Ethical-anthropological dilemmas of gamete and embryo donation: commodification, altruism, morality, and the future of the genetic family
Authors: Kiyashchenko Larisa P. , Bronfman Svetlana A. , Maylenova Farida G. 
Published: March 2020

ART and, in particular, IVF and ICSI, are essentially a laboratory experiment, but which, due to its specificity, goes beyond the disciplinary boundaries, explicitly acquiring an ethical-axiological dimension in the interaction zone of the members of a particular community involved in child-bearing. At the same time, it is noted that the activity and choice of a way to solve problems with childbirth has a characteristic severity, due to the traditions and level of civil and social maturity of a country, due, among other things, to the level and achievements of technical equipment in this industry of knowledge and practice. According to foreign studies, about half of all subfertile people (having problems with childbirth, but potentially able to become parents) in developed countries are trying to overcome their infertility with the help of medicine, and research data indicate that the proportion of such individuals is growing. The most difficult problems of reproduction are associated with low quality of oocytes (eggs) or low ovarian reserve (both age and hereditary, as well as associated with past diseases or iatrogenic); aspermia and deep teratozoospermia (the presence of only pathological forms of sperm in the ejaculate), can not give hope to a couple (or individual) to have genetically related offspring. However, donor programs create additional opportunities for social (non-biological) motherhood / paternity. Donation of oocytes (ova) is found in ART programs at least 3 times more often than donation of spermatozoa (for heterosexual couples, but not for single women). At the moment, donation of gametes and embryos raises a number of ethical, legal, medical and socio-psychological issues that require competent support from experts of a wide range of specialists, as well as competent, non-commercial, primarily due to the interaction between donors and recipients. The analysis of possible modifications of family and kinship ties is based on the idea of transforming social relations, in which assisted reproductive technologies (ART) play a fundamental role, building a system of “new kinship and new family.” By entering into the intimate process of the birth of life and acting as a regulator of the composition of participants in this process through the stimulation of responsibility to present and future relatives, reproductive technologies affect the initial moral requirements in the community, redefining universal values based on the specific situation. Scenarios of childbearing through ART with the involvement of additional participants (donors of sperm, oocytes or embryos) are possible in the context of the legal field, but legally fixed anonymity of the donor (except for the relative of the recipient) leaves many unresolved issues related to the problems of hereditary diseases, genetic abnormalities and epigenetic changes; in addition, there is a problem associated with the possibility of unintentional incest, as well as the difficulties of the child’s self-identification and the closeness of his genealogy. Solutions to these issues are postponed until later, thereby initiating future dramatic situations, ethical conflicts and dilemmas with a poorly predictable positive outcome.