Egg donations in the UK continue to decrease, not through any lack of demand but primarily due to a shortage of donors. In our own centre, we have been unable to meet the increasing demand for egg donors, with a drop from around 121 anonymous egg donation cycles per annum in 2001 to only 29 this year. We have witnessed an increase in reproductive tourism, with UK patients now travelling to Cyprus, Romania, Spain and the US for donated eggs.
During the SEED review, our proposed 'all-inclusive' financial allowance for donors to promote donor recruitment and shorten the waiting time to treatment - first raised over a decade ago at an HFEA sponsored meeting (St Anne's College, Oxford June 1995) - was summarily dismissed again early on in the debate, and received little further comment, despite the fact that an analogous system is in effective operation in Spain and the US. Furthermore, at the HFEA SEED Review Stakeholder meeting in July 2004, a similar proposition was put forward by others suggesting compensation varying from £300-500 for altruistic non-patient egg donors. Even this was ruled out by the HFEA (HFEA, 2005).
There is clearly confusion surrounding the so-called new 'compensation package for donors', with the HFEA promoting the concept of an improvement over the existing system. This positive 'spin' has unfortunately been swallowed even by those representing the infertile. The front cover of the latest InfertilityNetwork UK magazine (Autumn 2005) states that: 'Sperm and Egg Donors to receive more in compensation'. In the article the headline states: 'Sperm and egg donors will be compensated with more money'. This is simply not the case for many egg donors.
In reality, many donors may actually be worse off with the new compensation package, rather than the process being expense-neutral. While reasonable travel and subsistence expenses are allowed as they were before the consultation exercise, loss of earnings recompense and reimbursement of childminding expenses has been capped. So despite an apparent increased daily out-of-pocket expenses amount of £5.19, from £50 to £55.19, (to parallel jury duty), the total amount has been capped at £250. Thus an altruistic egg donor who visits the centre on more than four separate occasions (for one egg donation cycle) will be financially worse off under the new system.
Our 'all-inclusive' allowance (to include travel, subsistence and all other expenses) was never to be regarded as 'payment as inducement' but more as 'compensation for inconvenience and discomfort'. As one philosopher puts it: 'donors should not be paid for their eggs, but rather they should be compensated for the burdens of egg retrieval. Making the distinction between compensation for burdens and payment for a product has the advantages of limiting payment, not distinguishing between donors on the basis of their traits, and ensuring that donors are paid regardless of the number or quality of eggs retrieved' (Steinbock, 2004). Judging by the uninterrupted donor services in Spain and USA, reasonable donor compensation could redress the inequity of gamete donor service provision at a stroke, and is long overdue in the UK.
In the US, egg donors receive compensation in the region of between $5000 and $10000 dollars per donation, and the American Society of Reproductive Medicine has suggested capping compensation at $5000 to minimise exploitation and competition (ASRM, 2000). In Spain, egg donors are compensated to the tune of €1000 . Meanwhile, in the UK, the current amount of £15 pounds paid to gamete donors has not changed since it was introduced in 1991. We were hoping for more appropriate compensation for all donors, and our proposed all-inclusive package per cycle provides an appropriate level of transparency, reality and parity for all donors. As with the new HFEA proposal for out-of-pocket expenses, our proposal also represents a capped compensation, but at a more realistic and fairer level in which there would very rarely be a donor 'out-of-pocket' for donating. Those wishing to donate completely altruistically could still decide not to take any or receive only limited compensation. Furthermore, to prevent exploitation of financially compromised women, donors could be limited to a maximum number of donations.
We believe in the concept of altruistic donation and support the view that altruism should be the primary motivating factor for people to donate. However, there is always a disparity between the world as we wish it to be and the world as it is. There is a tacit assumption that all donors wish to donate altruistically but that has not been our experience. Up to 40 per cent of prospective egg donors at our centre decide not to continue upon learning that there is no financial benefit (Craft and Thornhill, 2005). Other evidence confirms that more than a third of egg donors welcome cash incentives (Ahuja et al, 1997).
One of the practical criticisms of compensation for egg donors is that the expense will be passed directly to the recipient. Ironically, the amount of work needed to manage the proposed bureaucratic system (involving receipts for food, travel, childminding, parking and proof of earnings) far outweighs that required to issue a single cheque for an all-inclusive allowance which is easily accountable and requires absolutely no receipts. Additional work means additional running costs. One thing is for certain - it will be the patient who pays the costs for a less efficient infertility centre.
