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

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2 Responses to Feetility – should we pay egg and sperm donors?

  • Dennis Tuchler says:

    It is remarkable, indeed wonderful, that many people are willing to give parts and personal products of themselves to help others. Of course, sociobiologists might say that donors of sperm and ova are really compensated by the expectation that their genes will survive (the donors’, not the sociobiologists’). I don’t know how the availability of compensation will affect the donors, but I suspect it would increase the available of parts and products. But is compensation a good idea? It will raise the cost of the transfer to the donee (purchaser).

    I have a hard time understanding the arguments, especially the distributive justice arguments against allowing sales of body parts and products. If the transfer is a good thing, it must be because of its effect on the donee. Once the transfer is allowed, one already treats the thing transferred as a bit of property. Why not, for example, let the family object to the transfer? Why not allow religious groups to do so? Because the transferred thing, we all acknowledge, is a thing that belongs to the person whose part/product it is/was! Why quibble about payment? The fear that the poor will be exploited comes up against the joy that the poor have new assets! It’s sort of like the argument against low-wage jobs, the alternative to which is unemployment. Then, there are those who take Monty Python’s “The Meaning of Life” too seriously.

    What of the anonymity problem? The only legtitimate point of the anti-anonymity argument is that the donor might have bad genes. Today, it is possible to provide adequate information about the donor’s genetic make up. That would add to the cost of the service, of course, and might deter some donors who might suspect their privacy would be invaded by the revelation of that genetic information.

    What of the mediator of the donation/sale? Someone has to pay for the costs of the service. I suppose it is now done by charitable gifts or by tax-fed subsidies. Once compensation is allowed, the mediator might become responsible for the financing of the mediation service. So, organizations that collect sperm and ova will have to charge for the service of delivering them. This adds to the cost of getting the ova or sperm, but, so what? Once one gets rid of the idea that prospective parents who can’t afford to raise the child should have one anyway, there is no reasonable objection.

  • Michelle Hutchinson says:

    The idea of paying people who are prepared to give their information sounds sensible to me. Would the burden of paying them fall on the nhs, or the individuals who had IVF? I don’t follow Dennis’ point that collecting sperm and eggs will become more expensive on this system – surely it could continue as is? The nhs could then be responsible for pay-outs, and the question is merely whether they should seek reimbursement for this from those receiving the gametes. Perhaps people could choose between paying for their child to be one who could trace its parents, or not paying. This might be considered unfair on the resulting children – that whether their parents wanted to pay extra or not made such a large difference to their lives. But we do allow parents to make big decisions on behalf of their children. And on the above system you would always be left with some children able to trace their ancestors and others not -it seems unclear to me that it would be fairer to make some form of random allocation of which can and which can’t.

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