How Much Screening Is Enough? The Growing Responsibility of Surrogacy Agencies
Surrogacy agencies are being asked to do more than ever before. For years, much of the screening in surrogacy has focused on the gestational carrier. She undergoes medical screening, psychological evaluation, background checks, and an extensive review of her personal and pregnancy history. But recent legal cases are forcing our industry to ask an equally important question:
How carefully are we screening the intended parents?
:
What Can Be Verified Should Be Verified
Brandon Keith Riley-Mitchell: Criminal Background Screening
The Case:
A registered sex offender in Pennsylvania became a parent through gestational surrogacy. Because this was surrogacy rather than adoption or foster care, the background screening and child welfare requirements that would apply in those systems did not apply in the same way.
The case generated public controversy and proposed federal legislation addressing registered sex offenders and surrogacy.
The Problem:
Many agencies thoroughly screen gestational carriers but do not require the same level of background screening for intended parents. A GC may therefore agree to carry a child without knowing significant information about the people who will ultimately raise that child.
The Safeguard:
Require government-issued identification and criminal background checks for intended parents and gestational carriers. Disclose relevant results so the parties can make informed decisions before agreeing to a match.
Mark Surrogacy: Verifying Who the Intended Parents Really Are
The Case:
Then came the extraordinary situation involving Mark Surrogacy in California. Authorities investigating an Arcadia home learned that Guojun Xuan said he had fathered 22 children, all but two through surrogates. Police found 15 children living in the home and later reviewed surveillance footage that they said showed a nanny physically and emotionally abusing children. Authorities asked the FBI to investigate after learning about interstate payments to surrogates and the collection of children.
The legal fallout is continuing. In August 2026, five women sued an Arcadia couple and attorneys in California state court, alleging that they had been deceived in connection with surrogacy arrangements. NOTE: A court has not yet established those allegations as fact.
The Problem:
A surrogate should know who she is carrying a child for. An agency cannot rely solely upon information provided by an intended parent without reasonable verification, particularly when information about identity, family circumstances, or multiple simultaneous surrogacy arrangements could be important to a GC’s decision to accept a match.
The Safeguard:
- Verify identities and addresses, conduct background checks,
- require the GC and intended parents to meet before signing contracts, and
- require disclosure of material information relevant to the match.
- Agencies should also require intended parents to disclose other simultaneous or planned surrogacy arrangements.
Identification Should Be Verified and Shared
Government-issued identification should not simply be collected and placed in an agency file. Copies of the GC’s and intended parents’ identification should be provided to the parties involved in establishing and carrying out the arrangement, including the agency, both parties’ attorneys, and the IVF clinic, subject to appropriate privacy and secure handling procedures.
The GC and intended parents should also receive one another’s verified identification. Everyone entering the arrangement should know the legal identity of the people they are contracting with.
These identification documents should also be incorporated into the parties’ legal agreement. This creates a clear record of each party’s identity and provides important evidence and accountability if someone submits fraudulent identification or misrepresents their identity. The agreement should expressly state that providing fraudulent identification or intentionally misrepresenting one’s identity constitutes a material breach and may give the other party the right to pursue available legal remedies.
This creates a documented chain of verification rather than relying upon one person or organization to simply say, “We checked.”
Nia Trent-Wilson: Financial Screening of Intended Parents
The Case:
Gestational carrier Nia Trent-Wilson experienced severe pregnancy complications. The pregnancy eventually became medically catastrophic. Trent-Wilson developed placenta accreta and underwent a cesarean section and hysterectomy, losing her uterus and fallopian tubes.
Meanwhile, according to reporting, the intended parents stopped replenishing the escrow account used to cover her expenses, including health insurance premiums. Trent-Wilson was ultimately left facing approximately $180,000 in medical bills. She sued ACRC, alleging that the agency breached its agreement with her by matching her with financially unsuitable intended parents.
The case raised an important question about what constitutes reasonable financial screening. According to court testimony reported by The Wall Street Journal, ACRC believed the intended parents’ initial $95,000 escrow deposit demonstrated sufficient financial suitability. The Journal reported that a more extensive background investigation might have revealed previous unpaid debts and judgments. NOTE: ACRC denied Trent-Wilson’s allegations, and the court case is pending.
The Problem:
Partially funding an escrow account at the start of a journey does not necessarily establish that intended parents have the financial resources to meet all obligations if the pregnancy becomes complicated. Surrogacy can involve substantial and unexpected expenses.
Before a gestational carrier assumes the physical risks of pregnancy, there should be reasonable assurance that the intended parents have the financial resources necessary to complete the journey.
The Safeguard:
Agencies should establish meaningful financial requirements before an embryo transfer occurs.
One approach would be to require intended parents to demonstrate access to approximately $250,000 for the journey, with two ways of satisfying that requirement:
Option 1: Fully Fund the Escrow Account
The intended parents deposit approximately $250,000 into the escrow account before embryo transfer. This provides the greatest financial protection because the funds anticipated to complete the journey are already available and being held by the escrow company.
Option 2: Partially Fund Escrow and Verify the Remaining Funds
Intended parents deposit a smaller required amount into escrow but provide the agency or escrow company with evidence demonstrating that they have access to the balance of approximately $250,000.
For example, if $150,000 were deposited into escrow, the intended parents would provide documentation demonstrating access to at least another $100,000. At a minimum, the initial escrow deposit should cover GC compensation, monthly expenses, insurance premiums, deductibles, co-payments, and reasonable medical expenses.
- Verification could include a recent bank or investment account statement or a letter from the intended parents’ financial advisor confirming that sufficient funds are available.
This gives intended parents greater flexibility while still providing the agency or escrow company objective evidence that the financial resources needed for the journey exist.
Health Insurance Funds Should Be Protected Separately
Regardless of which option is selected, certain funds should receive additional protection. Place the money needed to maintain the GC’s health insurance in a separate protected trust account and use it only for insurance-related expenses.
That account should contain enough to cover approximately 18 months of insurance premiums, the applicable deductible, and other reasonably anticipated insurance expenses. Those funds should not be available to pay GC compensation, monthly allowances, agency fees, or other journey expenses.
A depleted general escrow account should never result in a gestational carrier losing the health insurance intended to protect her during the pregnancy.
Medical Bills Should Not Become the GC’s Financial Burden
Medical bills require similar protection. Whenever possible, the intended parents should pay pregnancy-related medical expenses directly, through an escrow account, or a credit card designated specifically for medical expenses.
The GC may need to be identified as the patient on a hospital or physician’s account. But the financial structure of the surrogacy arrangement should be designed so that pregnancy-related medical expenses do not ultimately become her personal financial responsibility because the intended parents or escrow account failed to pay them.
No system can guarantee that intended parents will never experience financial difficulties. But reasonable financial verification and protected funds can substantially reduce the possibility that a GC completes a surrogacy journey only to discover that she is personally responsible for enormous medical bills.
McKenna West: When Someone Changes Their Mind
The Case:
McKenna West agreed to carry a child for intended parents in California. After the baby was diagnosed with a life-threatening medical condition, a dispute arose regarding termination.
West ultimately continued the pregnancy and temporarily relocated to Texas, where she delivered the baby. Litigation followed over parentage and medical decision-making, and West has also sued the agency, attorneys, and others involved in the arrangement. Her claims against those parties include allegations beyond the original matching decision and remain allegations unless established in court.
The Problem:
Termination and other difficult issues can and should be discussed before matching, but an agency cannot know with certainty how someone will respond when a hypothetical situation becomes a real medical crisis.
The Safeguard:
An agency should ask intended parents and gestational carriers about termination. This ensures they discuss difficult scenarios, document their positions, and decline to match people whose views are incompatible.
Importantly, the agency’s applications should ask the GC and intended parents exactly the same termination questions, using exactly the same answer choices. If the GC is given five possible positions on termination, the intended parents should be presented with those same five options, word for word. This allows the agency to make a meaningful comparison rather than interpreting answers to differently worded questions.
For example:
IP Application: No one wants to consider termination. However, in the rare event that termination has to be considered, please select the option below that best describes the circumstances under which you would request that the GC terminate the pregnancy:
- Only if the GC’s life or health is at risk.
- If the GC’s life or health is at risk, or the fetus has a diagnosis incompatible with life.
- If the GC’s life or health is at risk, or the fetus has a severe condition that would result in poor quality of life, excluding Down syndrome.
- If the GC’s life or health is at risk, or the fetus has a severe condition that would result in poor quality of life, including Down syndrome.
- If the GC’s life or health is at risk, or at the request of the intended parent(s).
GC Application: No one wants to consider termination. However, in the rare event that termination has to be considered, please select the option below that best describes the circumstances under which you would agree to terminate the pregnancy:
Then use the exact same five choices.
The agency should then compare the responses before approving a match. If the parties select different options, the agency should identify the discrepancy and require further discussion rather than assuming their beliefs are compatible. The parties’ responses and any subsequent discussion should be well documented and provided to their independent attorneys so their intentions can be accurately addressed in the surrogacy agreement.
But even when an agency follows this process, it cannot guarantee that someone will make the same decision months later when a hypothetical discussion becomes a devastating reality. Human beings can change their minds, and that alone does not mean the screening or matching process failed.
The agreement should therefore recognize the limit of screening:
An agency can document someone’s present intentions; it cannot guarantee that person’s future decisions.
Where Should Agency Responsibility Begin and End?
These four cases involve very different circumstances, but together they point toward a reasonable standard for our industry:
- What an agency can reasonably know should be verified.
- What an agency cannot reasonably predict should not become a guarantee.
Agencies can verify identity and addresses, conduct background checks, establish reasonable financial screening, confirm escrow funding and insurance, document that the parties met, and ensure that important issues such as termination were discussed before a match proceeds. And all of it should be documented.
But there must also be reasonable limits. An agency cannot guarantee that an intended parent will never experience financial difficulties, that a gestational carrier will never change her position regarding termination, or that people will behave exactly as anticipated when confronted with circumstances they could only imagine when they entered the arrangement.
There is an enormous difference between failing to discover information that reasonable screening could have revealed and failing to predict someone’s future behavior. Our industry should not wait for lawmakers or another troubling case to establish basic safeguards. Agencies should adopt meaningful standards now while also clearly defining the reasonable limits of their responsibility.
Ethical standards do not threaten surrogacy. They help protect gestational carriers, intended parents, children, agencies, and ultimately the future of surrogacy itself.
Where Should Agency Responsibility Begin and End?
These four cases involve very different circumstances, but together they point toward a reasonable standard for our industry:
- What an agency can reasonably know should be verified.
- What an agency cannot reasonably predict should not become a guarantee.
Agencies can verify identity and addresses, conduct background checks, establish reasonable financial screening, confirm escrow funding and insurance, document that the parties met, and ensure that important issues such as termination were discussed before a match proceeds. And all of it should be documented.
But there must also be reasonable limits. An agency cannot guarantee that an intended parent will never experience financial difficulties, that a gestational carrier will never change her position regarding termination, or that people will behave exactly as anticipated when confronted with circumstances they could only imagine when they entered the arrangement.
There is an enormous difference between failing to discover information that reasonable screening could have revealed and failing to predict someone’s future behavior. Our industry should not wait for lawmakers or another troubling case to establish basic safeguards. Agencies should adopt meaningful standards now while also clearly defining the reasonable limits of their responsibility.
- Verify what can be verified.
- Disclose what should be disclosed.
- Document what was done.
Ethical standards do not threaten surrogacy. They help protect gestational carriers, intended parents, children, agencies, and ultimately the future of surrogacy itself.
