Back in the mists of time when I was a reporter on a Sunday paper, I turned up an interesting tale about women offered free sterilisations in return for their eggs. Private fertility clinics were providing the surgery, which then cost £600, to women prepared to help an infertile couple or two. I called Dame Mary Donaldson, a former mayor of London and then head of the Human Fertilisation and Embryology Authority to get her reaction. "That's unethical," she snapped, without hesitation.
Twenty years on, offering free (or reduced cost) IVF treatment to women prepared to donate eggs is accepted practice. Now Dame Mary's successor at the HFEA, Lisa Jardine, is suggesting that in addition to the lure of free treatment, women should be offered cash to induce them to become donors. What was once condemned as "blackmail" we are now invited to accept as the normal working of the market.
Professor Jardine's reasoning is persuasive. There is a serious shortage of donor eggs and sperm, which has worsened since the removal of anonymity for donors in 2005 (treatment cycles using donated eggs fell 25 per cent between 2004-2006 and those using donated sperm were down 30 per cent).
Under existing rules, donors can get up to £250 in expenses but no fee for their services. Relying on altruism has failed to meet the demand and the shortage of donors is fuelling fertility tourism. If we allowed payment to donors, we might keep the patients and the donors here, where they can be treated in regulated clinics, rather than left to take their chance in the unregulated environment in countries overseas.
So far, so good. Men should get a lower payment, Professor Jardine suggests, because they can deliver a sample in minutes at no personal risk. But if young women want to flog their eggs to pay off their student loans, where is the harm? Provided they are properly counselled about the risks and receive top quality medical care.
For women, egg donation is a lengthy and invasive process, requiring them to take hormones to stimulate their ovaries before the egg retrieval is performed under anaesthetic. The payment should reflect the greater level of commitment and the higher risk.
Fine. But how is this different from the kidney donor looking for cash for their organ? There is a global shortage of organs for transplant, with around 40,000 people on transplant waiting lists in Western Europe, of whom between 15 and 30 per cent are expected to die. A transplant is the only cure for kidney failure (dialysis is expensive and never more than a stop-gap).
Transplant tourism has a longer history than fertility tourism and arguably poses tougher questions. Wealthy patients in western countries travel to parts of the world where the trade in organs is ignored, or tolerated, and life is cheap. Eastern Europe, Pakistan and the Far East are among the regions where it is booming. Last week, the FBI smashed a money-laundering gang in New Jersey, US, which brokered the sale of human kidneys, among other activities, and included three mayors, five rabbis and 36 others.
Professor Jardine says that the law treats eggs, sperm and embryos, regulated under the Human Fertilisation and Embryology Act, differently from other tissues which are regulated under the Human Tissue Act and there was no danger that selling eggs would set a precedent for selling kidneys. But the distinction drawn by the law appears to be without rationale. Setting a precedent is precisely what authorising donors to sell their eggs would do.
Transplant surgeons might welcome it. Cutting out bits of ourselves and selling them to the highest bidder strikes many people as grotesque – an act that should remain taboo. But senior doctors, including a former president of the General Medical Council, have called for a debate on the trade in organs, recognising, like Professor Jardine, that it cannot be stopped and would be better regulated. A person confronting their mortality, or that of a loved one, told it is wrong to buy a kidney is unlikely to be restrained by the law.
That, however, is an altogether bigger and more morally fraught debate which Professor Jardine was hoping, probably vainly, to avoid. So why head down this road at all? It is now clear that the shortage of egg and sperm donors has been aggravated by the removal of donor anonymity in 2005. A respectable attempt to give "donor" children equal rights to know their heritage has grievously backfired.
Instead of paying for eggs and sperm, which risks switching off the supply of altruistic donors as well as opening the door to the dubious organ trade, it is surely time to revisit the 2005 decision to remove donor anonymity – and reverse it.