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The key ethical issues in donor conception

This article discusses the key ethical issues in donor donation, and how new rules are making it easier to identify donors.
There is a fair amount of controversy over donor gametes both sperm and egg. There are several areas of controversy. One area of controversy is whether or not donations should be anonymous? That is to say that the donor is unknown and would always be unknown because it is fully anonymous so that in the future the child who was born of donor gametes could never identify who the parent was. Now much of this of course depends upon whether parents inform the child that the child is a product of not the gametes from the two parents who are married and have the child but of some third party.
Sperm donation has a very long history and for very many years it was conducted anonymously, probably in the past, I don’t know the actual facts most people never informed their children. However, there can be circumstances, unpredictable circumstances in which the child will find out. I will give you one quick story. This was a case in which the parents never told the child that she was the child of donated sperm and it turns out that the marriage collapsed and the parents had a bitter, bitter time during the divorce.
Both parents were trying to speak to the child and they got angrier and angrier and when the child said something favourable about her father the mother shouted out to the child “and he’s not even your father.” Now this is the wrong time to find something like that out. It is a delicate matter. A lot has to be explained to a child. The way the laws work now, when the laws require that the donor not be anonymous, that is identifiable, the child may be told at any age and at the time at the age of 18, where these laws exist, the child then has the opportunity, is granted the right actually to identify and to possibly make contact with the donor.
Again, this is a long history in sperm donation but the same is evolving in egg donation. Some countries have laws other countries have no laws, especially in the area of egg donation, which is more recent than sperm donation. It is less likely that these would be governed by laws. Some people argue that the child has a right to know who his or her genetic parent is. But of course there are many people who would be donors who do not want to be found at some time in the future. And so there is a difficulty sometimes in getting a sufficient number of donors.
I believe that in Sweden when the law was passed that prohibited anonymous donations the sperm donations dropped precipitously and there were not as many donations that were available. Another question about the sperm donors and the egg donors for that matter is how strict should the enquiry and the medical questions? What about psychological questions? Should there be a history that is taken for example of some psychological-, whether someone has visited psychiatrists? Is that a reason not to make it available to the child? The way that this is sometimes described is give the child the best available future or the best known future.
So I know that in my setting where we have an ethics committee, in my institution where the ethics committee meets and the reproductive endocrinologists, the physicians bring cases before the committee, many cases arise in which the question that is raised is what is in the best interests of the child? It is quite clear what the best interest is of the couple. But it is not so clear what the best interest of the child is.
So there is an array of questions with donor gametes some of which, especially when there is payment for the donor, what to do when the donor, and this would be a case for egg donation because it is a very expensive procedure and egg donors are paid a fair amount of money, what about couples in which there may be a need for the donation but the couple can’t afford to pay the donor or pay for the service actually that is provided either by a clinic or by the donor herself. Well, here the question arises what about the sharing of eggs? Or the sharing of the reproductive services I should say.
If you have a woman who is infertile, either because she has no eggs and another woman who is infertile because she has eggs but cannot carry a pregnancy should there be a sharing arrangement? Well that seems like a fair thing to do. But what if only some of the eggs are really good eggs or whether there are very few eggs? Who should get the eggs? The one who pays or the one who donates, the donor of course, there are two different individuals. There are a lot of unanswered questions and a lot of ethical controversies about donor gametes. In some religions it is actually prohibited.
The Muslim religion prohibits donor gametes from anyone although there is a thriving, because fertility is so important in the Muslim religion, there is a thriving activity by physicians in that area. If there are no religious or other kinds of objections then this is actually a way of helping infertile couples or individuals for having a genetically related child. Now one more point about this is that there are babies for adoption, babies that have no homes and they are either in foster care or there are fewer orphanages these days, and so there are some people who say the first step should be to look at living children who need a home.
Why is it so important it is argued for people to have a genetically related child? Well, whether it is instinctual or just the nature of human beings the desire for a genetically related child is so strong that, that is what has given rise to the gamete donation.

In the past, sperm donation was a fairly uncontroversial affair. A medical student might spend a lunch break taking the opportunity to earn some pocket money by donating to a fertility clinic. Rarely if ever would he think about the outcome of his donation.

There was a time when virtually all sperm donation to clinics was anonymous. It was not seen as important for the child to know or have access to identifiable information about the donor. That is still the case in many parts of the world today.

Identifiable donors

However, many countries have now changed their practices in relation to donor anonymity. In this interview, Professor Macklin describes how the field has changed dramatically over the last couple of decades in favour of known or identifiable donors.

In the past, prospective parents would often receive a few details about the donor. They might be given physical descriptions such as the donor’s eye and hair colour, their interests or their achievements.

Today, many countries have gone one step further and made it mandatory for donors to be identifiable, meaning that they can be contacted by the donor-conceived child in the future.

The role the donor plays has changed

In countries where this is allowed, donors can now be contacted by the child once they reach adulthood. This means that the role that the donor plays in the family structure changes, and this might have consequences for parental choices and whether they choose to disclose to the child.

Accidental disclosure

Like Diana Baranowski highlighted in her interview, the one thing that can be very damaging to the family dynamic is accidental disclosure.

Professor Macklin then goes on to cover egg sharing, which some clinics offer as part of their fertility service. Here problems can arise with regards to who gets to determine access to such donated gametes, and whether new laws are making it harder for clinics to recruit sufficient donors.

Concerns around religion

Finally, Professor Macklin mentions how concerns about anonymity might vary depending on cultural and religious background. In an increasingly globalised and multicultural world, it is vital to understand the perspectives that different cultures have on what family means to them.

The opportunities that the new assisted reproductive technologies bring are testing long-standing societal norms and the pace of change can be challenging.

If you’d like to learn more about ethical issues in donor conception, check out the full online course from UCL, below. 

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