Rent vs. Buy: Compensation Related to Womb and Organ Donation

Why is that we permit financial compensation related to renting a womb, but not for donating organs?  A recent article from the New York Times touched on this issue in discussing the insufficient regulation of surrogate parenting relationships.  A few days after the surrogacy article, an essay proposed that the government provide incentives for organ donation, such as a program for providing a tax credit or for contributing to a retirement account in exchange for such donations.  The answer for treating womb and organ donation differently can’t solely be the differential risk to life or health, as pregnancy and delivery, particularly by cesarean section, entail significant risks.  It also doesn’t seem to be that organ donation is less socially valuable than surrogate parenthood. Further, both types of compensated altruism seem just as likely to take advantage of a donor’s economic distress.

Perhaps, in part, it’s the difference between owning and leasing.  We tolerate financial compensation related to surrogate parenting, including sperm and egg donation, as the burden on the donor’s’ body is temporary.  While the ability to replenish and temporal limits on pregnancy reduce the biological impact on the donor in surrogacy, they don’t really alleviate the economic inducement to donate.  Margaret Atwood, in A Handmaid’s Tale, envisioned a future in which the poor would gestate the children of the rich.  While her work of fiction was
rich in hyperbole, the underlying cautionary note is clear:  those in economic distress might be induced to donate in a way that is socially and ethically troubling.

For both organ donation as well as surrogacy arrangements, perhaps financial compensation should be limited to reasonable medical expenses to prevent this harm?  The challenge would be in determining what is “reasonable” and monitoring such compensation arrangements. While limiting financial compensation might prevent a market for wombs or organs, it also raises concerns about paternalism and autonomy. Similarly, requiring informed consent and showing lack of financial duress might address the economic coercion issue. But, such requirements would deny compensation only to those that might benefit most from it.  Is the distinction between renting and owning sufficient to permit compensation for the donation of wombs, but not organs?  Should we reconsider regulations on compensation related to donation in these areas?

Brenda Simon