Ethical and legal issues in the use of related donors for therapeutic insemination

Donor insemination involving family members can be complex. Although it may offer some advantages to the requesting individuals, to the donor, or to the family, related donation does raise a significant number of concerns. The specific circumstances of these requests should be considered carefully--in most cases more carefully than with anonymous sperm donation. Still, in the United States the freedom of couples or individuals to decide whether, when, and how to reproduce is highly valued. Respect for the autonomy of the involved family members would favor serious consideration of proposals for intrafamilial sperm donation, when all parties have freely consented to participate. Without exception, standards governing anonymous sperm donation should be followed in evaluating the proposed sperm donor for infectious and genetic diseases. The semen specimens should be frozen and quarantined for 180 days. In many cases, the 6-month delay that results from this quarantine will discourage a couple from pursuing intrafamilial sperm donation. Adequate time is essential to assess these relationships when requested. Multiple visits to physicians, nurses, counselors, and lawyers may be necessary for a thorough assessment. Programs should require prospective participants, including recipients, donors, and partners of donors, to undergo psychologic counseling by a professional knowledgeable about gamete donation. Counselors should address issues such as emotional risks, potential impact on family relationships, the donor-recipient relationship, the future role of the donor in the offspring's life, and what information will be disclosed to the offspring. The process of obtaining informed consent from the requesting individuals, the donor, and, possibly, the donor's wife should involve a thorough discussion of potential risks to all parties. Clinicians should assure that the decision to be a sperm donor has been voulntary and free from manipulative and coercive influences. Financial incentives, including direct and indirect payment and inheritance, should not be so substantial that they become inducements that may lead the prospective donor to discount the emotional risk associated with the procedure. Legal counsel should be strongly encouraged to clarify issues of disclosure, rights, and duties, as well as the donor's relationship to the resulting offspring. Any possible changes in these issues in the event of divorce or death of requesting individuals should be addressed. In certain cases, requests should be immediately denied. Gametes from consanguineous relationships should never be used to initiate a pregnancy. Because of potential parental conflicts of interest, programs should not allow minors under the age of 18 years to donate sperm. The use of a family member may not be appropriate when sperm donation is chosen to prevent genetic diseases. Careful genetic counseling should be done before intrafamilial sperm donation is allowed in this situation. If, after careful consideration of the proposed arrangement, the physician chooses to facilitate the relationship, then all precautions should be taken to prevent medical, psychologic, and legal harm to the requesting couple or individual, the potential donor, and the prospective child. Programs that offer these arrangements should make every effort to obtain long-term follow up on the outcomes of these relationships, so that programs can provide more accurate information to families considering these relationships in the future. The physician or program should not feel obligated to agree to every request for intrafamilial sperm donation. When the assessment reveals consistent concerns about coercion of the prospective donor or about unhealthy family dynamics, the physician should feel free to deny these procedures. The physician should advise the requesting couple or individual to seek alternative methods, such as anonymous sperm donation, to conceive.