Taiwan (Republic of China) legitimizes substantial financial remuneration of egg donors: implications for reproductive tourism in East Asia

Recently in Taiwan (Republic of China), four substatutes to the newly drafted Artificial Reproductive Act have been finalized by the Department of Health, and were officially approved and enacted by the ‘Executive Yuan’ (cabinet of government ministers) in June 2007 [101]. The newly drafted legislation allows for what is euphemistically termed ‘nutritional compensations’ to both sperm and egg donors, which may provide a lawful basis for the ‘commercialization’ of human gametes. It is stipulated that an egg donor can receive nutritional compensation ranging from NT$50,000 (∼US$1500) to NT$100,000 (∼US$3000) but is prohibited from making further donations for the rest of her life, once a single live birth has been achieved using her donated eggs [101]. However, there is no statutory limit to the number of egg donation cycles that a woman can undergo, provided that no live birth has resulted from her donated eggs.

Enactment of the new legislation is probably motivated by the severe shortage of sperm and egg donors in Taiwan. According to the Department of Health, there are only approximately 300 cases of sperm or egg donation a year in Taiwan [101], out of a total population of approximately 23 million. On the surface, reimbursement of NT$50,000–100,000 given to egg donors may appear rather low, based on Western living standards, for example, in the USA, egg donors are routinely given reimbursement of US$5000 per cycle [1]. Nevertheless, it must be noted that goods and services are considerably cheaper in Taiwan compared with many Western countries. Moreover, the New Taiwan Dollar ($NT) is deliberately undervalued in the international foreign currency exchange market, so as to promote the export of Taiwanese products [102]. After correcting for purchasing power parity, a sum of NT$50,000–100,000 in Taiwan would in fact have the equivalent purchasing power of approximately US$3000–6000 within the USA. This is anticipated to be lucrative enough for many young women to volunteer as egg donors, in particular cash-strapped university students who need to pay tuition fees and service student loans [2]. The pertinent question that arises is how legitimization of substantial financial remuneration of egg donors in Taiwan will affect reproductive tourism [3] within the East Asian region, such as foreign childless couples traveling to Taiwan in search of donor eggs. First of all, it is imperative to take a brief look at the current situation of egg donation within neighboring East Asian countries.

In the People’s Republic of China (Mainland China), the monetary reimbursement of egg donors is banned by law, as is the solicitation of egg donation from nonpatient donors [4]. In fact, the only means of procuring donor eggs is through compensated egg sharing with other childless couples undergoing fertility treatment [4,5]. Ovarian stimulation with recombinant gonadotrophins (i.e., follicular stimulating hormone) results in the production of excess supernumerary eggs by the patient [6], which can potentially be shared with another patient, in return for free or heavily discounted fertility treatment [4,5]. However, most couples undergoing fertility treatment (including those having difficulties paying medical fees) are extremely reluctant to share their surgically retrieved eggs with another couple. Understandably, they are not psychologically comfortable with the prospect of begetting an unknown biological offspring when they are hoping to have a child of their own. This in turn results in a shortage of available donor eggs in the People’s Republic of China, which could provide an impetus for mainland Chinese couples to travel to Taiwan for egg donation.

In Hong Kong and Macau, two autonomous special administrative regions of the People’s Republic of China, there are also difficulties in procuring donor eggs for childless couples. Currently, there is no hospital or clinic in Macau that offers fertility treatment, while in Hong Kong there is a lack of financial incentives for prospective egg donors, since any monetary reimbursement/compensation given is based strictly on direct expenses incurred by the donor herself. Under Section 4.14 of the Code of Practice on Reproductive Technology & Embryo Research promulgated in 2002 [103], it is explicitly stated that donors should not be paid for the supply of gametes or embryos, except for reimbursing or defraying: first, the cost of removing, transporting or storing gametes or an embryo to be supplied; and second, any expenses or loss of earnings incurred by the donor. Detailed evidence in the form of bills, receipts, bank statements and paychecks has to be provided by the donor upon making any claim for expenses or loss of earnings, and there is also a statutory limit to the total amount of money that can be given for reimbursement. For example, the total daily amount that can be claimed for loss of earnings is HK$380 (∼US$48), while a fixed sum of HK$300 (∼US$38) is given to cover traveling expenses [103]. As expected, such prohibitive restrictions on reimbursement have led to a dearth of willing egg donors in Hong Kong.

In Japan, egg donation is banned under all circumstances [7], while in South Korea, egg donation is permitted but there are prohibitive restrictions on donor reimbursement/compensation. According to the Bioethics Safety Act that came into effect in late 2005 [104], payment to egg donors was completely banned, and violators face up to 2 years in prison or a maximum fine of 30 million Won (US$30,000). However, under revised laws recently proposed by the Ministry of Health and Welfare [105], egg donors would receive a small sum of compensation from the government and recipients would not have to pay for donations. The exact amount has not yet been determined but is likely to be just sufficient for covering traveling costs and other minor personal expenses. Following highly publicized scandals involving unethical procurement of donor eggs and fabrication of data by Hwang and coworkers [8,9], South Korean lawmakers and the general public are in no mood to condone substantial or lucrative financial remuneration that might serve as undue inducement for egg donation.

Hence, it is evident that in the East Asian region, only Taiwan would have substantial and lucrative monetary reimbursement for egg donors. This, in turn, could fuel reproductive tourism from neighboring East Asian countries, which may be further helped by the rather similar racial phenotype and common physical traits shared by populations of the various East Asian countries; that is, China, Taiwan, Hong Kong, Macau, South Korea and Japan. Certain legal loopholes may arise because the newly drafted legislation in Taiwan [101] does not specifically address the question of egg donation to foreigners or by foreigners. For example, as mentioned earlier, the egg donor is prohibited from making further donations once a single live birth has been achieved using her donated eggs [101]. Nevertheless, it may be difficult to confirm that egg donation to foreigners has resulted in a live birth, particularly if the recipients were to return to their home country after receiving fertility treatment in Taiwan.

Of even greater ethical concern would be egg donation by foreigners in Taiwan. Reimbursement of NT$50,000–100,000 given to egg donors in Taiwan would appear even more lucrative to foreign women from poorer developing countries, particularly from Southeast Asia; for example, Vietnam, Thailand and the Philippines. In recent years, Taiwan has gained some degree of notoriety as a location for the trafficking of Southeast Asian women to serve as mail-order brides for lower-income men, as well as for the vice trade [106,107]. Hence, there is a real danger of foreign women being exploited for egg donation in Taiwan. One possible scenario is that Taiwanese fertility clinics may become centers for the exchange of donor eggs between rich and poor foreigners; for example, Vietnamese egg donors for Japanese patients.

Financial disclosure

The author has no relevant financial interests related to this manuscript, including employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.