In a recent article in Human Reproduction, I present a new paradigm as a third way in between pure altruism and payment. In this system, which is called indirect mirror exchange, the partner of the person who needs gametes, donates in exchange for bonus points that are awarded to the infertile person. Simply put, a man donates sperm and his female partner receives bonus points by which she gets priority on the waiting list for donor oocytes. The same applies to the female partner. The system is based on the principle of fairness. According to this principle, a person is obligated to contribute his or her share of the costs when he or she voluntarily accepts the benefits of the system. This implies that people who intend to use donor gametes for their own reproduction are subjected to different moral rules and obligations than other persons. However, the model does not rely exclusively on the principle of reciprocity. Strict reciprocity would mean that people who cannot or want not donate, would not have access to donor gametes. There are several good reasons why this principle should be adjusted with need considerations. People who do not contribute also have a strong desire for a child and this desire demands consideration regardless of the contribution. Moreover, it would not be fair if people who cannot donate for genetic or medical reasons were to be excluded completely.
This system has a number of important advantages: it guarantees an increase of donors; it diminishes the pressure to start payment; the woman is personally involved in the infertility treatment and thus takes a risk partly for her own benefit; the system is compatible with the identifiability of the donor; and, couples who intend to use donor gametes for themselves are better aware than any other group what it is like to separate social and genetic parenthood. The main disadvantage would be the effort demanded of the female partner. However, the same objection can be made against altruistic egg donors (which are encouraged) who have no benefit whatsoever themselves. Moreover, some people believe that, just as for egg sharing, there is coercion involved. This objection, however, turns on a strange interpretation of moral obligation: if the people who intend to use donor gametes themselves have an obligation to contribute, then how can asking them to donate be coercive?
The rules regarding donation of gametes (and body material in general) exclude any benefit for the donor. However, for important social practices like our health insurance, we accept a certain quid pro quo when the benefit is framed in a system of mutually beneficial reciprocity. We should allow the same mechanism for gamete donation.