Altruistic surrogacy is a surrogacy arrangement where a woman carries and delivers a baby for intended parents without receiving payment beyond reimbursement for pregnancy-related expenses. It’s built on what ethicists call a “gift relationship,” where the surrogate’s motivation is helping someone build a family rather than earning a fee. This distinguishes it from commercial surrogacy, where the surrogate receives compensation on top of expenses in exchange for carrying the pregnancy.
How It Differs From Commercial Surrogacy
The core distinction is money. In commercial surrogacy, both parties enter a legally enforceable agreement where the surrogate bears a child in exchange for a fee, often tens of thousands of dollars. In altruistic surrogacy, the surrogate gives birth without payment, though she can be reimbursed for necessary expenses related to the pregnancy.
Because of this difference, altruistic surrogacy typically happens between people who already know each other. A sister, close friend, or cousin offers to carry the pregnancy. Commercial surrogacy, by contrast, often involves matching intended parents with a surrogate through an agency. Many countries that ban commercial surrogacy still permit the altruistic model, viewing it as less likely to exploit vulnerable women.
What Expenses Get Covered
Even in altruistic arrangements, surrogates don’t absorb the financial costs of pregnancy. Reimbursable expenses generally fall into several categories: medical bills and prenatal care, health insurance premiums related to the pregnancy, maternity clothing, travel costs for medical appointments, lost wages during recovery, and legal fees. The exact boundaries of what counts as a legitimate expense vary by jurisdiction, and some countries define allowable costs more narrowly than others.
It’s worth noting that in the United States, the IRS has ruled that intended parents cannot deduct surrogacy-related costs (including medical expenses, insurance, and legal fees) as medical expenses on their taxes, regardless of whether the arrangement is altruistic or commercial.
Where Altruistic Surrogacy Is Legal
Altruistic surrogacy is the legally permitted model in a growing number of countries, though the details vary significantly from one place to the next.
Australia is one of the clearest examples. All eight states and territories allow altruistic surrogacy while prohibiting the commercial form. Several jurisdictions, including New South Wales, Queensland, and the Australian Capital Territory, go further by making it a criminal offense for residents to engage in commercial surrogacy even overseas. Despite these shared principles, the specific rules differ by state, and intended parents must follow the laws of the jurisdiction where they live to be recognized as legal parents.
In the United Kingdom, altruistic surrogacy is legal but operates in a legal gray zone. Surrogacy agreements are not enforceable in court, and the surrogate is legally the mother at birth. Intended parents must apply for a parental order afterward to become the child’s legal parents. The Law Commission published a major reform proposal in March 2023 that would create a “new pathway” granting intended parents legal parentage from birth, subject to the surrogate’s right to withdraw consent and built-in safeguards like medical checks, criminal records screening, and independent legal advice. However, as of April 2025, the UK government has stated it is unable to prioritize surrogacy reform and does not intend to move forward with the recommendations at this time.
Within the European Union, Ireland, Greece, Cyprus, and Portugal have introduced legislation permitting altruistic surrogacy, though implementation remains incomplete in some cases. Portugal adopted its law but still lacks the regulations needed to put it into practice. Ireland passed the Health (Assisted Human Reproduction) Act 2024, but the surrogacy sections have not yet entered into force. The Netherlands introduced a proposal to regularize altruistic surrogacy in 2023 that is still being debated in parliament. Meanwhile, Italy moved in the opposite direction, amending its surrogacy ban in November 2024 to criminalize Italian nationals who enter surrogacy agreements abroad, with penalties of up to two years in prison.
Canada and several U.S. states also permit altruistic surrogacy. In the U.S., surrogacy law is determined state by state, with some states having comprehensive surrogacy statutes and others offering little or no legal framework.
Who Can Be a Surrogate
Screening requirements for surrogates are rigorous, even in altruistic arrangements. Guidelines from the New York State Department of Health offer a representative example of what most fertility clinics and jurisdictions expect. A potential surrogate must be between 21 and 45 years old, though surrogacy beyond 45 requires all parties to understand the elevated obstetric risks. She should have carried at least one previous pregnancy to term without complications and had no more than five total deliveries, with no more than three by cesarean section.
Medical screening includes a complete health evaluation and testing for sexually transmitted infections and HIV within 30 days before embryo transfer. Conditions like hepatitis B, hepatitis C, HIV, or active substance use disorders disqualify a candidate.
Psychological screening is equally important. Surrogates undergo a psychosocial evaluation that includes a clinical interview and psychological testing. Evaluators assess coping skills, emotional maturity, judgment, and the ability to separate from the baby after birth. Disqualifying factors include unresolved addiction, a history of major depression, bipolar disorder, psychosis, significant anxiety disorders, or a lifestyle the evaluator considers too unstable to support a healthy pregnancy.
The Legal Process for Intended Parents
Becoming the legal parent of a child born through surrogacy requires specific legal steps, and the process differs depending on where you live. In most jurisdictions, both parties work with separate attorneys to draft a surrogacy agreement before the pregnancy begins. This contract typically covers parental rights, medical decision-making, covered expenses, and the surrogate’s rights and responsibilities. Finalizing these contracts usually takes one to two months.
In some U.S. states, legal parentage can be established before birth through a pre-birth order, meaning the intended parents’ names go directly on the birth certificate. In other states and countries, parentage is established shortly after delivery through a court order. In the UK and Australia, intended parents must apply to the court for a parental order after the child is born, a process that can take several months. The surrogate, as the legal mother at birth, must consent to this transfer of parentage.
Emotional Dynamics and Ethical Concerns
Because altruistic surrogacy usually involves people who already have a relationship, the emotional landscape is different from commercial arrangements. Research from Australia found that intended mothers and surrogates in altruistic arrangements scored similarly high on measures of interpersonal warmth, higher than their respective partners. Researchers suggested that this warmth within close family and friendship relationships likely serves as a protective factor for the surrogacy outcome, helping both parties navigate the emotional complexity of the arrangement.
But the personal nature of these relationships also introduces a specific ethical risk: emotional or familial pressure. When a sister or close friend is the potential surrogate, the line between a genuine offer and a felt obligation can blur. The International Federation of Gynecology and Obstetrics has emphasized that in altruistic arrangements, particular attention should be given to ensuring decisions are genuinely voluntary and free from coercive emotional or familial pressures. A mother who feels she “should” carry a baby for her daughter, or a sister who fears damaging the relationship by saying no, may not be giving fully informed consent.
For this reason, ethical guidelines consistently recommend that surrogates have independent legal advice, separate from the intended parents’ attorney, so they fully understand their rights, responsibilities, and the meaning of any contracts they sign. Independent counseling serves a similar purpose, giving the surrogate a confidential space to explore her motivations and any ambivalence without the intended parents present.