Feetility – should we pay egg and sperm donors?
Lisa Jardine, the head of the UK Human Fertilisation and Embryology Authority, has called for public debate about paying egg or sperm donors. Currently donors are given a maximum of £250 in reimbursement for expenses. But donation rates have fallen in recent years, at least in part related to changes in rules in 2005 preventing donor anonymity. As a consequence a significant number of patients seeking donor egg or sperm for in-vitro fertilisation have been forced to travel overseas. In essence Jardine suggests that a regulated local market in donor eggs and sperm may be better than unregulated fertility tourism.
In countries like Australia and the UK there has been significant reluctance to pay donors for body parts or products such as blood, organs or gametes. It is thought to be a good thing if such donations are given altruistically, but ethically dubious or downright wrongful if the donor is motivated, even in part, by financial considerations. But if patients seeking IVF are travelling overseas and having to pay for donor gametes overseas the law against selling gametes is hardly having the desired effect. There is particular concern that donors in other countries may be exploited in a poorly regulated system. So maybe a local system for payment for eggs or sperm would be the lesser of two evils.
One question that is worth asking is whether the cost of donor anonymity is worth it. I don’t have enough information to assess whether the fall in donors in the UK is attributable to the law that has made it impossible for donors to remain anonymous. But if this rule has resulted in reluctance to donate perhaps it should be changed. After all, even if we think it regrettable for children to be unable to trace their biological parents, it is hardly so bad that it would be better for them never to have been born. It is sometimes suggested that children have a ‘right’ to know who their biological parents were. But it is by no means clear that this right is so forceful that it should be illegal to bring a child into existence who will lack that right. The anonymity law, if it discourages donation, has prevented a significant number of couples from accessing IVF and may have prevented a number of children from being born.
But secondly we should ask whether payment for egg or sperm donation is actually wrong at all. It is not thought unethical for women to take drugs to increase their egg production (at some personal risk), and then to undergo a procedure to retrieve the eggs, even if there is no (personal) medical reason for this. So why is it a problem for them to be paid for their time, effort, risk and discomfort? There are many selfless acts that people can undergo – working in a soup kitchen, teaching English to refugees, providing medical aid overseas. It is laudable when people do these things at no personal cost, but it doesn’t become wrong if they are paid for the same activities. It may be better for individuals to donate altruisitically, but it isn’t bad for them to donate for other reasons. It is sometimes thought to risk exploitation if women donate eggs in order to pay for college fees, or to feed their family. But whether it is exploitative depends upon how the donors are treated, the information that they are given about donation and the amount that they are paid. Although exploitation is possible (as is the case for almost any financial transaction) it is not inevitable.
If donor anonymity is not absolutely necessary or if it isn’t a particularly worrying thing for donors to receive reasonable payment for their gametes, then soul-searching about fertility tourism is unnecessary. The debate initiated by Professor Jardine should be short. But here is a suggestion that potentially addresses both questions and would likely lead to significantly improved donor numbers. Payment for donor gametes could be linked to consent for identifying information being available to offspring. Those who wished to remain anonymous would be able to donate altruistically, but wouldn’t be able to receive payment. Helping infertile couples to conceive is an extremely valuable service. We shouldn’t turn away those who wish to donate, but we can motivate them to provide information that their progeny desire.
Fertility donor pay debate call BBC News 27/07/09
Payment for egg and sperm donation? Don't do it Michael White Guardian 27/07/09
Compensating egg donors, rather than paying them, is the way forward Ainsley Newson The Times 27/07/09