Two California surrogacy stories from Europe, and a (pretty sad) one from Italy via Russia

Here's a late breaking story about an Italian couple that enlisted a surrogate in Russia, had the child taken from them by Italian authorities, and has just lost their appeal to the European Court of Human Rights.

ECHR rules in surrogate case--Court overrules its previous verdict
 "(ANSA) - Strasbourg, January 24 - The European Court of Human Rights said in a ruling Tuesday that Italy had not breached the rights of a couple after taking away a child born to a surrogate mother in Russia with whom they had no biological ties. The child was taken away from the couple after they returned from Russia following DNA testing showed that neither the man or the woman were its biological parent, even though a Russian birth certificate put them as parents.
    Tuesday's ruling overrides a previous decision made by the Strasbourg court in January 2015. "The Court considered that the contested measures had pursued the legitimate aims of preventing disorder and protecting the rights and freedoms of others," the ECHR said. "On this last point, it regarded as legitimate the Italian authorities' wish to reaffirm the State's exclusive competence to recognise a legal parent-child relationship - and this solely in the case of a biological tie or lawful adoption - with a view to protecting children".
    The child has been adopted by another family."

"PARADISO-CAMPANELLI VERSUS ITALY"
Surrogate motherhood: stopped by the European Court for Human Rights. The Chambre supports the Italian Court
"(Strasbourg) “The Court rules that the relationship between the applicants and the child is not part of family life”: this has been ruled by the Grande Chambre of the European Court of Human Rights, issued today about “Paradiso-Campanelli versus Italy”. The case is about an Italian couple living in the province of Campobasso, who went to Russia in 2011: through a private organisation, the married couple had had a child from a “surrogate mother” who has no biological relationship with the couple. Under Russian law, the couple could record the child as their own child, but, once back in Italy, the Court refused to record the child as the couple’s child and, after finding there was no biological relationship, it ruled that the child should be taken away from the applicants (the child was about eight months old back then) and then adopted by a different family. Today’s ruling overturns a ruling issued by the Court in January 2015: it claimed that taking the child away from the first couple breached article no. 8 of the Convention on Human Rights (right to private and family life), regardless of the child’s interest. The new ruling states, instead, that the Italian Court had actually ruled in the child’s interest and also stopped surrogate motherhood."

HT: Dorothea Kuebler
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Here are two earlier stories, set in England and Italy, from the blog Above the Law. about surrogacy as a repugnant transaction (at home) and the resulting fertility tourism (to California):

1."British aristocrats, the Viscountess and Viscount Weymouth... welcomed their second son on December 30, 2016. In what is likely a first for the British aristocracy, the child was born via surrogate.

The baby boy is the second grandson of the 7^th Marquess of Bath. I’ll just assume this is kind of a big deal in England. Lady Weymouth suffers from medical complications that made a second pregnancy too dangerous. So the couple turned to a California surrogate. To their credit, they are reportedly* sharing their story to help remove some of the stigma associated with surrogacy. Welcome and all hail the Right Honourable Henry Thynn. No typo. Honorable is spelled that way on purpose."

*They explain the differences between surrogacy in California and Britain as follows:

"Ceawlin explains that the US state has the most advanced legal system for the procedure. 
For example, it allows money to be exchanged, while Britain insists no more than expenses can be paid to the woman who will carry the child.
‘Obviously, we would have preferred to do it closer to home, but the legal system in Britain has not evolved with medical technology, so any contract with a surrogate is not binding,’ he says. 
‘Even if the baby is 100 per cent yours (ie the sperm and egg) the surrogate still has the right to keep the baby. California has the most evolved legal system in the world [for surrogacy].’ 

2. "Italy Is Not A Great Place To Be Gay. The parents of the twins are a gay Italian couple. While the U.S. made the move to permit gay marriage in 2015, Italy still denies same-sex couples the right to marry. Italy also denies gay couples the right to adopt children. Italian same-sex couples can’t even adopt their own family members through kinship adoptions. And, unsurprisingly, there is no same-sex step-parent adoption since gays can’t marry in the first place.

Having limited family-building options, the couple turned to an egg donor and California surrogate to conceive their children, and complete the family they dreamed of. Two embryos were transferred to the same surrogate. One was a donor egg fertilized with sperm from dad 1; the second was a donor egg, but this time fertilized with sperm from dad 2. The twins are biologically half-siblings with the same birthday. The conditions for an Arnold Schwarzenegger/Danny DeVito situation probably couldn’t have been set any higher.

This Is What Partial A Victory Looks Like. The fathers returned from the United States to Italy with their twins in tow. But the Italian government initially refused to recognize the children as (1) sons of the fathers, and 2) eligible for Italian citizenship. The fathers’ appealed, and were able to obtain what many consider a victory.

The court determined that despite the children being born to a gay couple (strike 1), using donor eggs (strike 2 – donating eggs and/or sperm is illegal in Italy) and to a surrogate (strike 3 – surrogacy is also illegal in Italy), it would be in the children’s best interest for Italy to recognize the parent-child relationship. The court awarded parental rights of each individual twin to the genetically related father."  

(NB: the two twins aren't legally related in Italy...)

"It Could Have Been Much Worse. While this was not a complete victory, it was a step forward for Italy. In prior cases, an Italian court has denied parentage to both parents — or even taken away a surrogate-born child from the parents and made the child a ward of the state! In an infamous case from 2014, an infertile couple in their 50s — who had been turned down for adoption three times — turned to surrogacy. They paid a Ukrainian surrogate €25,000 to carry a child conceived with donated genetic material. When they brought the child back to Italy, the government refused to register the child as theirs and charged them with fraud. Sadly, the court went further, ruling that the child, whose genetic and surrogate parents were unknown, was a “child of no one.” Despite even an Italian prosecutor advising that the child be allowed to stay with the intended parents, the court ruled that the child must become a ward of the state and put up for adoption. Heartbreaking.

Europe’s Anti-Surrogate Tendencies. Italy is not an anomaly. Most of Western Europe (including France, Spain, and Germany, among others) bans surrogacy. This has led to a number of troubling cases when Europeans go elsewhere for surrogacy and then try to bring their children home. In France, for instance, several surrogacy cases have involved French courts denying parental rights. But couples have had success appealing to the European Court of Human Rights. There, a child’s right to his or her parents has prevailed over French domestic law."

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The (U.S.) market for surrogate wombs

The NY Times has a great story on surrogacy, by Tamar Lewin:
Coming to U.S. for Baby, and Womb to Carry It--Foreign Couples Heading to America for Surrogate Pregnancies

"Other than the United States, only a few countries — among them India, Thailand, Ukraine and Mexico — allow paid surrogacy. As a result, there is an increasing flow in the opposite direction, with the United States drawing affluent couples from Europe, Asia and Australia. Indeed, many large surrogacy agencies in the United States say international clients — gay, straight, married or single — provide the bulk of their business.

The traffic highlights a divide between the United States and much of the world over fundamental questions about what constitutes a family, who is considered a legal parent, who is eligible for citizenship and whether paid childbirth is a service or exploitation.

In many nations, a situation that splits motherhood between the biological mother and a surrogate carrier is widely believed to be against the child’s best interests. And even more so when three women are involved: the genetic mother, whose egg is used; the mother who carries the baby; and the one who commissioned and will raise the child.

Many countries forbid advertising foreign or domestic surrogacy services and allow only what is known as altruistic surrogacy, in which the woman carrying the baby receives payment only for her expenses. Those countries abhor what they call the commercialization of baby making and view commercial surrogacy as inherently exploitive of poor women, noting that affluent women generally do not rent out their wombs.

But while many states, including New York, ban surrogacy, others, like California, welcome it as a legitimate business. Together, domestic and international couples will have more than 2,000 babies through gestational surrogacy in the United States this year, almost three times as many as a decade ago. Ads galore seek egg donors, would-be parents, would-be surrogates. Many surrogates and intended parents find each other on the Internet and make their arrangements independently, sometimes without a lawyer or a formal contract.

The agencies that match intended parents and surrogates are unregulated, creating a marketplace where vulnerable clients yearning for a baby can be preyed upon by the unscrupulous or incompetent. Some agencies pop up briefly, then disappear. Others have taken money that was supposed to be in escrow for the surrogate, or failed to pay the fees the money was to cover.

Surrogacy began in the United States more than 30 years ago, soon after the first baby was born through in vitro fertilization in England. At the time, most surrogates were also the genetic mothers, becoming pregnant through artificial insemination with the sperm of the intended father. But that changed after the Baby M case in 1986, in which the surrogate, Mary Beth Whitehead, refused to give the baby to the biological father and his wife. In the wake of the spectacle of two families fighting over a baby who belonged to both of them, traditional surrogacy gave way to gestational surrogacy, in which an embryo is created in the laboratory — sometimes using eggs and sperm from the parents, sometimes from donors — and transferred to a surrogate who has no genetic link to the baby.

But thorny questions remain: How much extra will the surrogate be paid for a cesarean section, multiple births — or loss of her uterus? What if the intended parents die during the pregnancy? How long will the surrogate abstain from sex? If she needs bed rest, how much will the intended parents pay to replace her paycheck, and cover child care and housekeeping?

“The gestational carrier has to agree to follow medical advice, but there has to be some level of trust,” said Andrew W. Vorzimer, a Los Angeles surrogacy lawyer who advises on many arrangements that have gone awry. “Once everyone goes home and the doors are closed, there’s no way to really monitor what’s going on.”

Since the Baby M case, the common wisdom has been that the main risk for parents is the surrogate’s changing her mind. But Mr. Vorzimer, who has tracked problem cases in the United States over the years, said it was the reverse: Trouble most often starts with the intended parents. One intended mother decided, well into the pregnancy, that she could not raise a child that was not genetically hers. Another couple, after a divorce, offered the surrogate mother money to have an abortion.

...

Critics sometimes draw an analogy to prostitution, another subject that raises debate over whether making money off a woman’s body represents empowerment or exploitation.

In Canada, as in Britain, payment for surrogacy is limited to expenses.

“Just like we don’t pay for blood or semen, we don’t pay for eggs or sperm or babies,” said Abby Lippman, an emeritus professor at McGill University in Montreal who studies reproductive technology. “There’s a very general consensus that paying surrogates would commodify women and their bodies. I think in the United States, it’s so consumer-oriented, so commercially oriented, so caught up in this ‘It’s my right to have a baby’ approach, that people gloss over some big issues.”

Germany flatly prohibits surrogacy, with an Embryo Protection Act that forbids implanting embryos in anyone but the woman who provided the egg. Ingrid Schneider of the University of Hamburg’s Research Center for Biotechnology, Society and the Environment said it is in children’s best interest to know that they have just one mother.

“We regard surrogacy as exploitation of women and their reproductive capacities,” Dr. Schneider said. “In our view, the bonding process between a mother and her child starts earlier than at the moment of giving birth. It is an ongoing process during pregnancy itself, in which an intense relationship is being built between a woman and her child-to-be. These bonds are essential for creating the grounds for a successful parenthood, and in our view, they protect both the mother and the child.”

With all that is known about adopted children’s seeking out their biological parents, other European experts say, it is wrongheaded to create children whose relationship with the woman who provided the egg or carried them will be severed.

...

The restrictions in many countries have been a boost for American surrogacy. For overseas couples, the big draw is the knowledge that many states have sophisticated fertility clinics, experienced lawyers, a large pool of egg donors and surrogates, and, especially, established legal precedent.

“We chose the United States because of the certainty of the legal process,” said Paulo, an engineer and scrub nurse. “Surrogacy is very secretive in Portugal. People don’t talk about surrogacy, and it’s hard to get any information. In the United States it is all clear.”

But it is not cheap. International would-be parents often pay $150,000 or more, an amount that rises rapidly for those who do not get a viable pregnancy on their first try. Prices vary by region, but surrogates usually receive $20,000 to $30,000, egg donors $5,000 to $10,000 (more for the Ivy League student-athlete, or model), the fertility clinic and doctor $30,000, the surrogacy agency $20,000 and the lawyers $10,000. In addition, the intended parents pay for insurance, fertility medication, and incidentals like the surrogate’s travel and maternity clothes.

Because surrogacy is so expensive in the United States, many couples travel to India, Thailand or Mexico, where the total process costs half or less. But complications have arisen — as in the case of a couple stuck in India for six years, trying to take home a baby boy, whom genetic testing had found not to be related to them, apparently because of a mix-up with the sperm donation.

Continue reading the main story

Four years ago, according to Stuart Bell, the chief executive of Growing Generations, a Los Angeles surrogacy agency, only about 20 percent of its clients came from overseas, but now international clients are more than half. Other agencies report the same trend.

“Anyone who can afford it chooses the United States,” said Lesa A. Slaughter, a fertility lawyer in Los Angeles."

Market for eggs and sperm

The Boston Globe reports Recession spurs egg and sperm donations
Giving provides extra income.

"Couples, and some single women, pay $20,000 to $30,000 for an egg donation, in vitro fertilization, and transfer to the recipient. Donors generally must be healthy nonsmokers between ages 21 and 32 with a good family health history, "reasonably educated and reasonably attractive," Benardo said. Screening involves physical, psychological, and genetic testing. If accepted, the woman undergoes hormone injections, then a surgical procedure to remove her eggs. Fees paid to the donor generally range from $5,000 to $10,000. Recipients choose prescreened donors."
...
"In Charlestown, NEEDS (National Exchange for Egg Donation and Surrogacy) also reports a 25 percent increase. "Very few of them will say just straight out it's for the money," said NEEDS manager Jan Lee. "They don't want to sound like a money-grabber. We ask them if they're applying because they need the money or out of the goodness of their heart, and they say both." "
...
"[Dr. Vito Cardone, founder of Cardone Reproductive Medicine & Infertility] cautions against women seeing this as a gold mine.
"The money that's given is limited; it's not going to be something to create a yearly revenue to get them through life," he said.
He believes in compensating women for their time and trouble but said there needs to be "some ethics to it" - both an altruistic motive and a monetary limit.
"When I see people who want to 'sell' their eggs for $20,000 or more it makes no sense, because then it becomes commercial, like selling any other thing," he said. "There has to be a little bit of kindness, because these couples have had a lot of hardship and desire a child very strongly." "
...
" Sperm donations are also on the increase, although they pay much less - an average of $85 to $100 per donation. Such "banks" generally require that the donor be at least 5-foot-8, a college student or graduate between the ages of 18 and 38, and in good health.
California Cryobank, which has offices in Cambridge, recruits largely on college campuses and asks each donor for a year's commitment, with the average donor contributing 2-3 times a week.
In the past six months, applications are up 20 percent, said Scott Brown, communications manager. "I think the recession has certainly opened up interest," he said. But less than 1 percent of applicants are chosen, based on family history, a physical exam, and analyses of blood, urine, and semen. "It's tougher to get into the Cryobank than into Harvard," Brown said."

Matching for platonic co-parenting: "like a divorce, without the wedding or the arguments."

The WSJ has the story, about two web sites that are trying to pioneer matching for people who want to conceive a child who will have two involved parents, who won't be married to each other:

Co-Parenting Sites Skip Love and Marriage, Go Right to the Baby Carriage
A new kind of online service matches people who want to have children, but not necessarily romance 
By Julie Jargon

"When Jenica Andersen felt the tug for a second child at age 37, the single mom weighed her options: wait until she meets Mr. Right or choose a sperm donor and go it alone.

"The first option didn’t look promising. The idea of a sperm donor wasn’t appealing, either, because she wanted her child to have an active father, just like her 4-year-old son has. After doing some research, Ms. Andersen discovered another option: subscription-based websites such as PollenTree.com and Modamily that match would-be parents who want to share custody of a child without any romantic expectations. It’s a lot like a divorce, without the wedding or the arguments."
...
"Given the prominence in today’s society of both single parenthood and online dating, this digital approach could be seen as a natural progression. It could also be considered shocking or even, as some have called it, an affront to marriage.
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Here's Pollentree.com: https://www.pollentree.com/, which also offers to match prospective moms with sperm donors.

And here's Modafamily: https://modamily.com/, which speaks of romantic, co-parenting, or known-donor relationships.

Law and economics of repugnant markets

Kimberly Krawiec at The Faculty Lounge, some time ago followed up on one of my posts with an interesting one of her own: Selecting for Sex: US entrepreneurship in the baby market

She is a professor at Duke Law, and a scholar of repugnant markets, often analysing them with respect to rent seeking behavior. See e.g.

Altruism and Intermediation in the Market for Babies, 66 WASH. & LEE L. REV. 203 (2009).
Abstract: Central to every legal system is the principle that certain items are off-limits to commercial exchange. In theory, babies are one such sacred object. This supposed ban on baby selling has been lamented by those who view commercial markets as the most efficient means of allocating resources, and defended by those who contend that commercial markets in parental rights commodify human beings, compromise individual dignity, or jeopardize fundamental values. However, the supposed and much-discussed baby selling ban does not, and is not intended to, eliminate commercial transactions in children. Instead, it is an asymmetric legal restriction that limits the ability of baby market suppliers to share in the full profits generated by their reproductive labor, insisting instead that they derive a large portion of their compensation from the utility associated with altruistic donation. Meanwhile, a wide range of baby market intermediaries profit handsomely in the baby market, without similar restrictions on their market activities. Baby selling "bans" thus have more in common with the rent-seeking by powerful marketplace actors seen in other commercial markets than with normative statements about the sanctity of human life. The author concludes with a call for the removal of the last vestiges of the "ban" against baby selling and other laws that diminish the capacity of baby market suppliers to access the marketplace.

Price and Pretense in the Baby Market, in BABY MARKETS: MONEY, MORALS, AND THE NEOPOLITICS OF CHOICE (Cambridge University Press, forthcoming 2009).

Show Me the Money: Making Markets in Forbidden Exchange, 72 LAW & CONTEMP. PROBS. (2009).

Sunny Samaritans and Egomaniacs: Price-Fixing in the Gamete Market, 72 LAW & CONTEMP. PROBS._ (2009).
Abstract: This Article considers the market structure of the human egg (or “oocyte”) donation business, particularly the presence of anti-competitive behavior by the fertility industry, including horizontal price-fixing of the type long considered per se illegal in other industries. The Article explores why this attempted collusion has failed to generate the same public and regulatory concern prompted by similar behavior in other industries, arguing that the persistent dialogue of gift-giving and altruistic donation obscures both the highly commercial nature of egg “donation” and the benefits to the fertility industry of controlling the price of a necessary input into many fertility services – namely, eggs. A comparison to the egg market’s closest cousin – the sperm market – does not reveal similar collusive attempts to depress the price of sperm. A further analysis of the industry explores potential reasons for this difference.

The last two articles appear in an edited online journal volume by Professor Krawiec, called Show Me the Money: Making Markets in Forbidden Exchange, which has articles on the sale of blood, organs, eggs and sperm, labor, and surrogate wombs: here's her blog post summarizing them.

Repugnant markets involving altruistic motivations

Kim Krawiec follows up on Kieran Healy's work on markets for organs, and how the distinction between gift giving and buying and selling isn't so clear.

Krawiec writes (I quote at length, but not the whole thing):

"...I agree with Kieran that financial incentives for human organs are more likely to win social acceptance if they resemble the gift-based allocation systems that have already gained social legitimacy. And the oocyte market – a clearly market-based system with the trappings of gift, including the language of donation -- is a good example of this phenomenon. 

In fact, as I’ve discussed before, this disconnect between market realities and gift narrative is an important feature of many taboo trades.  By normalizing otherwise jarring transactions, gift narratives may facilitate markets that otherwise would stagnate under the weight of social disapproval. For those, like me, who believe there is social value in enabling the infertile to reproduce or those dying from kidney failure to live – and, by corollary, allowing those who consider themselves better off by the receipt of compensation in exchange for an egg or kidney – to do so, this is a good thing. 

At the same time, though, the oocyte market example also illustrates the costs of denying market realities in favor of the pretense of gift exchange -- gifts in name only: 

(1) Legal misfit

Gift-based exchange regimes are typically governed by a different set of legal rules than are market-based exchange regimes.  We tend to recognize, for example, the possibilities for opposing interests and opportunistic behavior in a regime of market-based exchange.  And many legal rules governing market-based regimes are designed with these considerations in mind. In contrast, we often assume (incorrectly, especially when the gift is one in name only) an absence of opportunism and an alignment of interests in the case of gift-based exchange. 

(2) Social stereotypes

I do not know if, or how, this would play out in organ markets, but it has for some time concerned me with respect to reproductive markets, especially the oocyte and surrogacy markets.  Scholars have long noted the presumption that many services provided by women, including reproductive and domestic labor, should be provided altruistically, despite their high economic value.  Says Mary Anne Case, for example:

Much of what women have market power over, such as their sexual and reproductive services, they have long been expected not to commodify at all. Even when monetary compensation is allowed, it is often kept low and female providers are expected to be interested in rewards other than money.

The continued insistence that egg donors are, and should be, motivated primarily by altruism and the desire to help others, rather than by the desire for monetary compensation, threatens to reinforce gendered notions that the market activities of women are driven in large part by altruism and that women as a group are uninterested in reaping the full gains of trade from the provision of their goods and services. 

The comparison to sperm markets is especially telling. The insistence on the altruistic motivations of egg donors is in stark contrast to the presumed motivations of sperm donors, who are recruited through materials that ask, “Why not get paid for it?” and advertise, “your sperm can earn!” 

...

In the end, gifts in name only represent a trade-off.  On the one hand, the language of donation coupled with the realities of market-based exchange has the capacity to legitimate otherwise troubling exchanges, facilitating life-saving operations and parenthood for the infertile.  At the same time, gift-in-name-only exchange has consequences for the social, legal, and market structure of these industries, and for the consumers, producers, and others, including the public-at-large, affected by them."

Gamete exchange

 Here's a cheerful story of peer to peer assisted reproduction, from the Washington Post:

Two couples couldn’t have babies, so they helped each other  By Kyle Melnick

"Neva and her wife, Kelsey, were considering using a surrogate or an in vitro method to have a child. John and his wife, Amy, couldn’t carry a pregnancy because of a hysterectomy Amy underwent to treat endometriosis.

“Just give us your sperm,” Neva recalled telling John. “We’ll have a baby, and then we’ll just give you an egg. It’s not a big deal.”

...

"In 2020, John donated sperm so that Kelsey could become pregnant through an insemination service. The Bentons’ baby was born the next year in Kansas. Kelsey, now 32, then acted as a surrogate for the Cardenases and birthed the Arizona couple’s child in July.

...

"the couples bought an insemination kit and wrote up a surrogacy contract with an attorney’s assistance. Kelsey tracked her menstrual cycles; John, who’s now 41, took pills and adjusted his diet to produce healthy sperm."

Dealing with shortages of deceased donors in a future with fewer automobile accidents

Sometimes you find out that someone has already worried about something that you haven't even thought of worrying about.  I worry about some aspects of transplantation, and I sometimes think about driverless cars, but here's an article about a worry that is nowhere near the top of my list.  However the short article below (it's a comment on another article) raises some interesting points about how society may want to rethink increasing organ donation as we see (I hope) ever fewer deaths from automobile accidents:

How Do You Donate Life When People Are Not Dying: Transplants in the Age of Autonomous Vehicles

Zoe Corin, Roee Furman, Shira Lifshitz, Ophir Samuelov & Dov Greenbaum (2018) , The American Journal of Bioethics, 18:7, 27-29, DOI: 10.1080/15265161.2018.1478024

"While there are differences of opinion as to when autonomous or self-driving cars will actually invade our roads—some car manufacturers are predicting consumer-ready self-driving cars as early as 2021—there is broad consensus that their inevitability is assured. And while there are clear positive social consequences that will result from self-driving cars and trucks, there are also a number of often less appreciated negative externalities. Balanced against the saved lives, minimized commutes, reduction in pollution, and general decrease in daily stress are the driving-related job losses and the reality that there will be fewer organ donors."
...
"There are no quick fixes, and current laws already place significant restrictions on the organ acquisition process. Buying and selling organs is nearly universally objectionable, unethical, and illegal (Ludin 2008). Some countries even ban any benefit, or any form of valuable consideration whatsoever, in exchange for an organ (Caulfield et al. 2014
Caulfield, T., E. Nelson, B. Goldfeldt, and S.Klarenbach, 2014. Incentives and organ donation: what’s (really) legal in Canada?Canadian Journal of Kidney Health and Disease 1: 7.[Crossref], [PubMed], [Google Scholar]). Some jurisdictions go even beyond this altruistic-only donor requirement, and allow live donations only among blood relatives (India 1994Government of India. 1994. Transplantation of Human Organs Act, 1994.http://wwwmedindianet/tho/thobill1asp. [Google Scholar]).

...

"However, even these universal attitudes have some specific exceptions: In many countries, blood donors are paid, and sperm and egg donors can receive thousands of dollars in remuneration. But just because a handful of tissue donations have been commodified (albeit sometimes obfuscated as gifts with financial consideration), it is not clear that this cash for contribution system will expand anytime soon to include other types of living donations, such as liver lobes or kidneys. To wit: While New York sperm donors can make more than a thousand dollars a month (Lewinnov 2016

Lewinnov, T. 2016. 10 things to know about being a sperm donor, New York Times, Nov. 3 2016. [Google Scholar]), surrogacy contracts are still void and unenforceable by law (New York 2014New York. 2014. N.Y. Dom. REL. Law §§ 121-124 Surrogate Parenting Contracts Organ Donation and Recovery Improvement Act (2004). [Google Scholar]).

Nevertheless, in light of the need for organs, a number of jurisdictions have tried to indirectly incentivize donation, either through financial or non-financial mechanisms. Such incentives include paying for funeral costs of non-living donors, or for the out-of-pocket expenses directly associated with transplantation (US 2004)."

Fertility tourism and the British ban on paying egg donors

The fertility treament covered by Britain's National Health Service causes many Britons to seek treatment privately, elsewhere in Europe, the London Times reports: 'Thousands of Britons' travel abroad for IVF, research finds.

"Restricted access to fertility treatment on the NHS, the high cost of private therapy at domestic clinics and a serious shortage of donated eggs are driving couples to visit overseas clinics for help in starting a family. "
...
"IVF patients who need donated eggs are particularly likely to travel. Domestic donors are in short supply because of the removal of anonymity and tough rules against selling eggs.Spain and the Czech Republic are prime destinations, due to laws allowing donors to be paid €900 (£765) and €500 respectively for eggs. British donors get no more than £250 in expenses. "

Now the ban on payment for eggs is being reconsidered:

Pay donors to end the shortage of IVF eggs, says watchdog
"A longstanding ban on selling sperm and eggs should be reconsidered to address a national shortage of donors, the head of the Government’s fertility watchdog says. Payments to donors could cut the number of childless couples travelling abroad for treatment, Lisa Jardine, of the Human Fertilisation and Embryology Authority, told The Times. The removal of anonymity for donors in 2005 and strict rules against payments have provoked a crisis in fertility treatment, forcing many couples to wait years for the therapy they need to start a family. A recent study showed that access to eggs and sperm was the main reason why hundreds of British couples became “fertility tourists” each month."
...
"Her move will raise concerns about a market in human tissue and exploitation of women as egg donation is invasive and involves an element of risk. In countries that allow payment, such as the United States, Spain and Russia, young women often donate to wipe out debts or to fund university fees. Professor Jardine said that the law already treated eggs, sperm and embryos differently from other tissues, so there was no danger of setting a precedent for the sale of organs such as kidneys. Payment would also ensure that more women were treated in licensed domestic clinics, rather than in countries with less stringent regulations. “I’m not saying the decision arrived at before I became chair wasn’t the right one at the time,” she said. “But given the evidence that egg shortage is driving women overseas, I feel a responsibility to look at it again.” "

Surrogacy law in Italy (moderated by subsequent court decisions)

The Italian law governing reproductive technology and surrogacy dates from 2004, but (although I don't think the law has been amended), some of the things it forbids have been modified by subsequent court decisions.

"This law prohibits research and reproductive cloning, the manipulation of embryos, the use of donated eggs or sperm for ART, and the cryopreservation of embryos (with the exception of severe injury/illness preventing embryo transfer). A maximum of three eggs can be fertilized and transferred per reproductive cycle. Sex-selection is only permitted through sperm sorting for sex-lined genetic diseases. All forms of surrogacy are prohibited. The use of preimplantation genetic diagnosis for the selection of embryos is generally prohibited, but has been allowed through the courts on a case-by case basis. Genetic testing for non-medical purposes is prohibited. The use of ART is restricted to stable heterosexual couples who live together, are of reproductive age, are over the age of 18, have documented infertility, and have been first provided the opportunity for adoption.”
(From G12 Country Regulations of Assisted Reproductive Technologies)

Surrogacy laws in Europe (mostly banned) and some countries where it is allowed

EuroNews has the story (and a map):

Where in Europe is surrogacy legal?

Families Through Surrogacy provides some information about countries around the world that allow surrogacy

The table below lists issues related to surrogacy in various countries which allow it.

COUNTRY	LIMITATIONS	EGG DONORS
AUSTRALIA	Altruistic surrogacy only available. No donor or surrogate matching available. Advertising for surrogates not legal. All donors must be identified Ethics committee approval often required. Foreigners cannot access surrogacy in Australia	User groups such as www.eggdonationaustralia.com.au can provide
CANADA	Altruistic surrogacy only available. Foreigners can access surrogacy	via seperate Egg donor providers
GREECE	Heterosexual couples and single females eligible. Foreign nationals allowed to engage. Surrogate cannot be compensated beyond out-of-pocket expenses	Donors, if required, must be anonymous. Eggs/embryos/sperm are able to be shipped directly from your registered clinic.
GEORGIA	Compensated surrogacy available  to heterosexual couples, including foreigners. Legal protections in place
INDIA	Only available for Indian residents	In-country donors are anonymous however donor photos may be available other details provided: age, height, weight, previous donation history, children, blood group, education level/ occupation
ISRAEL	Altruistic surrogacy available only to heterosexual Israeli residents
KENYA	Compensated surrogacy available to locals and foreigners. No legal protection
LAOS	Compensated Surrogacy available  to foreigners. Gestation & birth occurs in Thailand. No legal protection
MEXICO	Tabasco state closed to surrogacy. Other states have no legal protections. Embryo transfer occurs in Cancun or Mexico City often	Caucasian and Latin Sperm and Egg Donors available. Possible to bring your own surrogate and /or known donor. No waiting list
NIGERIA	Altruistic and commercial surrogacy available to Nigerian heterosexual residents	Egg donors available
SOUTH AFRICA	Altruistic surrogacy available to heterosexual South African residents
THAILAND	Only available altruistically to Thai residents
UK	Altruistic surrogacy only available. Advertising for surrogates not legal foreigners cannot access surrogacy in UK
UKRAINE	Only heterosexual married couples	Caucasian, offer photos with family history, occupation/ area of study, previous donor history and physical details.
USA	Gay and heterosexual foreigners can access surrogacy here see surrogacy laws by US state	Very wide range available from donor agencies or privately

COUNTRY	APPROX COSTS($US)	DONOR & SURROGATE SCREENING	YEARS EXPERIENCE	LEGAL ISSUES
AUSTRALIA	IVF: $25,000 Expenses: $10,000 Legals & counselling: $22,000	Donor screening offered only if through an egg bank	<5 td="" years="">	Transfer of legal parentage available 4-6 months post birth if uncompensated surrogacy used domestically.
GEORGIA	IVF: $8,500 Surrogacy: $26,000 + Local egg donor add $5,000 +	according to age, genetics and lifestyle, mental and physical health	10 years	Intended Parents named on birth certificate to meet the criteria of countries such as the UK, single surrogates are available and DNA testing is available
CANADA	$90,000		>15 years	Transfer of parentage. Canadian passport available
KENYA	$50,000		<3 td="" years="">	No legal protection
UK		Surrogacy UK, COTS	>15 years	Transfer of legal parentage available
USA	IVF costs: $25,000 Surrogacy: $68,000 Other costs: $20,000	Varies by agency	30 years	Parents names on the BC as mother and father
UKRAINE	IVF: $8,500 Surrogacy: $26,000 + Local egg donor add $5,000 +	according to age, genetics and lifestyle, mental and physical health	~5 years	Intended Parents named on birth certificate to meet the criteria of countries such as the UK, single surrogates are available and DNA testing is available. No eligibility for Ukraine citizenship
GREECE	IVF: $20,100 Surrogacy: $44,000 Legals: $10,000+ Local egg donor: $1,360		10+ years	Recently opened up to foreigners Parents names on the BC as mother and father. Court case prior to IVF ensures transfer of parentage occurs before embryo transfer
MEXICO	$80,000 (incl US egg donor)	unknown	<1 td="" year="">

Surrogate births, payments, and legal rights in Britain, continued

The Telegraph reports Childless couples win the right to pay surrogate mothers: Childless couples will be able to pay surrogate mothers large sums of money to have babies for them, following a landmark High Court ruling.

"A senior family court judge allowed a British couple to keep a newborn child even though they had technically broken the law by giving more than “reasonable expenses” to the American natural mother.


"Mr Justice Hedley said the existing rules on payments were unclear, and that the baby’s welfare must be the main consideration. Only in the “clearest case” of surrogacy for profit would a couple be refused the necessary court order to keep the baby.

"His comments, among the first in recent years on the subject by a senior legal figure, will be taken by many infertile couples as a welcome sign that they can now pay women to bear children for them without fear of breaking the law, and so be denied a family.

"Mr Justice Hedley warned that the courts would continue to consider the amount of money paid in each individual case, to ensure that a market is not established.

...
"Surrogacy was regulated in Britain in 1985, after Kim Cotton was paid £6,500 to carry a child conceived using her own egg but the sperm of a man whose wife was infertile, in what is known as “straight surrogacy”. In “host surrogacy”, embryos are created through IVF using the eggs and sperm of both intended parents are transferred to the surrogate mother.


"Under the Surrogacy Arrangements Act 1985, companies were banned from brokering deals between couples and potential mothers for profit. All arrangements have to be based on trust rather than money, and are not legally binding. Only “reasonable expenses”, which now can average £15,000, are allowed and must be agreed upon by the parties.

"In 1990, another law introduced the system of Parental Orders which couples must obtain following the birth in order to be regarded as the surrogate baby’s legal parents, rather than the natural mother.
...
"It is estimated that each year just 70 women in Britain have surrogate babies, but many more couples desperate to start a family now travel to countries such as India where the “reasonable expenses” will be far lower.


"In the current case, the unnamed British couple had made contact with a woman in Illinois, where no restrictions on payments to surrogate mothers apply. Her baby had been allowed to enter Britain on temporarily on a US passport, but the judge granted a Parental Order so it can now stay in the country with its new parents.

"Mr Justice Hedley agreed that the criteria, which also require that the surrogate acted of her own free will and that one of the couple must be a biological parent of the baby, had been “fully met” by the “most careful and conscientious parents”.

"However some have criticised the implications of his comments that payments above “reasonable expenses” were acceptable.

"Andrea Williams, director of the Christian Legal Centre, said: “Children are not commodities to be bought and sold. It is not the case that everybody has the right to a child, whatever the cost.

“The regulations that we have in this place regarding surrogacy are supposed to ensure that there is no element of profit in the whole process."
Here is my earlier post on this matter: Surrogacy, payments, and parental rights in Britain: Couples who pay surrogate mothers could lose right to raise the child.