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Assisted conception: Should egg and sperm donors be paid?

The Human Fertilisation and Embryology Authority is conducting a public consultation on how egg and sperm donation should work in theUK. Brenda Almond and John Parsons disagree about one topic in the consultation.

Dear Brenda,

If we consider donors’ motives, are financial reward and altruism completely separate?  Most people would probably have a price at which they would donate. This suggests a sliding scale dependent on the potential donor’s degree of altruistic feelings, his or her financial needs and the degree of inconvenience they would have to endure. Thus there must be a group of men and women who, for a relatively small sum, because they are altruistically motivated as well as incentivised by payment, would be willing to donate. Whereas without the payment, they would not.
 
We should not prohibit the payment of a proportionate amount of money to informed consenting donors without good evidence that to do so would cause significant harm. The argument that payments will lead to the exploitation of vulnerable donors is not evidence based. In fact the evidence is rather the other way - women in the UK are allowed to exchange their eggs for cut price or free treatment. These ‘vulnerable’ women, who donate their eggs because they cannot afford to pay for treatment, are generally happy with what they did whether or not they or their recipient conceive.1 There are no data on the views of donor conceived children.

Yours, John

1 G. Simons and K. Ahuja (2005),  The Obstetrician and Gynaecologist 7: 112 – 116

Dear John,

I can’t accept the suggestion your opening question seems to imply: that the case against offering payment for the transfer of ova, sperm or embryos is based simply on a belief that altruism and financial gain can never go hand in hand. Mixed motives are common in life. The issue here is rather whether the money motive should ever have a place in transactions where the product of the transaction is a human being.
 
I should like to take up your central argument – the libertarian one – in a later exchange, leaving aside the issue of egg-sharing which raises other issues.  You hint that you might find the case more compelling if it could be shown that the donor is vulnerable to financial exploitation. But vulnerability can take many forms, of which economic vulnerability is only one. Nor is it only the donor who is potentially vulnerable – vulnerable, that is, in respect of emotional and practical matters, including health and future medical treatment. These can affect not only the adults immediately involved, but also the resulting child. So my question here is why you think it right to take so little account of the interests of the person who results from the transaction?

Yours, Brenda

Dear Brenda,

Your response reveals your fundamental belief that money should never be involved in transactions whose product is a human being. I use the word fundamental because you have not presented an argument in support of this belief.

My concern for the interests of the resultant children contributes to my view that payment to donors is acceptable.  We cannot meet the increasing demand for donor eggs in the UK so women travel overseas to clinics where donors are paid and not identifiable. The resultant donor conceived children are not able to contact their donor parent(s) when they reach maturity. This is potentially harmful psychologically, an abuse of their human rights and denies them the opportunity to gain knowledge about their donor’s medical history. Payment of a regulated amount of money to donors in this country where donors are identifiable will increase the number of donors and thus reduce the need for women to seek donors overseas.

There are no data on the views of donor conceived children as to whether they would prefer that their donor parent(s) gave their gamete(s) without payment. Even if they did express a preference a detrimental effect would have to be shown to justify a total ban on payment.

Yours, John

Dear John,

There have to be fundamental values if ethics rather than unqualified cost-benefit calculation is to guide our decision-making. The commercialisation of conception is as morally objectionable as the trade in babies and should, I believe, evoke the same fundamental response that has led other civilised countries to make it the subject of severe legal penalties.

But there are empirical arguments as well. While it is too early for the specific question of whether payment was involved to have been singled out as a factor, there is much evidence from donor-conceived adults that the loss of a genetic parent and of their own genetic identity and personal history can be felt as a serious loss later in life. I suspect – again too early for any research results – that it would be harder to come to terms with this loss if you came to see it as the result of a commercial transaction.

I share your concern about people going abroad for a donor, for we are quite clear in this country that donor-conceived children should have access to knowledge of their genetic parentage. But the conclusion you draw from this seems to me as unacceptable as arguing that putting a burglar-alarm on your house encourages burglars to rob your neighbours.

Yours, Brenda

Dear Brenda,

I have not suggested that an unqualified cost benefit analysis is an adequate guide to our decisions in this sensitive area. In my first email I pointed out that there are likely to be people who, for a small amount of money to compensate them for the inconvenience endured, would be willing to donate when otherwise they would not have done so. They would do this because of their empathy with the recipients, not for the money per se.

Unsavoury commodification could be avoided by careful regulation. The maximum payment allowed as compensation for the inconvenience associated with the donation would be the least that leads to an adequate number of donors.  Higher payments for donors with “desirable” characteristics would not be allowed.

Sperm donation is relatively simple but egg donation places a lot of demands on the woman’s time. She has to face a surgical procedure and some risks which, although very rare, can be serious and include death. I firmly believe that it is important to continue the emphasis on altruism as the primary motivator to donate in the United Kingdom, but I believe that to expect adequate numbers of women to do this without offering compensation is unrealistic and not supported either by arguable beliefs or data.

Yours, John

Dear John,

Yes, ‘unsavoury’ commodification is bad, but when is the commodification of human beings ever acceptable? True, there could be safeguards, but given the situation in the USA and Eastern Europe, I am not as confident as you about how things would work out in practice. I am also sceptical about the extent of real need, and wary that increased availability might encourage expansion of demand.

Nor should the risks to donors and recipients be overlooked. Egg-sharing may seem a happy solution because the donor has already accepted the risks involved in her own treatment. But consider the emotional pain risked by a woman who sells her own eggs in her fertile prime and later finds herself unable to conceive. 
 

The most important stakeholder here, though, is the person who results from the transaction. Those who demand freedom to offer payment believe they are striking a blow for liberty, but true libertarianism has at its root protection of the vulnerable. Already the donor-conceived are vulnerable, both medically and socially, but the addition of payment would risk repeating aspects of the history of paid blood-donation. Their greatest vulnerability, however, remains their loss of important genetic connections, especially that between child and mother – something I continue to see as a basic human right.

Yours, Brenda

Professor Brenda Almond
Professor Brenda Almond is Emeritus Professor of Moral and Social Philosophy at the University of Hull. She has served on both the Human Fertilisation and Embryology Authority and the Human Genetics Commission. Her book, Fragmenting Family (OUP, 2008) discusses the role of the new reproductive technologies.
Dr John Parsons
Dr John Parsons was until recently a consultant gynaecologist at King’s College Hospital, London. He set up the Assisted Conception Unit there, and has been involved in setting up others at hospitals in the UK and abroad.
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