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August 23, 2013 | Posted By Lisa Campo-Engelstein, PhD

Unlike organs, the U.S. allows gametes to be purchased. Given this dichotomy between the legal treatment of gametes and the legal treatment of organs, the question then arises: how should we legally classify ovaries, which can be used to treat both reproductive conditions (infertility) and non-reproductive conditions (premature menopause)?  

I believe ovarian tissue should be aligned with gametes rather than organs. I recognize that this leads to concerns about the sale of ovarian tissue (e.g., price, access, limitations, etc.). However, ovarian tissue like gametes and unlike other types of transplant, can lead to pregnancy, a socially and ethically important difference. The potential to create a new life is significant because new life often engenders new relationships and legal responsibilities. Whereas organ donors, both living and cadaveric, can remain anonymous, gamete donors typically cannot, at least not fully anonymous. Gamete donors are generally required to provide personal information on a variety of topics, such as physical characteristics, family medical history, religion, personal achievements, and personality traits. Potential recipients (and fertility centers) are usually the only ones who have access to this personal information. 

However, it is becoming more common in western countries for donor information to be made available to donor offspring upon request. For example, the UK’s Human Fertilisation and Embryology Act of 1990 grants donor offspring, once they reach 18, access certain information about their biological parent(s). There is concern that allowing offspring information about their biological parent(s) would discourage anonymous donations, as some donors do not want potential offspring to know their identity, let alone seek a relationship. In addition to an interpersonal relationship, some donors do not want a legal relationship with potential offspring (i.e., one in which they would have to assume financial and/or social responsibility for their biological children). Given the lack of uniform law on reproductive technologies in the USA, especially regarding what criteria are used to determine who a child’s legal parent(s) are, it is understandable that donors would not want their identity known or made available to be known.

Yet there is a bigger concern with transplantations that can lead to pregnancy than anonymity and it gets at the heart of why ovarian tissue should be classified with gametes rather than organs. Ovarian tissue transplantation is intrinsically tied to a basic human right: the right to or not to reproduce. An ovarian tissue recipient becoming pregnant with her donor ’s biological child without the donor’s permission is a violation of the donor’s reproductive rights. People should have the freedom to choose whether to become a parent and with whom they become a parent. The donor has both of these freedoms violated. It is as if she is forced to reproduce against her will and then not control who raises her future child. Similar situations that have arisen due to gamete mix-ups in infertility clinics have been met with moral outrage. 

Given the concerns that arise if the recipient has the biological child of the donor against the donor’s wishes and the fact that there is no easy way to regulate and prevent such pregnancies, it is possible to obviate these concerns by restricting the transfer of ovarian tissue to infertility clinics. Distributing ovarian tissue through infertility clinics rather than UNOS (United Network of Organ Sharing) makes it clear to both donors and recipients that pregnancy is a potential, and usually a desired, outcome of ovarian tissue transplantation. Even if National Organ Transplantation Act were to decide to include the ovary among regulated organs (like livers, kidneys, etc.), it seems unlikely that women who sign organ donor cards would think that their ovaries might be among organs that could be donated.

In short, classifying ovarian tissue like organs could lead to many logistical, legal, and ethical concerns, many of which can be sidestepped by treating it like gametes. While it is unlikely that ovarian tissue transplantation will become a mainstream treatment, exploring the philosophically interesting question of how to classify ovarian tissue is not just useful for current cases of OTT, but also for uncovering some of the theoretical foundations of how we understand and classify medical procedures. 

For my published paper on this subject, please click here.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

1 comments | Topics: Assisted Reproduction, Fertility, Reproductive Medicine, Women's Reproductive Rights

Comments

John Kaplan

John Kaplan wrote on 08/25/13 8:27 PM

Of course irregardless of the legal and philosophical arguments an ovary is an organ containing many gametes.

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BIOETHICS TODAY is the blog of the Alden March Bioethics Institute, presenting topical and timely commentary on issues, trends, and breaking news in the broad arena of bioethics. BIOETHICS TODAY presents interviews, opinion pieces, and ongoing articles on health care policy, end-of-life decision making, emerging issues in genetics and genomics, procreative liberty and reproductive health, ethics in clinical trials, medicine and the media, distributive justice and health care delivery in developing nations, and the intersection of environmental conservation and bioethics.
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