The right to choose your donor: a step towards commercialization or a step towards empowering the patient?

Guido Pennings

Department of Philosophy, Pleinlaan 2, Lok. 5 C 442, Free University Brussels, 1050 Brussels, Belgium

The practice of gamete donation differs greatly from centre to centre and from country to country. One would have a hard time finding a guideline in the procedure which is exactly the same in all countries of the European Community. The guidelines common to all countries are the hardest to question since they are part of the background and, as such, do not attract our attention. One such guideline is that recipients do not choose their own donor. This clashes with the practice in the USA where it is relatively common to give women the possibility to select their own donor. The discrepancy in policies merits serious scrutiny. What arguments can be brought against a woman who wants to pick her own donor? This article analyses the pros and cons of that policy.

In a large number of sperm banks in the USA, women receive a catalogue with all the available donors. More recently, the same option is offered for oocyte donors in some programmes (Braverman, 1993Go). The information provided differs from fertility centre to fertility centre but there is a core of generally available information. This set, which constitutes the `short profile', includes ethnicity or race, age, weight, height, eye colour, hair colour, complexion, education or occupation and blood type. The medical history of the donor is also included. The `long profiles' give complementary information on the medical, social and educational history of the parents, grandparents, siblings and offspring of the donor. In addition, other kinds of information are provided, e.g. religion of the donor and his parents, sexual orientation, left or right handedness, language skills, musical skills, favourite colour and favourite sports. In some cases, all this can be supplemented with a drawing or photograph of the donor, an audio tape, a video tape and a written essay.

Whether the selection of the donor is made by the physician or by the recipient, three standards can be distinguished: the partner of the recipient, an overall attractive person and the presence of one or more specific characteristics. The applicability of the standard depends, of course, on the relational context of the recipient(s). Matching to the partner is only possible when there is a partner. On the other hand, it is not because there is a partner that matching should be the only option. The first two standards do not seem to generate much commotion. Most problems are connected with the selection on the basis of one or more specific features of the donor. Frequently, this possibility is ridiculed by predicting that `soon they will want a small red-haired software engineer with an IQ of 150 who plays the piano'. This presentation may be effective to express one's opinion (and to influence the audience) but it does not answer the question of whether the choice is morally acceptable.

Matching with the partner and the desire for secrecy

In a sense a woman chooses her own donor by choosing her partner. Most women desire a donor who resembles their partner as closely as possible. The resemblance is generally restricted to hair colour, eye colour, race and height. These are striking physical features that are largely inherited. The visibility of these features is important. In a recent survey, 85% of the Danish and Swedish couples indicated that they speculated about the physical appearance of the donor and about the chance that the child would resemble them (Nielsen et al., 1995Go). Physical and personality resemblance are prominent concerns for the parents (Klock and Maier, 1991Go). The reason behind the wish for resemblance is secrecy. The clearest indication that matching is meant to allow the secrecy of the donor origin is the fact that donor and partner of the recipient are matched on blood group. Matching allows the parents to act as if the child is their `own'. The general intention behind the organization of the procedure is to make the donor invisible and to conform the new-founded family to the ideal of the natural family. This framework also explains why the rule acquired a normative status; every woman should prefer a donor who resembles her partner. Once we realize that secrecy is the underlying rationale of the matching rule, we acquire the possibility to question it.

As well as the wish for secrecy, there is another reason for wanting a donor who closely resembles the partner in heterosexual and homosexual couples. The partner is, after all, chosen as a partner because of certain characteristics which please the woman. She likes her partner and wishes the donor to resemble this person (Nijs, 1982Go). Opting for a donor who clearly deviates from the partner can be seen as an indirect rejection of the partner. A man may feel uncomfortable if his partner prefers a `reproductive partner' whose characteristics are largely discordant with his characteristics. However, the decision will presumably be made by both members in consultation. They have to reach an agreement on which donor is acceptable before they proceed with the insemination. A third reason for desiring a resembling donor is that the likeness can enhance and facilitate attachment and bonding between social parent and child (Aronowitz and Feldschuh, 1989Go; Scheib et al., 1998Go).

Lesbians and single women

The advent of intracytoplasmic sperm injection (ICSI) has drastically changed the characteristics of the recipient group for donor insemination. Only a minority of heterosexual couples (those with a genetic condition and those where the male partner produces no spermatozoa at all) have to rely on donor material. The proportion of single and lesbian women in the population of recipients has increased up to a point where they constitute the majority (if, of course, the legislation does not deny them access to treatment). It is not clear to what extent this alteration in the recipient population has contributed to the evolution towards donor choice. However, the indirect influence of this change should not be underestimated. These new groups clearly express the untenability of matching with the male partner as the sole possible standard and, as such, force us to consider new standards.

Lesbian and single recipients not only defy the `partner standard', they also invalidate the secrecy motive. For these categories of recipient, secrecy is not a real option. However, these groups only demonstrate a more general point, namely that those prospective parents, including heterosexual couples, who do not intend to keep the secret have no compelling reason to select or require a matching donor.

Criteria used by the recipients when offered the choice

Since the option of choosing one's own donor is of recent date, there are relatively few studies on the subject. In the survey by Scheib et al. (1998), the two most mentioned criteria for the selection of the semen donor were his willingness to release his identity when the child becomes 18 years old and the physical resemblance with the recipient's partner (if she had one). Other frequently reported criteria were donor height and factors in the donor profile that indicated a well-rounded and positive character. To interpret these results, the fact that 79 % of the couples were lesbian should be kept in mind. Still, in a retrospective survey among heterosexual married women, lesbian and single women, all groups considered the donor race/ethnic origin, physical features, medical history and education level as the most important characteristics (Baker et al., 1998Go).

Three studies of oocyte recipients were conducted. In the first survey, the patients attributed the highest importance to the genetic profile, the talents, the blood type and the personality characteristics of the donor. On the second place came the IQ, the athletic ability, the psychological profile, appearance and family social history. Of least importance were the photo of the donor and the written stories (Heinemann-Kuschinsky et al., 1995Go). A second study included a survey of infertility patients who were not oocyte recipients on which information would be most desired in selecting an oocyte donor. The following information was mentioned as `essential': previous intravenous drug use, sexual preference of the donor, whether the donor was a mother herself, height and weight, educational level, her reason to donate and the number of sexual partners (Voll et al., 1996Go). In the most recent study, women who were presented with a possible ovum donor gave a variety of reasons to reject them: weight, too short, too tall, education... (Lindheim and Sauer, 1998Go). One woman rejected the candidate because she was not cosmopolitan enough and another because of the religious background of the donor. These findings clearly show that every recipient chooses according to her own personal preferences.

The findings gathered by the surveys concerning the criteria used by recipients are rather diffuse and muddled. The studies used different methods on different populations of respondents and were carried out in a different practice and context. It is at present impossible to deduce general priorities and tendencies. Almost every part of the available information has been mentioned by some people as crucial to the selection decision.

Arguments against the right to choose the donor

A child on command
People who refer to this argument reformulate the wish for a donor with certain characteristics as the wish for a child with those characteristics. A woman who asks for a donor with black hair wants a child with black hair. This introduces the idea that the child will only be valued if certain specifications are met (Warnock, 1984Go). To equate the two wishes is rather simplistic. For more complex characteristics, it is impossible to predict with a reasonable degree of certainty what the phenotypic result of the combination of the genes of the mother and those of the donor will be. The influence of environmental conditions is largely ignored in this argument. But it cannot be denied that by choosing a donor with certain characteristics, one increases the chances of having a child with similar features to the extent that these features are genetically determined. It is essential that the lack of guarantee concerning the outcome is stressed during counselling to avoid serious disappointment to the parents if their expectations are unfulfilled (Human Fertilisation and Embryology Authority, 1990Go). This warning is all the more important because some commercial sperm banks in their advertising emphasize the idea that choosing the donor equals choosing the characteristics of the future child.

The equation explains to a large extent the rejection of the practice. One of the background theories that play a role in the moral evaluation of the guideline is a theory on `responsible parenthood'. This theory contains a set of moral opinions on the attitudes, motives etc. prospective parents ought to have toward their offspring. The choice of the donor by the recipient conflicts with the `principle of unconditional parenthood'. This principle states that the parents should accept their child as it is. The principle also underlies the rejection of sex selection for non-medical reasons (Pennings, 1996Go). For the majority of the members of the Warnock committee, the possibility that the prospective parents would try to influence specific characteristics of the child was sufficient reason to limit the amount of information on the donor made available to the parents (Warnock, 1984Go). The American Fertility Society, on the other hand, encouraged the choice of specific characteristics of the donor by the acceptors when several men meet the matching points (American Fertility Society, 1993Go). The National Advisory Board on Ethics in Reproduction (NABER), an interdisciplinary think tank which studies ethical questions concerning the new reproductive technologies, points out that people do make choices concerning the features of the individuals they decide to invite into their families. `For instance, one factor affecting the decision of couples to marry is that certain attributes of the other meet their personal preferences. Similarly, it is ethically acceptable to match the features sought in a child when oocyte donation is carried out' (NABER, 1996Go). The standards used to judge the application of the new reproductive technologies are stricter than those applied to `natural' procreation. While we accept that a woman picks out her partner because she thinks he will make a good father or because she thinks that they will have beautiful and intelligent children, we do not accept the same motive in people who have to rely on donor gametes.

Commercialization
Offering the recipient the option of choosing her own donor can be seen as a step towards the commercialization of the programme. The practice seems to have its origin in the commercial sperm banks to which it is also largely restricted (Robertson, 1994Go). The fact that the possibility was first offered in the USA should, however, not only be attributed to the existence of commercial sperm banks. Two general elements may contribute to this fact: (i) the accordance of a very large autonomy to the patient/client. The physician is much less inclined to refuse some request for paternalistic reasons or for reasons of incompatibility with the function and role of the physician; and (ii) There is a general acceptance of organising the health care system according to the market rules (Cohen, 1997Go).

Blunt commerce has a very bad taste for most European physicians and bioethicists. Although they may not always be successful, medical associations and the legislators try to restrain the influence of the market in medical practice. While I strongly support this goal, I caution against the `contamination' argument. It is not because a certain option, practice or guideline is available in a mainly commercial setting that this option etc. should be considered as solely a commercial strategy and thus as condemnable. For some people `photo-matching' for instance is the culminating point of foolishness. Some sperm banks offer to look for a donor who resembles a person on a photograph sent by the recipient. The impulse for the sperm banks to provide this service is based on their experience that recipients appreciate the assistance on this point. Offering the service gives the bank an advantage over its competitors. But, alternatively, the service may also be seen as a sophisticated version of the matching that is at present done in most sperm banks in Europe. Photo-matching may do a much better job than the primitive and rudimentary matching that is now proposed to the clients. For some people who reject this service, the real objection may be situated in the possibility that the recipient does not demand matching with her partner.

When the guidelines are dissociated from the commercialization, other possible explanations for the practice can be sought. In New Zealand, a country where the general meaning of the donation is completely different from the meaning in the United States, the sperm banks increasingly offer the recipients the possibility to choose certain characteristics of the donor (Daniels, 1995Go). Apparently, the same policy can be defended from very different perspectives. The following hypothesis can be offered to explain the concordance. The commercialization process is connected to two associated movements: firstly, this evolution coincides with the dropping of moral restrictions that were linked to the original (medical) setting. The new all encompassing criterion is the ability to pay for the treatment. Secondly, the commercialization leads to an increase of the power of the non-medical parties, recipients as well as donors. The principle that `the customer is always right' questions the position of the physician and requests a justification for his/her present qualifications. This is especially true for those dimensions where the decision does not directly concern medical aspects of the procedure or where the doctor cannot claim priority on the basis of his/her superior knowledge. Once the donors have been checked on their genetic and general health, there seems to be no reason left why the physician rather than the recipient should select the donor. The attribution of the right to choose to the recipient thus fits the more general tendency to re-evaluate the traditional role of the doctor. To conclude, the greater autonomy of the recipient can be either a part of the wish to empower the non-medical parties involved or an indirect consequence of the commercialization of the practice.

Positive eugenics
As well as objections to the possibility that parents may determine certain characteristics of their children like hair colour and eye colour, there is the possibility that `better' or `superior' features will be preferred. The Repository of Germinal Choice (which favours spermatozoa from Nobel prize winners) serves as the ideal illustration (Kaplan and Tong, 1994Go). According to some, the `consumer choice' or self-determination expressed by the recipients will become the instrument to attain eugenics and human selection (Beck-Gernsheim, 1990Go). If more institutions would start collecting semen from famous men, several different eugenic criteria could be introduced: intelligence, celebrity and beauty (Jalbert et al., 1989Go). More concretely, this means that if parents are offered the possibility to choose their donor, they will prefer the famous, good-looking Nobel prize winner (how many of these are there?) above the normal, ordinary man. This argument, however, does not make much sense. First of all, it is not obvious which characteristics are `better' and thus when parents are making a eugenic choice. Not everyone will agree on which characteristics are the best. As one physician who allows her patients to choose their donor, said: `I have found that my beliefs and my judgments are different from those of my patients. The criteria they use to pick a donor are different from those of the staff and the doctors involved' (Grant, 1994Go). People choose according to the characteristics by which they set great store but is this wrong? The opponents of choice assume `maximizing' motives in people. However, some compromise will have to be made. Donors who excel in one field (e.g. athletic ability) may be a lot less proficient in other domains (e.g. musical talents). Moreover, a large number of recipients will prefer resemblance to their partner above superior intelligence or a specific skill. They may choose the donor on the simple fact that he practices the same sport as their partner or that he does a lot of charity work. And, needless to say, the overwhelming majority of the donors are not superhuman.

At present, the donors are (or should have been) selected on their physical health, their normal or even higher than average intelligence and the absence of illnesses and deformations. The original reproach of eugenic practices had nothing to do with the choice of the donor by the recipient but with this preselection of the donor group and with its disproportionately high number of medical students (Annas, 1980Go; Curie-Cohen et al., 1979Go; Worsnop et al., 1982Go). We accept that donors are selected on all those characteristics that are so strongly associated with eugenics, e.g. hair colour, eye colour, height, intelligence, etc. Moreover, we see no reason to intervene when a woman chooses her partner on those characteristics. When a woman who needs medical assistance does the same, it is called eugenics.

The eugenics argument presupposes a wish of the recipients to have the best donor in terms of (a combination of) some isolated characteristics. Although I do not think that this is the way people decide, the data provided in the donor profile should not encourage the selection of donors on such basis. As a general rule, exact numbers should be avoided in the donor profile because they risk being misleading. Talking in categories (tall, very tall, intelligent, above average, etc) corresponds better with the way we normally describe other people and this is sufficient to give recipients, and possibly the resulting child, an impression of the donor as a person. Precision of the data may give the wrong idea, especially when the features are quantifiable, and may encourage comparison. Intelligence is an appropriate example. At present, the information provided to the recipients remains fairly general. IQ scores are not mentioned although this information may be worth a lot to some recipients. Sperm banks which provide these scores may gain a competitive edge. The same would be true for other scores on psychological tests. However, most data in donor profiles do not allow comparison. How would you introduce a ranking between an economist and a biomedical engineer? Between someone who plays the saxophone and another who likes computers? There is no universal ranking system. A recipient may like some feature better than another but her reasons are connected to her personal preferences, just like her partner choice. The proposal to give the recipients the option of choosing their donor is not generated by the idea that they will do a better job than the medical personnel but by the belief that there is no objective way to fill in `better'. They will choose a person they like, someone with characteristics they prefer.

Discrimination
The NABER group found no indications that matching (a term they use to express fitting the features of the donor to features sought in the child) at present is used to increase the quality of the human gene pool. They propose that this problem may be avoided by composing a standard list of characteristics among which the potential oocyte recipient can choose (NABER, 1996Go). As long as there is no consensus among the institutions that offer oocyte donation concerning the characteristics that should be included in the list, every clinic should present the recipients in advance of their treatment with a list of features for which they can request matching. NABER does not mention any concrete example and it is consequently difficult to know which characteristics they would exclude from the list. The most evident way to avoid discrimination is to hold back information on a specific element. However, when we look more closely at the list of features, we might be forced to conclude that almost all characteristics can be used to discriminate. What should we think of the educational level, social family background, or race?

An obvious example of a feature that can be used to discriminate, is the information on whether the donor is Jewish (Deech, 1998Go). However, American sperm banks mention this information, just as they mention whether the donor is Irish. This example is complicated by the fact that, given the fear of incest, some Jewish authorities recommend the use of a non-Jewish donor (Mor-Yosef and Schenker, 1995Go). The information on his ethnicity may be desired by Jewish people and used to exclude the Jewish donors although this religious reason cannot be considered as discriminatory.

Another example is the information on the sexual orientation of the donor. Undoubtedly, some recipients will refuse a homosexual donor because they believe that homosexuality is genetically determined and because they do not want a homosexual child. Sexual preference of the oocyte donor was considered essential information for 60% of the recipients in one study (Voll et al., 1996Go). On the other hand, some people prefer a homosexual donor while for others sexual orientation makes no difference whatsoever. Since the population that requests donor insemination contains more and more lesbians, this is even likely.

The threat of discrimination is a serious argument that cannot easily be dismissed. While distinctions based on physical attributes can be explained on the basis of preferences, such an explanation cannot be offered for the rejection of a donor on the basis of his or her sexual orientation and his or her religion. Although both forms of differential treatment are based on prejudices and/or preferences, a distinction should be made between differential treatment that should be tolerated and differential treatment that should not be tolerated. The context is very important in the evaluation of an act as falling into one or the other category. If a sperm bank rejects all Jewish or homosexual candidates, this constitutes discrimination. At present, a large number of sperm banks refuse homosexuals as donors because of an increased risk of transmitting diseases (American Society for Reproductive Medicine, 1998Go). This looks a specious argument since sexual orientation does not determine the sexual behaviour. The fear for infections (given the fact that all donors are screened for sexually transmitted diseases and human immunodeficiency virus) justifies the rejection of all people who demonstrate promiscuous behaviour regardless of their sexual orientation. The sperm bank should be able to give a relevant reason for rejecting donors with certain characteristics. The only reasons that make sense are medical and genetic reasons, meaning the possibility of transmittable diseases and genetic illnesses.

For individuals, the situation is completely different. Private choices based on anti-Semitic or homophobic arguments are morally wrong but they should not be legally sanctioned or forbidden. If I reject a person as a friend because I learned that he is a homosexual or a Jew, I am blameworthy but I should not be punished or forced to keep him as a friend. And neither should the information be kept from me in order to prevent that I act on it. Choosing friends, partners and donors is basically a subjective and private matter. Nobody refers to the Declaration of Human Rights to criticize a person's mate choice. The reason is that selecting someone as a partner is not a question of justice. People choose a partner on the basis of characteristics that appeal to them. Likewise, the recipients will pick the donor according to characteristics that are important for them. This choice is not open to general rational justification (Engelhardt and Wildes, 1991Go).

Paternalism
The opponents of choice could argue that making people choose is a kind of paternalism. They can appeal to a right not to know. In an older study of Dutch couples, 89% of the women and 94% of the men indicated that they did not want information on the appearance, the character, the education or the profession of the donor (Kremer et al., 1981Go). Especially the male partner may not want to know anything about the donor besides the fact that he is a white, healthy male (Gillett et al., 1996Go). Due to the information on the social and psychological characteristics, the donor becomes a real life person and, as such, he is more difficult to ignore and forget. Possible fantasies of the woman about the donor may get a footing by these data. The limitation of the information on the donor to those aspects which concerns the health and the genetic quality fits the presentation of the donor as a sperm cell. Whether the reintroduction of the donor as a person is an advantage or a disadvantage is open for discussion (Warnock, 1984Go).

The results of the surveys are not univocal. However, it looks as if the attitude of the recipients is changing. 33% of Swedish and Danish couples were interested in getting descriptive information about the donor, his education and social background (Nielsen et al., 1995Go). The argument about paternalism can, however, be easily countered by leaving the option to the recipients. If they do not want to know anything, they can ask that the donor is selected on the standard features that are used at present. The issue is not about coercing patients to make a choice but about offering them the opportunity to do so.

Jeopardizing the anonymity of the donor
The danger for the anonymity of the donor increases the more non-identifying information he/she provides. In fact, given the access to all kinds of data banks, the recipient may be able to find the name of the donor if she is prepared to spend some time and effort. Up till now, there are to my knowledge no cases published of donors who have been traced against their will. However, this possibility is real and especially when the donor objects to the release of his/her identity, precautions should be taken to avoid this.

Advantages of the right to choose the donor

Autonomy of the recipient
Recipients in general worry about the person of the donor. The possibility to select the donor gives the woman or couple a sense of control (Lindheim and Sauer, 1998Go; Mahlstedt and Greenfeld, 1989Go). All recipients in an anonymous oocyte donation programme (n=47) felt that they should have significant control in donor selection and they wanted more input in the selection process (Heinemann-Kuschinsky et al., 1995Go). They have the largest stake in the selection of the donor because it will be their child. This fact strongly favours the transfer of the decision from the doctor to the future parents. The importance of autonomy as a value increases when we are talking about essential and crucial events in a person's life. Precisely in those areas, a person should have the right to make his/her own decisions. Choosing one's donor, like choosing one's partner, can be considered as one of those decisions.

The psychological impact on the recipients can be clarified by comparing the choice of a donor to the choice of a partner. In Western countries, the practice of marrying off has become utterly unacceptable. Some recipients feel the same way about leaving the selection of their donor to the physician as most of us currently feel about leaving the choice of our future husband or wife to our parents or to the priest or rabbi. Even if we are mistaken in our choice (and judging by the divorce rates we frequently are), the important point is that the choice is ours. Just as arranged marriages are made unacceptable by the introduction of `true love', `arranged matching' is made indefensible by a new view on reproductive autonomy.

Respecting autonomy means respecting the value hierarchy of the person. Every decision by the recipients balances a number of values. Some heterosexual couples accept a donor whose blood group does not match with the partner's blood group to avoid a longer waiting period. They value speed higher than secrecy. Since a perfect match can rarely be offered, this kind of balancing happens frequently. The same principle should apply to people who adopt another hierarchy for the selection of their donor. People who have particular requests have to pay a price for being choosy. If they are not satisfied with the available donors, they have to wait longer. It is up to the recipients to balance this disadvantage against an imperfect match (Herpin, 1994Go).

Experience of the transaction
The opponents of choice have very little confidence in the discretion and common sense of the recipients. They seem to believe that parents only have reprehensible goals in mind when they want to have a say in the matter of the donor. Parents claim this right because they want a child with special features, a perfect child or a child according to their wishes (Warnock, 1984Go). But it may very well be that the request for information and choice has nothing whatsoever to do with these presupposed intentions. The request may be due to the importance the couple or the woman attaches to the person of the giver, and not only to the quality of the gift. If the desire underlying the choice of the donor is the wish to determine the features of their future child, the recipients would only be interested in inheritable characteristics. A large part of the data provided in the extended donor profiles cannot be considered as indicative of the abilities or possibilities of the future child. This is the case for the donor's religion or world view, his hobbies and his present profession. But these data do tell us something about the donor as a person, about the kind of man he is. For those who do not exclusively look at spermatozoa as the building blocks for a child but who establish an interpersonal relation, however detached, with another person when they accept his gift, this kind of information is important. This is partly corroborated by the fact that some recipients attribute great weight to the donor's essay in their decision (Baker et al., 1998Go). Another indication of the presence of the dimension of the gift is the importance attributed to the donor's motives to donate. A number of American sperm banks probe for the donor's reasons on this point.

Reducing anxiety
One of the greatest sources of anxiety and tension for the recipients is the unacquaintance with the donor. The only thing they know is that he belongs to the same race and has no proven diseases or deformities. This fear of the unknown can be strongly reduced by providing information on the donor. In a recent survey, 22% of Polish couples indicated that they would like to know the characteristics of the donor prior to the first insemination attempt (Bielawska-Batorowicz, 1994Go). Oocyte recipients who want to meet the donor or who want to see a picture of the donor wish to alleviate concerns about the donor's health, intellectual capacities and physical appearance (Applegarth et al., 1995Go; Mahlstedt and Probasco, 1991Go). This motive is indirectly illustrated by oocyte recipients who mention the fact that they know the donor personally as one of the major reasons for choosing known donation. Knowing the donor provides the couple or woman with background information on her family, her personality and her social and religious background (Lindheim and Sauer, 1998Go). The two major reasons given by oocyte recipients who opted for known donation instead of the `personalised anonymity' procedure were fear of the unknown origin of the genetic material and trust in the personality of the donor (Baetens et al., 1995Go). Moreover, an important reason for selecting a donor is not her superior intelligence, her beauty or some exceptional quality but the fact that the recipient likes the donor as a person (Adair and Purdie, 1996Go). This finding also demonstrates a clear inconsistency in the position of European fertility centres. Most centres ask their patients to bring their own oocyte donor and, more important for the present issue, they do not oblige them to step into a `personalised anonymity' programme (France is an exception). Those who bring their own donor can keep this donor and thus are given the right to choose their donor.

Part of the reason why the recipient is not allowed to choose her donor seems to be linked to the norm that she should accept a certain extent of `coincidence' or unpredictability. There is an aspect of wishing too much control over the outcome and an impression of ungratefulness. Never look a gift horse in the mouth. When you need help, you should not be too particular. Instead the recipient should be grateful for what she gets. To the extent that this idea indeed influences the attitude towards the issue, it is misplaced and preposterous.

The initial situation, at least in Europe, is that prospective parents have no right to non-identifying information. However, given the evident interest of the parents in the donor, the burden of proof should be in the camp of the adversaries of this right. The starting position should be that the parents have the right to non-identifying information and that arguments should be offered to deny them this right in certain circumstances. Once parents have a right to non-identifying information, it becomes much more difficult to argue that they cannot select the donor themselves on the features about which they are informed.

Information to the child
A positive consequence of offering prospective parents the possibility to make a choice is that they possess information on the donor very early in the decision process. If it is to the advantage of the child to get information, and there seems to be a consensus growing on this point, it may be a good thing if the parents get this information as early as possible (Pennings, 1997Go). If they also have the possibility to pick the donor of their choice, the fear of telling the child about the donor may diminish. More information and more control prepares the recipients better emotionally for discussing the donation with their offspring (Heinemann-Kuschinsky et al., 1995Go). This is an empirical contention which can be verified by research: do more parents who had the possibility to select their donor inform their children than parents who did not have this option? A second question, which is also related to the welfare of the child, is whether parents who could choose their own donor feel more comfortable in accepting the gift than other parents. The non-identifying information, in combination with the increased control over the process and the outcome, can help the parents in accepting the assistance of the donor in the creation of their family. The acceptance of the parents is crucial for the adjustment of the donor offspring (Mahlstedt and Probasco, 1991Go). Provision of detail can be reassuring and may help to resolve some of the emotional problems generated by the anonymity of the relationship (Walker et al., 1987Go).

Conclusions

The present practice of denying recipients the possibility to choose their own donor seems largely due to the unquestioning acceptance of the existing practice. People are asked to offer a reason to change this rule. However, the overwhelming interest of the recipients in the quality of the material and in the person of the donor gives them priority over all other people involved in the donation. The respect for the autonomy of the recipients and the reduction of the anxiety caused by the uncertainty constitute the main reasons for allowing the choice of the donor.

Fertility centres and sperm banks are under no obligation to provide all possible information on the donor. Practical and financial reasons will limit the extent of the information gathered. However, there should be a discussion on the features and facts that ought to be given to the recipients. The demarcation of the donor profile should be based on the goal this profile serves: to give the recipients (and possibly the donor offspring) a fairly accurate image of the donor so that they are reassured about the origin of the material and are able to handle the transaction more easily. If the information is later passed on to the donor offspring, it should be sufficient for them to fill in the first chapter of their life story.

Notes

This opinion was previously published on Webtrack 98, December 8, 1999

References

Adair, V.A. and Purdie, A. (1996) Donor insemination programmes with personal donors: issues of secrecy. Hum. Reprod., 11, 2558–2563.[Abstract]

American Fertility Society (1993) Guidelines for gamete donation, 1993. Fertil. Steril., 62 (Suppl. 1), 100S–107S.

American Society for Reproductive Medicine (1998) Guidelines for therapeutic donor insemination: sperm. Fertil. Steril., 70 (Suppl. 3), 1S–4S.

Annas, G.J. (1980) Fathers anonymous: beyond the best interests of the sperm donor. Fam. Law Quart., 14, 1–13.

Applegarth, L., Goldberg, N.C., Cholst, I. et al. (1995) Families created through ovum donation: a preliminary investigation of obstetrical outcome and psychosocial adjustment. J. Assist. Reprod. Genet., 12, 574–580.[ISI][Medline]

Aronowitz, B.R. and Feldschuh, J. (1989) Artificial insemination by donor: yours, mine, or theirs? In Offerman-Zuckerberg, J. (ed.), Gender in Transition: a New Frontier. Plenum Press, London, pp. 151–161.

Baetens, P., Verté, D., Ponjaert-Kristoffersen, I. et al. (1995) Counselling recipients for oocyte donation. In Hox, J.J., van der Meulen, B.F., Janssens, J.M.A.M. et al. (eds), Advances in Family Research. Thesis Publishers, Amsterdam, The Netherlands, pp. 285–292.

Baker, W., Copeland, J., McKeachie, S. et al. (1998) Choosing a sperm donor: comparison of preferred characteristics by recipient marital status and sexual orientation. Fertil. Steril., 70, suppl., S185–S186.

Beck-Gernsheim, E. (1990) The changing duties of parents: from education to bio-engineering. Int. Soc. Sci. J., 126, 451–463.

Bielawska-Batorowicz, E. (1994) Artificial insemination by donor – an investigation of recipient couples' viewpoints. J. Reprod. Infant Psy., 12, 123–126.

Braverman, A.M. (1993) Survey results on the current practice of ovum donation. Fertil. Steril., 59, 1216–1220.[ISI][Medline]

Cohen, C.B. (1997) Unmanaged care: the need to regulate new reproductive technologies in the United States. Bioethics, 11, 348–365.[ISI][Medline]

Curie-Cohen, M., Luttrell, L. and Shapiro, S. (1979) Current practice of artificial insemination by donor in the United States. N. Engl. J. Med., 300, 585–590.[Abstract]

Daniels, K.R. (1995) Information sharing in donor insemination: a conflict of rights and needs. Cambridge Quart. Healthcare Ethics, 4, 217–224.[ISI][Medline]

Deech, R. (1998) Legal and ethical responsibilities of gamete banks. Hum. Reprod., 13 (Suppl. 2), 80–89.[Medline]

Engelhardt, H.T.Jr. and Wildes, K.W. (1991) The artificial donation of human gametes. Baillière's Clin. Obstet. Gynecol., 5, 637–658.[ISI][Medline]

Gillett, W.R., Daniels, K.R. and Herbison, G.P. (1996) Feelings of couples who have had a child by donor insemination: the degree of congruence. J. Psychosom. Obstet. Gynecol., 17, 135–142.[ISI][Medline]

Grant, J.L.P. (1994) Single women and conception. Can. Fam. Phys., 40, 1709–1711.[ISI][Medline]

Heinemann-Kuschinsky, E., Davis, S., Brochard, E. and Vasilenko, P. (1995) Assessment of recipient patient's concerns and feelings associated with anonymous oocyte donation. Fertil. Steril., 64, S251–S253.

Herpin, N. (1994) Obstacles to sperm donation in France. In Elster, J. and Herpin, N. (eds), The Ethics of Medical Choice. Macmillan, London, UK, pp. 48–69.

Human Fertilisation and Embryology Authority (1990) Code of Practice. HFEA, London, UK.

Jalbert, P., Leonard, C., Selva, J. and David, G. (1989) Genetic aspects of artificial insemination with donor semen: the French CECOS Federation Guidelines. Am. J. Med. Genet., 33, 269–275.[ISI][Medline]

Kaplan, L.J. and Tong, R. (1994) Controlling our Reproductive Destiny. MIT Press, Cambridge, Massachusetts, USA.

Klock, S.C. and Maier, D. (1991) Psychological factors related to donor insemination. Fertil. Steril., 56, 489–495.[ISI][Medline]

Kremer, J., Frijling, B.W. and Nass, J.L.M. (1981) Donor inseminatie en privacy. Medisch. Contact, 36, 41–44.

Lindheim, S.R. and Sauer, M.V. (1998) Expectations of recipient couples awaiting an anonymous oocyte donor match. J. Assist. Reprod. Genet., 15, 444–446.[ISI][Medline]

Mahlstedt, P.P. and Greenfeld, D.A. (1989) Assisted reproduction technology with donor gametes: the need for patient preparation. Fertil. Steril., 52, 908–914.[ISI][Medline]

Mahlstedt, P.P. and Probasco, K.A. (1991) Sperm donors: their attitudes toward providing medical and psychosocial information for recipient couples and donor offspring. Fertil. Steril., 56, 747–753.[ISI][Medline]

Mor-Yosef, S. and Schenker, J.G. (1995) Sperm donation in Israel. Hum. Reprod., 10, 965–967.[Abstract]

NABER (1996) Report and recommendation. In Cohen, C.B. (ed.), New Ways of Making Babies: the Case of Egg Donation. Indiana University Press, Bloomington, IN, USA, pp. 233–320.

Nielsen, A.F., Pedersen, B. and Lauritsen, J.G. (1995) Psychosocial aspects of donor insemination. Attitudes and opinions of Danish and Swedish donor insemination patients to psychosocial information being supplied to offspring and relatives. Acta Obstet. Gynecol. Scand., 74, 45–50.[ISI][Medline]

Nijs, P. (1982) Aspects médico-psychologiques de l'insémination artificielle. Jus Medicum (Acta Fourth World Congress on Medical Law), 69–81.

Pennings, G. (1996) Family balancing as a morally acceptable application of sex selection. Hum. Reprod., 11, 2339–2343.[ISI][Medline]

Pennings, G. (1997) The `double track' policy for donor anonymity. Hum. Reprod., 12, 2839–2844.[Abstract]

Robertson, J.A. (1994) Children of Choice: Freedom and the New Reproductive Technologies. Princeton University Press, Princeton, New Jersey, USA.

Scheib, J.E., Raboy, B.L. and Shaver, P.R. (1998) Selection of sperm donors: recipients' criteria and donor attributes that predict choice. Fertil. Steril., 70 (suppl., 1), S279.

Voll, S., Hamacher, P. and Toner, J. (1996) Pertinent oocyte donor characteristics – what oocyte recipients wish to know about oocyte donors. Fertil. Steril., 66 (Suppl.), S25.

Walker, A., Gregson, S. and McLaughlin, E. (1987) Attitudes towards donor insemination – a post-Warnock survey. Hum. Reprod., 2, 745–750.[Abstract]

Warnock, M. (1984) A Question of Life. The Warnock Report on Human Fertilisation and Embryology. Blackwell, Oxford, UK.

Worsnop, D., Mack, H., Bobbie, M. et al. (1982) Human artificial insemination: donors in Melbourne. Aust. Fam. Physician, 11, 218–224.[Medline]





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