Cancer of the colon in an egg donor: policy repercussions for donor recruitment

This paper describes the tragic case of a young woman who died of cancer ofthe colon after successfully donating eggs to her younger sister. Althoughthere is no direct link between her operation and the subsequentdevelopment of bowel carcinoma, this case imparts a feeling of unease whenseen in conjunction with other cases reported during the last few years. Itis a reminder that little is known of the long-term consequences of someaspects of assisted conception. Women undergoing ovarian stimulation forthemselves or a matched recipient have the right to be advised, in anagreed format, that there is some concern about unproven potential risksfrom the stimulatory drugs. The safety of egg donors must assume priorityover all other considerations, including lack of donors or any moralposition. The recent decision by the Human Fertilisation and EmbryologyAuthority (HFEA) to withdraw any form of payment or recompense to eggdonors does not seem to us to be based on a balance of scientific advances,patient needs and the ethics of gamete supply. They state that theintention to withdraw payments was implicit in the 1990 Human Fertilisationand Embryology (HFE) Act. However the Act was based on the Warnock reportmade 6 years earlier. Even in 1990 ovum donation was uncommon and fertilitydrugs had not yet caused any unease. The Act provided the HFEA withdiscretionary powers to issue directions so that the future policies wouldbe consistent with any emerging new medical evidence. It is imperative thatthe HFEA provide convincing evidence on how the current policy of paymentto donors harms society, donors or recipients, and how in the UK the newpolicy will improve medical practice in assisted conception. Successfulpilot studies must precede the implementation of any new policy. Failure todo this could cause irreversible harm to the practice of assistedconception using donor gametes, which will ultimately be against the basicaims of the 1990 HFE Act.