Intended for healthcare professionals

Education And Debate

An ethical dilemma: Should egg donors be paid?

BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7091.1400 (Published 10 May 1997) Cite this as: BMJ 1997;314:1400
  1. Ian Craft, directora
  1. a London Gynaecology and Fertility Centre, 112A Harley Street, London W1N 1AF

    An “inconvenience allowance” would solve the egg shortage

    I favour egg donation without financial reward, but the demand for eggs far outstrips the supply from women who donate for altruistic reasons. The end results are an inordinate delay, often of 1-2 years, for treatment for women who are destined to be barren, and the proliferation of private organisations that put donors and recipients in contact for financial reward.

    Figure1

    Egg retrieval is an inconvenient procedure.

    HANK MORGAN/SCIENCE PHOTO LIBRARY

    My preference is probably unrealistic in today's world, where money determines health care. Our prime concern is to provide an efficient clinical service. The principle of payment for donation is enshrined in the Human Fertilisation and Embryology Act 1990 since sperm donors are allowed £15 ($24) per donation. They can earn hundreds of pounds over several months for acts of transient pleasure. Concerns that egg donors were receiving £750 per treatment cycle led to the Human Fertilisation and Embryology Authority hosting a conference on payment to donors in June 1995. Delegates pointed out that egg donation required greater involvement and invasive treatment than did sperm donation and that the acts were hardly comparable.

    I have argued for the setting up of a national body of paid officers (counsellors, doctors, and nurses) to recruit egg and sperm donors nationwide.1 A body organised along the lines of the blood transfusion service would gain public acceptability and respect. High professional standards and accountability would be essential. Inclusion criteria for donors should be set up and data kept on screening and treatment outcomes.

    I now believe that payment of an “inconvenience allowance” would be a practical way of solving the problem of profound shortage. Within such a framework, donation could be made without recompense or for a realistic reward without abuse. Is £15-£35 for a sperm donation and £350-£450 for an egg donation unreasonable? What price do infertile people already pay for their continuing infertility? Infertility can destroy relationships and break up families, and every so often it leads to suicide.

    I do not believe that it is amoral for donors to receive an “inconvenience allowance.” We know already that more donors would come forward if there were some recompense for the trouble involved. Medicine is failing the public by its inability to implement an efficient donor gamete service. Indeed, I believe a national organisation should advertise for donors in the media, allowing the whole issue–including payment–to be brought out into the open. The public is generally supportive of new humanitarian concepts when the details are fully and honestly discussed.

    So what is the official position with regard to payment? Our centre assumed that differential payments for egg, as opposed to sperm, donation were being considered following the Human Fertilisation and Embryology Authority's conference, especially when one of the officials requested that we forward “tariff” details, depending on whether egg donation was completed or was interrupted for various reasons. However, this consideration was abandoned when the BBC screened a sensational television programme (Here and Now, 1November 1995) that reported payments between recipients and donors.2

    Within weeks the Human Fertilisation and Embryology Authority issued a policy statement on payments to egg donors which insisted that clinics not use donors who received payment of more than £15 from an agent, agency, or from any other source.3 Despite this edict some clinics still use donors recruited by private agencies.

    More recently, a new document from the authority has indicated that an even more restrictive policy will be implemented, preventing any payment whatsoever for future donors.4 The Human Fertilisation and Embryology Act 1990 allows directions to be made that alter existing law without the need for further parliamentary debate. Media reporting of fertility issues often results in immediate changes in policy, or in law, which disadvantage infertile people.5

    Such a policy has other consequences for donor sperm banks that operate commercially. The Human Fertilisation and Embryology Authority may dislike the pragmatism of offering money to overcome a donor shortage but it seems to be less concerned about which “expenses” are remitted, provided they are not seen as payment. When we met to discuss this matter they were unable to indicate clearly which expenses are considered to be reconcilable.

    The public knows that payment still occurs with some treatments that are licensed by the authority. Surrogacy involves donating the eggs and sperm of an infertile couple to the host. Call it “expenses” if you will, but the £10 000 that is usually paid to a woman for carrying a child for nine months is in reality payment. So what will the authority do now? Ban surrogacy? Surrogacy now falls within its remit after a ruling that a couple requiring this treatment be considered as donors to the host. Presumably the authority has until now condoned this arrangement provided it was “parcelled up” as a £15 payment for the nine month carrying fee and £9985 for expenses. The need for egg and sperm donation for couples who do not require surrogacy is not different in principle–only in degree.

    Surely the Human Fertilisation and Embryology Authority must realise that the sham of what is deemed acceptable is what upsets the public and our profession. We can start to remedy this by promoting the concept of a publicly accountable national egg and sperm donor organisation–infertile people deserve at least that.

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