United Kingdom : broad survey

The conditions for medically assisted reproduction involving a donor, in widespread use in Great Britain will be changing over the next two years : the law has just been modified, and as from April 2005, donors of gametes or embryos will be identifiable by the children whose conception they contributed towards, if the latter so wish when they reach 18 years of age. in April 2006, European directive No. 2004/23/CE dated 31^st March 2004 on human tissues and cells¹ will become applicable in Great Britain ; the existing  regulations will have to be adapted, in particular with respect to the safety and quality of tissues and cells (including gametes), received from non-European countries. At that opportunity, HFEA (Human Fertilisation and Embryology Authority), the British authority responsible for human reproduction and embryology, will be organising a broad survey on medically assisted reproduction involving donors of sperm, oocytes or embryos, in order to make this practice more efficient.

 A move towards payment of donors ?

How should donors be compensated ? Should they be paid, how should they be compensated for the costs generated by the donation, the inconvenience of whatever nature which is involved and how can one achieve a realistic evaluation of these ? Should a maximum compensation figure be set ?… With respect to sperm donations, opinions seem to vary between no compensation and a maximum figure of £ 50, bearing in mind that a donor may give up to 50 donations in six months... The financial compensation should be far greater for the donation of oocytes which involve invasive medical and surgical procedures which are much more unpleasant both from a physical and a mental point of view. A level of compensation ranging from £ 100 to £ 1000  has been suggested as a basis for the current discussions. The HFEA document also suggests that women who donate their oocytes could benefit from lower cost treatment for their own treatment against sterility. Finally, regarding the donation of embryos, it would appear that no compensation is being considered, since this concerns embryos for which the parents have no « parental project ».

 Importation of gametes or embryos

Gametes (in most cases sperm) and embryos may currently be imported, but on the basis of case by case authorisations; this practice will be concerned by the measures regarding identification of donors, introduced in April 2005 and by the European directive on tissues and cells. Should the HFEA continue to authorise this practice on a case by case basis or should it authorise approved centres to import gametes at their discretion, subject to the foreign partner centres presenting all the necessary guarantees regarding the recruitment of donors and the treatment of gametes ?

 

Romanian oocyte trafficking

Current practice is already providing some answers to these questions and thoughts : faced with the difficulty of obtaining oocytes in England, a British medically assisted reproduction centre has recently set up an exchange programme with a Romanian establishment, the Global Art Centre in Bucharest. Young Romanian women donors, aged between 18 and 34 are said to be altruistic and willingly donate their oocytes whereas they are not suffering from any lack of fertility. Freely ? This is somewhat doubtful in view of the pain involved in ovulation stimulation and in extraction of the oocytes… The waiting period for British mothers to be has now fallen to three months, and once the donor has been selected for her physical, medical and genetic qualities, a sample of the partner's sperm is simply sent to Bucharest. The ICSI technique is then used to fertilise the ova which are then deep-frozen and then there simply remains to plan a trip to Bucharest in order to transfer the embryos.

 The risks inherent in ovarian stimulation

However, the dangers associated with such practices are very real. According to the WHO, ovarian hyperstimulation syndrome occurs in 1% of cases and can be fatal for the patient. This is increasing with the spread of oocyte donations and is exposing certain categories of European women, victims of artificial reproductive tourism.

Finally, the marketing of gametes could be considered as a new form of prostitution, although medically, and legally controlled, in complete disregard of the medical risks for the women who « provide » the oocytes ?
 

Nowadays, research scientists are working in fields which the major civilisations have always considered as sacrosanct : life, death and mankind. And consciences are accepting these exploits by adapting as fast as technology advances. This collection of interviews between Jacqueline Dauxois and Marc Andronikov, doctor in charge of the casualty ward at Antoine Béclère de Clamart hospital, who embodies all the enlightenment of Orthodox Christianity, effectively overturns all the weak consensus on scientific progress (1).

Have we any right to refuse ?
Technically, anything can be done to mankind. It is possible… but do we not have a right to refuse ? Do we not have the right to consider ourselves and to consider others as more than an assembly of interchangeable organs and tissues  ? What treatment can one accept ? Who is to decide what becomes of our bodies when consciousness is lost ?… Is it admissible that a doctor in the casualty ward should be able to decide that a patent, who is condemned, must absolutely be revived using the full range of respiratory and circulatory machines… in order to be able to transplant his/her organs ? Since the 1976 Caillavet law, the consent of the patient is implicit and anyone who has not wilfully declared that they are opposed to the taking of their organs, is taken as accepting such practices. But who is aware of the fact ?

 « Death is not death »
Death is no longer defined as the ceasing of the three vital functions ; nowadays, only cerebral death is considered in the scientific world and by the law as death but surely this definition which authorises the taking of organs from patients in irreversible coma must be a scientific mistake ? It is claimed that the brain determines death because brain damage is currently irreversible whereas other organs, the heart, lungs can be replaced, by artificial means. Medical realities and the person as such are defined according to what is technically achievable today. Whereas death is a process, since all the functions do not cease at the same time... But the notion of cerebral death enables organs which are not affected to be taken before they are damaged. 

Therefore « the concept of equivalence between death and irreversible coma is based on three major errors : considering continuity as a point in time, considering a part as the whole, considering the foreseeable future as an event already achieved. »

Sex in the casualty ward : society without responsibility
One example among many taken from this book full of experience : since the free availability of the abortive pill, known as the "morning after" pill, young girls no longer come to the emergency wards to ask for it. But we still see youngsters in tears, asking for medical protection because their  contraceptive has burst and they are afraid of catching AIDS. The hospital is called upon urgently in order to provide tritherapy treatment !

Man : a clump of cells ?
« Use a contraceptive and do what you like », you will not be responsible for your body or the body of your companion »,  so say the advertisements. Mankind is reduced to its constituent organs, in this case the organs of pleasure or their cells. And finally, since man is no more than a clump of cells, cloning is no worse than reducing the number of supernumerary embryos, experimenting on them or converting them into cosmetics, aborting them, or choosing the genetic characteristics of a child and eliminating those which cannot be used… At every stage in life, man is encouraged to slump into what is considered to be well-being instead of bracing to face up to events. This book provides food for thought.

French Establishment for Grafts
A few days after release of the book, the news revealed a major increase in the number of applications for grafts in France. At that opportunity, the French Establishment for Grafts (EFG) proposed a change in the practices In order to compensate for the shortfall in grafts, the organisation would like to see a change in the regulations (decree dated 2^nd December 1996) in order to authorise the taking of organs in the event of cardiac arrest ; the organs could then be used, subject to their being preserved by quickly injecting them with a cooling liquid, via a catheter ; the EFG ethics committee considers that such techniques could be implemented before consulting with the next of kin ; in the event of their refusal, the probe would be removed.

Moral certainty of clinical death ?
Finally, a few days later, whilst encouraging the free donation of organs, Pope Jean Paul II recalled that it is necessary to establish the moral certainty of the clinical death of a person before taking any organs. At the time he asked the Pontifical Academy of Science to provide a precise definition of death.

 1 - J. Dauxois and Dr M. Andronikof, Casualty Ward Doctor,  published by . Editions du Rocher, January. 2005