Saturday, March 21, 2009

Stem Cell Research

Stem cell research is a controversial issue. Even in countries that allow embryonic stem cell research, strict principles and procedures have been established. These include limiting the growth of the embryo to 14 days (enough time for the primitive streak to form), informed consent for the donor, patient confidentiality, noncommercialization (i.e. you can’t pay for embryos), avoidance of conflicts of interest, limitations to therapeutic purposes, ethics reviews, and traceability to cell lines with respect to their sources. A developing procedure is able to create stem cells using a woman’s oocyte and adult stem cells which are easily harvested. This is called somatic cell nuclear transfer (SCNT). One problem with this method is that women who donate their oocytes exclusively for research are taking an unnecessary health risk. Up to 10% of the women who undergo ovarian stimulation to procure oocytes experience severe ovarian hyper-stimulation syndrome, which can be painful, lead to renal failure, cause infertility, or even death. We could view these people as research subjects, who willingly submit to risky situations, except most research subjects gain some kind of benefit in return. Physician’s fiduciary obligations would prevent recommendation of such a course of action for no benefit. Altruistic donation seems reasonable when it goes to a family member (an organ transplant for example) but is it ethical to do such for a stranger? Who in their right mind would walk up to the hospital today and donate their kidney with no particular person in mind? Even if one would donate the organ since the benefits of organ transplants are so well established, who would act co altruistically for a procedure like SCNT which has no clearly established benefits? There is a wide gap between research and therapy. Stem cell research needs to be understood as research, not as a therapy that will se immediate results. “Stem cell therapy” is still years away, so donors will not be directly influencing themselves or their loved ones. Understanding of this is important for informed consent of any potential oocyte donors.