The last vial. What it means to (aspiring) parents to use the same sperm donor for siblings.

Introduction: A lot of attention has been given to the quest of parents, children and donors to find donor siblings (= half siblings who share the same donor gametes but who are born in different families). However, literature is scarce about the use of the same sperm donor for subsequent children in the same family.Methods: This study included 68 lesbian and heterosexual (aspiring) parents, recruited at the Department of Reproductive Medicine of Ghent University Hospital (Belgium). The in-depth semi-structured couple interviews were performed between October 2012 and October 2013. Data were analyzed through step-by-step inductive thematic analysis.Results: The couples showed a clear preference to use the same sperm donor for their children. The most common reasons for this preference were related to the family or sibling relationships and medical reasons. Uncertainty about the availability of the same donor over time seeped through in their stories. Most lesbian aspiring parents decided that both partners should have a genetic link with at least one child.Conclusion: The use of the same sperm donor for subsequent conceptions appeared quasi unambiguously in the interviews of the lesbian and heterosexual (aspiring) parents in our study.

The Meaning of the Sperm Donor for Heterosexual Couples: Confirming the Position of the Father.

In the literature, relatively little attention has been paid to the meaning of donor involvement in the intimate couple dyad. The current study aimed to enrich our understanding of couples' meaning-making regarding the anonymous sperm donor and how they dealt with the donor involvement. Semi-structured interviews were conducted with nine couples, who had at least one child conceived through sperm donation. Our thematic analysis showed that the donor conception was seen as a different path to create a normal family. Once the family was formed, most couples avoided talking about the donor because it was perceived as disrupting men's growing confidence in their position as father. Participants tried to confirm the position of the father to protect the family relationships. Uncertainties about how they were perceived as parents showed the continuing dominance of genetic ties within our social discourse. Participants also dealt with reminders of the donor in their daily life. Overall, they tried to manage the space taken up by the donor and to protect the position of the father. We relate our findings to literature on topic avoidance and shared obliviousness in families. For counseling practice, it could be useful to explore couples' meaning-making about the donor as this seemed to serve family functioning.

Creating a family through connection websites and events: ethical and social issues.

Over the years, connection websites and speed dating events have increasingly attracted singles and couples who cannot have a child in the 'traditional' way. These initiatives bring together candidate gamete providers and recipients with the promise of offering more freedom of choice than fertility centres or sperm banks currently do. Depending on the level of contact desired, the role of the gamete provider may range from not being involved at all to sharing full parental rights and obligations. In this paper, we take a look at the ethical and social issues that emerge with these new forms of family arrangements. We suggest that, although the private arrangements promote greater autonomy and control for all parties involved, risks and questionable assumptions are also at play. In particular, risks involve insufficient screening of the involved donor or co-parent, particularly in terms of motives and psychological characteristics. One must also be wary of the risk of unregulated commercialization and, more importantly, of disappointments and legal conflicts caused by unclear or changing expectations. We also warn for the risk of reinforcing heterosexist and genetic norms of parenting and valid family building.

Donor Conception Disclosure: Directive or Non-Directive Counselling?

It is widely agreed among health professionals that couples using donor insemination should be offered counselling on the topic of donor conception disclosure. However, it is clear from the literature that there has long been a lack of agreement about which counselling approach should be used in this case: a directive or a non-directive approach. In this paper we investigate which approach is ethically justifiable by balancing the two underlying principles of autonomy (non-directive approach) and beneficence (directive approach). To overrule one principle in favour of another, six conditions should be fulfilled. We analyse the arguments in favour of the beneficence principle, and consequently, a directive approach. This analysis shows that two conditions are not met; the principle of autonomy should not be overridden. Therefore, at this moment, a directive counselling approach on donor conception disclosure cannot be ethically justified.

Recipients' views on payment of sperm donors.

The aim of this qualitative study was to explore how recipients viewed payment of sperm donors. The study was conducted in Belgium, where, as in many countries, sperm donors receive recompense for their time and expenses. Face-to-face semi-structured interviews were conducted with 34 heterosexual and lesbian couples who, at the time of data collection, had at least one donor-conceived child aged 7-10 years or who were undergoing donor conception treatment. Although participants commonly described the issue of financial compensation as something that did not really concern them, all supported the idea that some level of payment was acceptable or even necessary. The participants also identified several ways in which donor payment offered advantages to their own position as (future) parents. Although the idea is commonly rehearsed that sperm donation is a gift and that monetary transaction for conception is demeaning, the participants of this study did not generally share this view. To them, a small financial return served as a symbolic acknowledgement of the donor's contribution and helped secure the type of relationship they expected from their donor. There was clearly concern, however, over high payments and the risk of attracting the wrong kind of donor.

Open-Identity Sperm Donation: How Does Offering Donor-Identifying Information Relate to Donor-Conceived Offspring's Wishes and Needs?

Over the past years, a growing number of countries have legislated open-identity donation, in which donor-conceived offspring are given access to the donor's identity once the child has reached maturity. It is held that donor anonymity creates identity problems for such children similar to the "genealogical bewilderment" described within the adoption context. The study of the social and psychological effects of open-identity donation is still very much in its infancy, but what has been left unquestioned is whether (and to what extent) offering access to the donor's name and address is an adequate response to such effects. This study has two goals: First, we aim to provide a systematic review of the reasons why donor-conceived (DC) offspring want to know the identity of their sperm donor. Second, we examine to what extent the provision of donor-identifying information can satisfy the reasons mentioned. The most important motivations appear to be: (1) to avoid medical risks and consanguineous relationships; (2) to satisfy curiosity; (3) to learn more about the self or to complete one's identity; (4) to learn more about what kind of person the donor is (biographical information, why he donated, etc.); (5) to form a relationship with the donor and/or his family; and (6) to learn about one's ancestry/genealogy. Our analysis shows that for nearly all of these reasons access to the donor's identity is not necessary. In those cases where it is, moreover, donor identification is not sufficient. What is really needed is (extended) contact with the donor, rather than the mere provision of his name.

The right to know your genetic parents: from open-identity gamete donation to routine paternity testing.

Over the years a number of countries have abolished anonymous gamete donation and shifted toward open-identity policies. Donor-conceived children are said to have a fundamental "right to know" the identity of their donor. In this article, we trace the arguments that underlie this claim and question its implications. We argue that, given the status attributed to the right to know one's gamete donor, it would be discriminatory not to extend this right to naturally conceived children with misattributed paternity. One way to facilitate this would be through routine paternity testing at birth. While this proposal is likely to raise concerns about the conflicting interests and rights of other people involved, we show that similar concerns apply to the context of open-identity gamete donation. Unless one can identify a rational basis for treating the two groups differently, one's stance toward both cases should be the same.

The right of the donor to information about children conceived from his or her gametes.

The field of gamete donation for medically assisted reproduction purposes is evolving. While anonymous gamete donation was long the preferred practice, a new focus on the rights and interests of donor-conceived children has led a number of countries to shift towards an open-identity system. However, this evolution appears to overlook whether information exchange could also be of interest to the other parties involved, in particular the gamete donors. In this article, we analyse the question whether donors should be granted a right to some information about the offspring conceived by their donations. We constructed five arguments which donors could use in support of such a claim: (i) It can be of great importance to the donors' and their own children's health that they receive medical information (in particular, evidence of an unsuspected genetic disease) about the donor offspring; (ii) basic information (such as whether any children were born) could be a way to acknowledge donors for their altruistic behaviour; (iii) general information (information about the child's wellbeing) about the donor offspring could ease the donors' potential concern about and sense of responsibility for the offspring; (iv) basic information could provide an important enrichment of the donors' identities; (v) identifying information would be useful for donors who want to contact the donor offspring. No strong arguments in favour of granting donors the right to identifying information were found. An exchange of this type of information should only be accepted when all parties agree. Taken together, the four first arguments form a strong case for granting donors a right to several types of anonymous information about the donor offspring.

Earning points for moral behavior: organ allocation based on reciprocity.

Anticipating the reevaluation of the Dutch organ procurement system, in late 2003 the Rathenau Institute published a study entitled 'Gift or Contribution?' In this study, the author, Govert den Hartogh, carries out a thorough moral analysis of the problem of organ shortage and fair allocation of organs. He suggests there should be a change in mentality whereby organ donation is no longer viewed in terms of charity and the volunteer spirit, but rather in terms of duty and reciprocity. The procurement and allocation of donor organs should be seen as a system of mutually assured help. Fair allocation would imply to give priority to those who recognize and comply with their duty: the registered donors. The idea of viewing organ donation as an undertaking involving mutual benefit rather than as a matter of charity, however, is not new. Notwithstanding the fact that reference to charity and altruism is not required in order for the organ donation to be of moral significance, we will argue against the reciprocity-based scenario. Steering organ allocation towards those who are themselves willing to donate organs is both an ineffective and morally questionable means of attempting to counter organ shortage.

Use of pigs for xenotransplantation: the speciesism by proxy syndrome.

BACKGROUND: When questioning whether it is acceptable to use pigs as sources of xenografts, focus easily shifts to demonstrations that it is more acceptable to exploit pigs rather than primates. Both practical and ethical reasons against the use of primates do not stand when applied to the use of pigs. Consequently, use of pigs is held to be justified. METHODS: In this paper, I examine the weaknesses that shelter within three ethical arguments commonly rehearsed in defense of choosing the pig as source animal: (a) that the use of pigs for human purposes is embedded in a long tradition; (b) that pigs are not an endangered species; and (c) that they do not share the cognitive and emotional capacities with humans to the same extent that primates do. RESULTS: All of the arguments rest on presumptions that are themselves in need of further discussion or clarification. CONCLUSION: Other approaches are necessary in justifying use of pigs as sources of xenografts.