011) 3
2. The British Fertility Society estimates that we need at least 500 sperm donors a year to meet demand in infertility treatment: BFS, Working Party on Sperm Donation Services in the UK: Report and Recommendation (2008) 7
3. See House of Commons Science and Technology Committee, Government Proposals for the Regulation of Hybrid and Chimera Embryos. Fifth Report of Session 2006-07. HC 272-I, para 60.
4. HFEA, Sperm, egg and embryo donation (SEED) policy review: findings of the clinic survey (2004) paras 2.3 and 3.3.
5. Eg ICSI (intracytoplasmic sperm injection), which involves the injection of a sperm into an egg, has been in use since 1992: see HFEA (n 1) 4. This technique reduces the need for donor insemination.
6. The HFEA's long-term data show that egg donation for both treatment and research decreased significantly between 2001 and 2006: HFEA, A long term analysis of the HFEA register data 1991-2006 (2008) table 25a
7. See F Walsh, 'UK's first hybrid embryos created' BBC News (1 April 2008),http://news.bbc.co.uk/1/hi/health/7323298.stm..
8. Eg Nuffield Council on Bioethics, Give and take? Human bodies in medicine and research (2010) para 3.83.
9. Department of Health, Liberating the NHS: report of the arm's length bodies review (July 2010) Public Bodies Act 2011
10. See, http://www.nhsbt.nhs.uk.
11. HFEA, Consultation on the Implementation of Withdrawal of Payments to Donors (1998) paras 4.1-4.4.
12. BPS (n 1) 2
13. Nuffield Council of Bioethics (n 7) para 7.66.
14. See BFS (n 1) 6 ('just under 40% of registered DI cycles carried out in the UK in 2006 were single women and lesbian couples') and HFEA (n 1) 3-4
15. [1990] Act, s 13(5), as amended by 2008 Act, s 14(2)(b)
16. See eg 2008 Act, ss 35-47 (recognising a second woman as the other parent) and s 54 (recognising same sex couples as potential beneficiaries of a parental order)
17. One study found that over 62% of recruited volunteers were rejected as sperm donors: S Paul, S Harbottle, and JA Stewart, 'Recruitment of Sperm Donors: The Newcastle-upon-Tyne Experience 1994-2003' (2006) 21(1) Hum Reprod 150, esp 156
18. [1990] Act, s 31ZA, as inserted by the 2008 Act and replacing HFEA (Disclosure of Donor Information) Regulations 2004/1511
19. In 2005, there were 825 patients treated with donor sperm, compared to 651 in 2008: HFEA (n 1)
20. In 2005, 251 men registered as sperm donors and 921 women as egg donors, whereas these numbers were 396 and 1150 in 2008: HFEA (n 1) 4
21. http://www.hfea.gov.uk/3411.html.
22. See HFEA (n 1) 4
23. It has long been the case that egg donors are more likely to be known to the recipient than sperm donors: C Murray and S Golombok, 'Oocyte and Semen Donation: A Survey of UK Licensed Centres' (2000) 15 (10) Hum Reprod 2133
24. See, http://www.hfea.gov.uk/3422.html#3425.
25. See further the discussion in DW Riggs and L Russell, 'Characteristics of Men Willing to Act as Sperm Donors in the Context of Identity-Release Legislation' (2011) 26 Hum Reprod 266
26. E Blyth and L Frith, 'The UK's Gamete Donor "Crisis" - A Critical Analysis' (2008) 28 Critical Social Policy 74
27. HFEA (n 1) 8
28. Stem cells were first extract from human embryos in 1998: see JA Thomson and others, 'Embryonic Stem Cell Lines Derived from Human Blastocysts' (1998) 282 Science 1145
29. I am here referring to stems cells derived from an embryo that is between 5 and 14 days old: see further P Menendez and others, 'Human Embryonic Stem Cells: Potential Tool for Achieving Immunotolerance?' (2005) 1 (2)Stem Cell Reviews 151-158
30. SD Pattinson, Medical Law and Ethics (3rd edn, Sweet & Maxwell 2011) esp 355-356
31. See eg HFEA, Donating Eggs for Research: Safeguarding Donors (HFEA, 2006) 4
32. See also the first embryonic stem cell trial in the UK: F Walsh, 'Europe's first embryonic stem cell trial at Moorfields', BBC News (22 September 2011)
33. See I Wilmut and others, 'Viable Offspring Derived from Fetal and Adult Mammalian Cells' (1997) 385 Nature 810
34. They are not quite genetically identical because some genes are outside of the cell nucleus and these are not replaced by this technique: see MJ Evans and others, 'Mitochondrial DNA Genotypes in Nuclear Transfer-Derived Cloned Sheep' (1999) 23 Nature Genetics 90
35. Non-embryonic body cells have been successfully reprogrammed to become pluripotent and these cells are known as induced pluripotent stem (iPS) cells: see K Takahashi and others, 'Induction of Pluripotent Stem Cells from Adult Human Fibroblasts by Defined Factors' (2007) 131 Cell 861
36. J Yu and others, 'Induced Pluripotent Stem Cell Liens Derived from Human Somatic Cells' (2007) 318 Science 1917
37. 1990 Act, Sch 2 and the discussion in Pattinson (n 27) 361-3
38. 1990 Act, Sch 2, para 3A
39. HFE (Research Purposes) Regulations 2001/188 and the 2008 Act
40. See, in particular, Sch 2, para 3A(1)(b) ('providing knowledge') and Sch 2, para 3A(2)(a)-(b) (which refers to 'other serious medical conditions')
41. 1990 Act, ss 3(1)(a) (creation of an embryo for research) and 1(1) (definition of an embryo)
42. Exceptions include Belgium (Law of 11th May 2003, Art 4) and Sweden (in legislation passed in 2005)
43. ss 12(1)(e) and 41(8)/(9), 1990 Act
44. See HFEA, Consultation on the Implementation of Withdrawal of Payments to Donors (1998), para 1.2.
45. See HFEA, 'Paid egg sharing to be regulated, not banned', Press Release, 10 December 1998
46. This was confirmed in 2004: HFEA, 'HFEA confirms UK position on payment for egg donors', Press Release, 25 February 2004
47. See HFEA, Minutes of the meeting of the HFEA Ethics and Law Committee, 16 January 2007, para 6.8.
48. HFEA (n 1) 9
49. See HFEA, SEED Report: A report on the Human Fertilisation & Embryology Authority's review of sperm, egg and embryo donation in the United Kingdom (2005)
50. HFEA (n 1)
51. HFEA, 'HFEA agrees new policies to improve sperm and egg donation services', 19 October 2011
52. Nuffield Council on Bioethics (n 7) para 57
53. Paras 131 and 132-3, respectively
54. See eg Tyrer v UK (1979-80) 2 EHRR 1, para 31
55. See Glass v UK (2004) 39 EHRR 15, para 58
56. MAK v UK (2010) 51 EHRR 14, paras 31 and 77 (Arts 5-8)
57. See eg Evans v UK (No 6339/05, 10 April 2007) (2008) 46 EHRR 34, para 40 (Art 5);Özalp v Turkey (No 32457/96, 8 July 2004); and Juhnke v Turkey (No 52515/99, 13 May 2008) (2009) 49 EHRR 24, para 56 (Art 5)
58. Vo v France (No 53924/00, 8 July 2004) (2005) 40 EHRR 12, paras 84-85 (Arts 1, 2, and 18)
59. Art 1(1)
60. Even when not implemented, Directives give rise to interpretative obligations on national courts (Marleasing SA v La Comercial Internacional de Alimentacion SA [1990] ECR I-4135, para 8, and Miret v Fondo de Guarantia Salaria [1993] ECR I-6911, para 20) and an 'unconditional and sufficiently precise' provision may be relied on directly against the State in the domestic courts (vertical direct effect): eg Case C-152/84 Marshall v Southampton and South West Hampshire AHA [1986] QB 401, para 46
61. Recital 7
62. Arts 2 and 3(d)
63. Nuffield Council on Bioethics (n 7) para 2.44.
64. HFEA (n 1) 12
65. See also F Rapport, 'Exploring the Beliefs and Experiences of Potential Egg Share Donors' (2003) 43 Journal of Advanced Nursing 28
66. Nuffield Council on Bioethics (n 7) para 5.28.
67. See A-M Farrell, 'Is the Gift Still Good? Examining the Politics and Regulation of Blood Safety in the European Union' (2006) 14 Med LR 155, 157-8
68. RM Titmuss, The Gift Relationship: From Human Blood to Social Policy (George Allen and Unwin 1970)
69. Farrell (n 62), 161
70. N Garrido and others, 'Sperm and Oocyte Donation Selection and Management: Experience of a 10 Year Follow-up of More Than 2011 Candidates' (2002) 17 Hum Reprod 3142
71. Eg BBC, 'Donor sperm safety "in question"' BBC News (Friday 30 October 2009): http://news.bbc.co.uk/1/hi/health/8316814.stm..
72. Eg T Eastlund, 'Monetary Blood Donation Incentives and the Risk of Transfusion-transmitted Infection' (1998) 38 Transfusion 874
73. T Eastlund, 'Willingness of Volunteer Blood Donors to be Volunteer Semen Donors' (2003) 80 (6) Fertility and Sterility 1513 at1513
74. See also Nuffield Council on Bioethics (n 7) para 6.17.
75. Nuffield Council on Bioethics (n 7) 231
76. See eg KR Daniels, 'To Give or to Sell Human Gametes - The Interplay Between Pragmatics, Policy and Ethics' (2000) 26 Journal of Medical Ethics 206
77. B Steinbock, 'Payment for Egg Donation and Surrogacy' (2004) 71 Mount Sinai Journal of Medicine 255
78. I Hyun, 'Fair Payment or Undue Inducement?' (2006) 443 Nature 629
79. See HFEA (n 1) and Nuffield Council on Bioethics (n 7)
80. BBC, 'Expert says IVF couples exploited' (Thursday 31 May 2007) http://news.bbc.co.uk/1/hi/health/6707175.stm..
81. See Medicines for Human Use (Clinical Trials) Regulations 2004/1031, Sch 3, Part 1 (ethics committee authorisation), but cf Sch 1, Part 4, para 8 (children) and Sch 1, Part 5 (incapacitated adults)
82. Nuffield Council on Bioethics (n 7) para 6.9.
83. HFEA (n 10) para 1.6.
84. See also the report of the Australian Senate Committee: Senate Legal and Constitutional Affairs References Committee, Donor Conception Practices in Australia (10 February 2011) para 7.41.
85. As one of the reviewers has noted, employees in such risky environments have high level insurance cover and it maybe that introducing rewards for gametes would require increased insurance cover
86. For objections to the commodification of body parts see eg CB Cohen, 'Selling Bits and Pieces of Humans to Make Babies: The Gift of the Magi revisited' (1999) 24 Journal of Medicine and Philosophy 288
87. HFEA (n 3) para 26
88. Cf CA Erin and J Harris, 'A Monopsonistic Market: or How to Buy and Sell Human Organs, Tissues and Cells Ethically' (2004) 15 Fulbright Papers 134
89. HFEA (n 1) 8
90. Nuffield Council on Bioethics (n 7) esp paras 6.74 and 6.81.
91. As a result of the Human Tissue Act 2004, the HTA is currently responsible for regulating the removal, storage, and use of tissue (other gametes and embryos) for research, medical treatment, post-mortem examination, teaching, and public display
92. In 2009-10, NHBT managed to meet 99.9% of blood product requests: NHSBT, Annual Review 2009/10: Saving and Improving Lives 10.
93. See Chief Medical Officer's National Blood Transfusion Committee, A Plan for NHS Blood and Transplant and Hospitals to address Red Cell Shortages (2009)
94. esp para 2.2, Nuffield Council on Bioethics (n 7) 18. In 2009-10, NHSBT managed to meet 99.9% of blood product requests: NHSBT, Annual Review 2009/10: Saving and Improving Lives (NHSBT 2010) 10.
95. http://www.blood.co.uk/.
96. In the year to the end of March 2010, 552 patients died while on the waiting list for a transplant: NHSBT, Activity Report 2009/10: Transplant Activity in the UK (2010) 1
97. This figure does not reveal the full picture, because not all those who could benefit from an organ are put onto the waiting list: Department of Health, An Investigation into Conditional Organ Donation: The Report of the Panel (HMSO 2000) para 3.17.
98. See,www.organdonation.nhs.uk. for the current policies, practices, and statistics.
99. See eg L Cherkassky, 'Economy or Mortality? The Secret World of Liver Transplant Candidate Assessment' (2011) 11 (1) Med LI 23
100. For studies of the psychological effects of involuntary childlessness and the positive effects of even unsuccessful IVF, see M Hull, Infertility Treatment: Needs and Effectiveness. A Report from the University of Bristol Department of Obstetrics and Gynaecology (Serond Laboratories 1992).
101. S Koropatnick and others, 'Infertility: a Non-event Transition' (1993) 59 Fertility and Sterility 163
102. J Boivin and others, 'Reactions to Infertility Based on the Extent of Treatment Failure' (1995) 63 Fertility and Sterility 801
103. J Boivin and L Schmidt, 'Infertility-related Stress in Men and Women Predicts Treatment Outcome 1 Year Later' (2005) 83 Fertility and Sterility 1745, 1745
104. On which see G Pennings, 'Postmenopausal Women and the Right of Access to Oocyte Donation' (2001) 18 Journal of Applied Philosophy 171
105. See Sch 2, 1Z1(1)(b) of the 1990 Act, which permits embryo testing to avoid the transmission of a gene, chromosome, or mitochondrion abnormality
106. Use of this measure is suggested for a different purpose in G Pennings, 'Gamete Donation in a System of Need-Adjusted Reciprocity' (2005) 20 Human Reprod 2990, 2992
107. See the discussion in J Harris, 'Assisted Reproductive Technological Blunders (ARTBs)' (2003) 29 Journal of Medical Ethics 205 at 206
108. Human Tissue Act 2004 (Persons who Lack Capacity to Consent and Transplants) Regulations 2006/1659, Reg 12(4)
109. The HFEA has decided to adopt an explicit ban this practice, even though there are no known cases of UK clinics mixing the gametes of close genetic relatives: HFEA, 'HFEA agrees new policies about family donation and the number of families one donor can create' Press Release, 14 July 2011
110. NHSBT, Activity Report 2010/2011: Transplant Activity in the UK (August 2011) 1
111. See Nuffield Council on Bioethics (n 7) para 1.17.
112. Directions given under the Human Fertilisation and Embryology Act 1990: giving or receiving money or other benefits in respect of any supply of gametes or embryos (Ref.D.2001/1) para 5, available at,http://www.hfea.gov.uk/docs/D2006_1.pdf..
113. Pennings (n 95) at 2992 and 2993
114. See HLA Hart, 'Are There Any Natural Rights?' (1955) 64 Phil Rev 175 at 185
115. J Rawls, A Theory of Justice (Oxford University Press 1973)
116. See further R Nozick, Anarchy, State and Utopia (Blackwell 1974)
117. AJ Simmons, 'The Principle of Fair Play' (1979) 8 Philosophy & Public Affairs 307
118. A Gewirth, Reason and morality (University of Chicago Press 1978) 284-8
119. Such as one of the reviewers of this article
120. See also AP Ferraretti and others, 'Semen Donor Recruitment in An Oocyte Donation Programme' (2006) Human Reprod 2482, 2484, which goes on to propose an alternative form of indirect mirror exchange, which addresses this concern but only encourages sperm donation for treatment
121. Pennings (n 95) 2992
122. The live birth rate for IVF per cycle is only 24.1% and the donor insemination birth rate per cycle is only 11.5%: HFEA, Fertility Facts and Figures 2008 (December 2010) 4.
123. Egg donors must be aged between 18 and 35 years old: Nuffield Council on Bioethics (n 7) para 3.13.
124. See SD Pattinson, 'Consent and Informational Responsibility' 35 (3) Journal of Medical Ethics 176
125. Further Gewirth (n 107)
126. J Harris, The Value of Life: An Introduction to Medical Ethics (Routledge 1985) chs 2-3, esp 57
127. P Singer, Practical ethics (Cambridge University Press 1993) 229-46
128. Rawls (n 107). 114. Cf Nozick (n 107).
129. See eg Capital and Counties v Hampshire CC [1997] QB 1004 at 1035, per Stuart-Smith LJ, and Re F [1990] 2 AC 1 at 77-78, per Lord Goff
130. HFEA (n 44) para 5.11.
131. See eg the fraud trial that collapsed after 2 years, largely because of jurors' difficulties: D Leigh, 'Jury Protest Forces Fraud Trial Collapse After 2 Years' The Guardian (23 March 2005)
132. Titmuss (n 63)
133. See Ferraretti and others (n 108) esp 2483
134. s 14(1)(c), (4), and (5), 1990 Act and Human Fertilisation and Embryology (Statutory Storage Period for Embryos and Gametes) Regulations 2009/ 1582, as amended by Regulations 2009/2581
135. See HFEA, Code of Practice, paras 7.3-7.5.