New challenges for gamete donation programmes: changes in guidelines are needed.

In the UK, the Human Fertilisation and Embryology Act 1990 prevents children born as a result of donor-assisted conception from gaining access to identifying information about their genetic origins. There is growing concern that current screening protocols regarding gamete donation are ill-suited, especially in relation to genetic disease. There are no guidelines addressing the issues of confidentiality that might arise if a disease emerges after insemination and establishment of pregnancy. Donors may become aware that they are at risk of a familial condition after they have donated gametes or recipients of donated gametes may become aware of a genetic illness in the resulting child. At present, there is no agreed method for allowing this information to be given to the donor or other recipients of gametes from that person. We suggest that these issues should be raised with donors, and appropriate counselling and predictive tests offered to them. Changes in regulations regarding gamete donation should be considered that accommodate recent and possible future developments in genetics. Furthermore, consideration should be given to the storage of samples of DNA from donors for the future provision of genetic information.

Clinical perspectives on gamete and embryo donation.

Clinical staff involved in assisted reproduction frequently encounter ethically complex clinical problems. Such difficulties often relate to the use of donor sperm, eggs or embryos. Despite a fall in the number of donor insemination (DI) cycles performed in the UK over the last few years, which is partly explained by the availability of intracytoplasmic sperm injection (ICSI), there is still a considerable demand for the treatment both in natural cycles and in IVF. The burden on clinics in providing sound recruitment and screening strategies for donors is enormous and is the subject reviewed in this report. If remuneration of donors were withdrawn, as proposed by the Human Fertilisation and Embryology Authority (HFEA), the capacity to maintain a clinical service would be in doubt. Advances in technology are now pushing to the extremes the limits of what is socially acceptable. Those involved in providing clinical services face decisions on rationing the limited funds available to treat patients, which in some instances may impinge on patient autonomy. Clinical ethics committees may have a role in assisting providers in reaching decisions regarding access to treatment. Inequity of access to treatment may relate to the inability to pay for treatment, with the consequent danger of different ethical standards applying to different sectors of the population.