Australia should (carefully) permit compensation for donors of surplus frozen eggs

Currently, Australia faces a massive supply-and-demand disparity in egg donation, with a ratio of approximately one egg donor for every 52 hopeful parents. Such a shortfall drives many Australian women towards 'reproductive tourism', in order to access commercialised egg donation overseas. This is not only highly expensive but also exposes these women to various medical and legal risks in foreign jurisdictions with lax regulations.

An ethically justifiable means of overcoming this shortage may be to offer monetary reimbursement or compensation to incentivise former elective egg freezing patients to donate their unused frozen eggs to other patients in need. Several academic studies have concluded that the overwhelming majority of women who freeze their eggs do not eventually use them, estimated to exceed 80 percent in Australia. Consequently, it is estimated that there are approximately 100,000 unused frozen eggs that are currently sitting in cryostorage within Australia that could potentially be donated.

It can be justified that former egg freezing patients would have already invested substantial money, time, and effort during the egg freezing process, including paying expensive cryostorage fees over several years. When deciding the fate of their unused eggs, these women often perceive the loss or wastage of their hard-earned money. Offering monetary compensation can thus be seen as merely a refund or reimbursement of expensive medical fees that have already been paid, enabling these women to recoup their investment. It can be argued that compensating women for the costs of already frozen eggs should be allowed under Australian legislation as a 'reasonable expense' of the donation process.

Moreover, the current system of altruistic egg donation in Australia is grossly unfair and inequitable because IVF clinics are able to profit, yet former egg freezing patients are not even allowed a simple reimbursement or compensation for the large sums of money that they have already invested in their unused frozen eggs. In effect, 'everyone gets paid but not the donor'.

Furthermore, increasing the domestic supply of donated eggs by offering reimbursement to former egg freezing patients would make Australia less reliant on importing donor eggs from overseas. Relying on local donors is beneficial because, in Australia, donor-conceived people have the opportunity to access information about their donors as donor anonymity has been abolished, ensuring greater transparency for the child's genetic heritage compared to donor eggs sourced from overseas.

Nevertheless, it must be noted that paying former egg freezing patients for donating their unused frozen eggs also carries various ethical, legal and social risks. It is thus suggested that Australia should impose the following regulatory safeguards.

First and foremost, the top priority must be to ensure donor autonomy and informed consent. The core of ethical donation rests on rigorous, systematic, and comprehensive counselling. Hence, safeguards must be imposed to ensure that counselling is neutral to the patient's ultimate decision and should not be focused on the needs of other patients in need. In effect, counsellors should not encourage donation. Medical professionals who performed the original egg freezing procedure should not be involved in soliciting or encouraging egg donations from their former patients. This avoids the conflict of interest where doctors would earn additional medical fees by subsequently performing egg donation procedures.

It is imperative that counselling should first verify and ensure that the donor genuinely and sincerely has no desire to use their frozen eggs to conceive a child in the future, before proceeding with signing donation consent forms. This is crucial because prospective donors among former egg freezing patients tend to be much older than conventional donors, reducing their chances of conception if they later regret their donation. Perhaps older prospective donors (eg above 35 years old) should be required to have given birth to at least one child before being allowed to donate, to avoid psychological problems and decision regret related to remaining childless while having an unknown donor offspring.

The donor must also be allowed to withdraw her consent at any time before the frozen eggs are used for IVF treatment. However, requiring the donor to refund the payment upon withdrawal is ethically problematic if she is unable to afford it due to a shortage of funds. The donor's spouse or partner should ideally be involved in counselling and decision-making, as they have a right to be informed due to the risk of consanguinity between unknown donor-conceived offspring and the couple's natural children. The situation differs from conventional egg donation, which usually involves young, single and childless women.

Safeguards against financial discrimination and market forces must also be imposed. If reimbursement is permitted, specific steps must be taken to ensure payment does not create a market where some donors are deemed more valuable or desirable than others. Ideally, regulatory safeguards should mandate a fixed equal sum of money to be given as reimbursement to all donors, regardless of their race, ethnicity, educational levels, socioeconomic class, individual talents, or physical appearance (such as height, complexion, or beauty standards). This prevents market forces from leading to accusations of racial discrimination and unfairness.

To prevent recipients from selecting donors based on discriminatory preferences, information sharing must be restricted. Information on the donor's occupation, educational and professional qualifications, special talents, and abilities should be denied to prospective recipient patients. Similarly, photos of prospective donors should not be shared. Recipient patients should be strictly matched as closely as possible to prospective donors based on similar physical attributes, such as race/ethnicity, blood group, height, weight, complexion, hair, and eye colour. Prospective recipients should not be allowed to select donors of a different race or physical characteristics than their own.

Last but not least, safeguards for distributive justice also need to be imposed, to ensure fair allocation and prevent profit-driven abuses by IVF clinics. It is suggested that fertility clinics should be banned from controlling the distribution and allocation of donated frozen eggs. Instead, this function should be managed by a government agency using a centralised donor registry and waiting list of prospective recipient patients, thereby ensuring distributive justice based on need. Local recipient patients, particularly Australian citizens and permanent residents should be given priority over foreign patients in receiving donated frozen eggs. To prevent exploitative practices that maximise profits, a 'single recipient per donor rule' should be imposed by banning fertility clinics from dividing up a single donor's cohort of frozen eggs for donation to multiple recipients, in order to maximise medical fees. Instead, the entire cohort of frozen eggs from one donor should be used for one recipient patient to maximise their chances of reproductive success.

The underlying principle of all these safeguards must be to put people first (both patient and donor), above and before profits, in attempting to overcome the shortage of donor eggs in Australia.