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Available online 20 June 2013
We report the results of a qualitative study carried out in metropolitan Australia between 2009 and 2011
that canvassed the issue of payment for research ocyte donation with participants drawn from three
potential donor groups; fertility patients, reproductive donors and young, non-patient women. Research
ocytes are controversial tissues because women around the world have proved largely unwilling to
donate them altruistically. In the ensuing international debate about procurement, the issue of money
and its appropriate and inappropriate uses in tissue donation has taken centre stage. While there is now
an abundance of expert commentary on this matter, there are almost no studies that probe this issue
with potential donor populations. Our study asked the three groups of women about their understandings of altruistic, reimbursed, subsidised, compensated and paid donation for both reproductive
and research eggs. We identify a resistance to the introduction of money into the sphere of reproductive
donation, which the majority of respondents felt should remain an area of personalised gift relations. In
the area of research donation we nd a strong relationship between degrees of liquidity (the extent to
which money is constrained or unconstrained) and a sense of ethical appropriateness. We also describe a
culturally specic sense of fairness and equity among participants, associated with the relatively high
public subsidisation of fertility treatment in Australia, which they used to benchmark their sense of
appropriate and inappropriate uses of money. While the participant responses reect the regulatory
environment in Australia, particularly the absence of a US style market in reproductive ocytes, they also
make an important contribution to the global debate.
2013 Elsevier Ltd. All rights reserved.
Keywords:
Australia
Tissue donation
Research ocytes
Money
Ethics
Fertility medicine
Liquidity
Introduction
Since the mid-twentieth century in the advanced industrial
nations, two methods have been used to procure human tissues for
research. The rst is altruistic donation through formal consent.
The second is the harvesting of so-called abandoned or waste
tissue, left behind in the clinic after surgical procedures, diagnostic
tests or biopsy, in which the patient is assumed to lack interest.
While regulatory reform and increasing concern over patients
rights have made the category of abandoned tissue more residual,
for the most part the principle of altruistic donation for public
benet remains intact, despite assorted controversies over the
patenting or commercialisation of human tissues after donation
(Waldby & Mitchell, 2006).
35
36
dates were chosen to ensure that, rst, the IVF experience was no
more than two years old and second, interviewees were not
actively engaged in treatment during interviewing. The rst round
of recruitment identied 193 potential participants, while the
second round of recruitment identied a further 100. A consent for
contact letter was then sent to approximately 300 women inviting
them to participate in the study. The response rate of twenty-ve
women who proceeded to interview is consistent with other
qualitative studies with IVF patients (Haimes & Taylor, 2009).
The young non-patient women were recruited through advertisements placed on campuses noticeboard and in student publications of two large universities in the Sydney region, inviting both
staff and students to participate in a two-hour discussion. In the
end, recruitment only proceeded at one campus. The following
table sets out the demographic information gathered about the
respective cohorts.Table 1
The majority of participants (65%, n 28) were under the age of
35 years of age, arguably still in peak years of fertility. However
within the cohorts there is signicant variation in age, with the
majority of IVF patients being in the 30 s (65%, n 13) and the
young women in their 20 s (50%, n 9). 67% (n 29) of the women
did not have children at the time of research participation. 53%
(n 23) of participants had a Bachelor degree or higher, with the
most highly educated cohorts being the Egg Donors and Young
Women with 60% and 61%, respectively, holding a bachelor or
higher degree. Hence we can say that the cohorts were considerably better educated than the Australian average of 27% of women
with a University Degree (Australian Bureau of Statistics, 2012), and
while we did not collect information about ethnicity, we can say
that our participants spoke uent English.
We used in-depth interviews in relation to the ex-patient and
reproductive donor groups, and focus groups in relation to the
young, non-patient women. Interviews were used for the rst two
groups because they had extensive personal experience of fertility
treatment and ocyte extraction. We anticipated that more time for
these cohorts would be needed in order to draw out the implications of their experience. The majority of interviews were conducted in the homes of participants, and lasted between 60 and
90 min. All interviews were audio-recorded. Interviews were semistructured, with open-ended questions (Kvake, 1996: 129). We
Table 1
Demographic data interviewees.
Age (years)
26e30
31e35
36e40
41e45
46e50
Highest educational qualication
Postgraduate degree or diploma
Bachelor degree
Advanced diploma,
diploma or certicate
Secondary Education
Number of children
0
1
1 currently pregnant
2
2 currently pregnant
Participants who have Family
Member/s with Medical
Condition/s Potentially Treatable
by Stem Cell Therapies
IVF patients
(n 20)
Reproductive
egg donors
(n 5)
Young
women
(n 18)
3
6
7
3
1
1
3
1
0
0
9
6
3
0
0
5
4
8
2
1
1
3
8
1
8
7
1
2
2
N/A
3
0
1
1
0
N/A
37
used focus groups for the young women because this is an appropriate technique when participants are not well informed about the
eld. They allow the facilitator to provide an overview and generate
understandings and reasoning through group interaction (Rice &
Ezzy, 2000). The focus group data was hence somewhat more
dialogical and speculative than the interview data, however as we
describe below, each of the three groups were presented with very
similar regulatory scenarios regarding money, so that the content of
their responses can be compared. Focus groups were conducted on
University premises, and participants were reimbursed $25 for
their time. One focus group had eight participants, the second six
and the third, four participants. In each case, the focus groups were
provided with information about the logistics of ocyte provision
and stem cell research. Focus groups were audio-recorded.
The idea of money exchange in relation to research ocyte
donation was an explicit part of the interview and focus group
schedules. The women were told about the UK egg-sharing scheme,
the US market in reproductive and research ocytes and the
Australian reimbursement model and asked their attitudes to each
model. They were also asked if they thought Australian egg donors
should be paid, and if payment was appropriate for either reproductive or research donation, and for either public or commercial
research. We drew on these various scenarios in order to generate a
full range of responses to the different policy settings used around
the world and to the various professional bioethical debates. We
were interested to encourage a participant contribution to these
global debates, even when the policies themselves were unlikely to
be introduced into the Australian setting. All interview and focus
group data were transcribed verbatim by a professional transcriber
and checked by the researchers. Data analysis followed thematic
coding (Boyatzis, 1998) using NVivo software. All names used in this
paper are pseudonyms.
The value of ocytes
Issues of money in relation to ocyte donation need to be
located in a broader framework regarding the ways women value
their eggs. As we will see, this valuation is contextual, and depends
on the kinds of signicance that ocytes have for the participants,
their capacities, their meaning for the self and for possible recipients, and the different systems available to transfer them from
one party to another. In turn, these different signications condition the extent to which the women regarded their ocytes as
having exchange value, a degree of substitutability quantiable in
money terms. This sense of value is also shaped by broader understandings of social equity, the national health and distributive
fairness, articulated most clearly in the discussions of UK eggsharing programs and the commercialisation of stem cell
research. In the following discussion, we organise the responses
according to a spectrum of exchange value, moving from the most
embedded and least liquid intimate gift exchange to the most liquid
and monetised forms of frank payment. We discuss the various
cohorts responses within these categories.
Altruistic gift systems
18
0
0
0
0
4
The IVF patient group placed the highest value on their ocytes,
in the sense that most stated that they would not donate for any
reason during a treatment cycle. They expressed an acute sense of
the difculties in obtaining fertile ocytes during the treatment
process, and of the way the odds of success rapidly dwindled at
each stage. This account is typical of this groups experience.
The rst [treatment] cycle, it was something like twelve eggs,
nine fertilised, ve divided . one fresh, four in the freezer, all
38
39
If you didnt have much money, youd think, yeah, well this is a
great opportunity; we can try to have our child and were maybe
giving to stem cell research, or were giving another couple, you
know, a chance as well.
40
Conclusion
We can see that, for our participants, different forms of money
carried strong ethical associations when discussed in relation to
ocyte donation. Broadly speaking, the more liquid its form, the
closer it approximated to a cash nexus and to transactional,
impersonal relations of exchange, the more concerns were raised
about its coercive powers and its inappropriate uses. In the case of
their own ocytes, most respondents thought that reproductive
donation should remain within the realm of kinship and intimacy,
as an exceptional act of generosity to a needy sister or friend.
Because reproductive donation produced irreplaceable benets,
children and family, it constituted a non-fungible, singular good. To
follow Simmels (1990, 1900) analysis, it could not enter into any
form of commensuration, nor the creation of value through
41
Acknowledgements
This research was funded by an Australian Research Council
Linkage Project Grant: Human Ocytes for Stem Cell Research:
Donation and Regulation in Australia, LP0882054 and an Australian
Research Council Future Fellowship: The Ocyte Economy: The
Changing Meanings of Human Eggs in Fertility, Assisted Reproduction and Stem Cell Research FT100100176. It was also supported by the EU COST Action no. IS1001 Bio-objects and their
Boundaries: Governing Matter at the Intersection of Society, Politics
and Science. The authors would like to thank the three anonymous
readers for their incisive comments and the women who so
generously participated in this research.
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