Small Change: Is It Time To Reconsider Compensation For Gamete Donors?

The latest event produced by the Project Educational Trust (PET) was focused on the question of what level of compensation – financial or otherwise – should be standard, and permissible, for gamete donors.

Sarah Norcross, director of PET, opened the meeting with an overview of the history of compensation for gamete donors in the UK. She discussed how the Human Fertilisation and Embryology Authority (HFEA) last reviewed its donor compensation policies more than a decade ago, in 2011.

The HFEA permits donors to be given fixed sums in compensation, with a maximum of £35 per clinic visit for sperm donors and a maximum of £750 per cycle of donation for egg donors. These figures were based on comparators from other European countries in 2011 (Denmark for sperm donors and Spain for egg donors), also taking into account time spent and lifestyle alterations required during the process of donation.

The first speaker was Nayla Tohme, a patient engagement officer at the London Egg Bank. which is the largest egg bank in the UK. She said that egg donation is a lengthy process, and that donors incur a significant amount of costs along the way. 'An egg donor's journey is never straightforward. Trains get cancelled, blood samples come back inconclusive and need to be repeated, work and family emergencies happen, and this means that our donors have to come to the clinic quite a few times.'

As someone involved in managing the donor's donation cycle from start to finish, Tohme added that £750 barely covers all of the costs incurred by egg donors, especially when one considers recent increases in the cost of living. 'Increasing gamete compensation to match today's cost of living will help us fulfil our role and honour our amazing donors and the unmatched gift that they provide.'

Second to speak was Hayley King, a donor-conceived person who is also herself a mother of twins conceived with donor sperm. Her concern was that an increase in UK donor compensation might shift the donation model from altruistic to opportunistic, stating 'I do worry it could be a slippery slope if we end up having a completely "for reward" type of model'.

Historically, sperm donors in the UK were anonymous and recruited at a local level. Many were medical students, who became donors as a means of earning money to support their studies. King's biological father was one such student, and despite the fact that he donated anonymously, she has since identified and met him. He had told her that the £8 compensation he received for each clinic visit, when he donated sperm in the 1970s, had helped to pay for his rent and rates in London at the time.

King said she was wary of supporting a drastic increase in reimbursement for donors, in case a situation arose where donors were motivated primarily by financial gain, with little or no regard for the long-term implications for the people they were helping to create. King concluded that more needs to be done to support donors after they have donated.

The third speaker was Saghar Kasiri, director of European Operations at Cyros International, which is the largest sperm and egg bank in the world. She echoed Tohme's emphasis on donation being a lengthy process, explaining that that the screening and testing process for donors is extensive, and requires substantial commitment. For example, each cycle of egg donation involves 10-15 clinic visits. Due to this rigorous process, only four percent of the donor candidates are accepted.

Kasiri added that the majority of European countries pay egg donors anywhere from €1000–2000 (£869.31-1738.61), and said that in Greece this is now up to €3500 (£3042.55). She expressed concern about the low rates of donation in the UK compared with other European nations, and thought that an increase in levels of compensation in the UK might help to address this.

The final speaker, Dr Ben Hurlbut – associate professor of bioscience ethics at Arizona State University – explained that in the USA, reimbursement for egg and sperm donation is neither regulated nor capped. He said that while some commentators argue that autonomy is restricted if there is a financial inducement to donate, others argue the reverse. They say that a cap on reimbursement restricts autonomy, by removing the donor's freedom to engage in economic exchange and choice.

Dr Hurlbut was sceptical of the latter argument, which seems to have prevailed in the USA. He suggested that levels of donor reimbursement serve to exploit Americans who are financially vulnerable.

During audience questions, one attendee asked whether patients who paid more for treatment with donor gametes might thereby feel entitled to be more 'picky' about the characteristics of the donor. Kasiri responded that she thought it inappropriate to label fertility patients unreasonable, if they wished to have greater control over parts of the highly emotive process of using donor gametes.

Another attendee – Dr Leah Gilman, research fellow at the University of Sheffield – argued: 'I think it's really important to recognise that the social meaning which payments end up having is really dependent on the contexts in which they're made (not just the amount). So the language we use (compensation, payment, expenses), whether they are fixed or variable, paid as lump sum, delayed or immediate etc).'

Panel members generally agreed that it was in the best interests of donors, recipients and donor-conceived people for the process of donation remain as altruistic as possible, but that it would be fair to increase compensation to UK donors in line with inflation.

PET is grateful to the Association of Reproductive and Clinical Scientists and the British Fertility Society for supporting this event.