14 January 2013
ByAppeared in BioNews 688
The image of the sperm donor nipping off between lectures to donate casually for a few quid's worth of beer money was neatly set aside by a thought-provoking debate that took place in London on 12 December 2012. In his place, in strode the complex male - knowledgeable, thoughtful, sensitive, and probably over 25. 'Giving: The Gamete Donor Perspective' - the first of three debates on gamete donation organised by the Progress Educational Trust as part of its 'When It Takes More Than Two' project, which is supported by the Wellcome Trust - explored the motivations behind gamete donation, and revealed a deeply personal side to the story of gamete donors. The event was chaired by Rosamund Scott, professor of medical law and ethics at King's College London.
While the removal of donor anonymity was heralded as a landmark reform, fears of a drastic reduction in donor numbers do not seem to have been justified. Rather than deterring potential donors, the removal of anonymity may have in fact reinforced an aspect to donation that has been paid relatively little attention in the debates around the 'right to know' - the emotional investment of the donor.
The first speaker, Kriss Fearon of the National Gamete Donation Trust and an egg donor herself, highlighted the complex social aspect of gamete donation and the vast range of personal motivations involved. There is, unsurprisingly, not a typical donor. Some people donate to help their own friends and children, whereas others may feel sentimental about certain physical and family characteristics and want these to be passed on to future generations. Most donors talk to friends and family before donating, rather than keeping it a secret. Some men even refrain from donating at their partner's request.
Fearon's presentation highlighted the fact that donors are not merely statistics, depositors of gametes, facilitators of fertility arrangements, or political targets - they are ordinary people who want to help someone out. She conceded that while egg donors are widely thought to be 'okay', sperm donors are still considered by some to be 'a bit creepy'. Egg donors may receive chocolates, but many sperm donors don't even receive a thank you card. However, sperm and egg donors alike are often motivated by and interested in the welfare of others.
Next, Venessa Smith, a donor coordinator at the London Women's Clinic (LWC) and the London Sperm Bank, reinforced the idea of showing appreciation to gamete donors - and not just for their assets. A key aspect of the LWC approach is to make donors feel appreciated, and its strategies include organising social events to give donors the opportunity to share their experiences with one another.
This reinforced Fearon's characterisation of the social sperm donor as an ordinary person, performing a special task with reciprocal commitment and consideration. The message that donation is meaningful is one that clinics could do more to promote. Smith argued that it is important to provide donors with the right amount of information before they donate, so that they themselves are certain about why they are there and what they hope to achieve.
A focus on the donors also raises patient satisfaction, noted Smith - patients want to feel that donors are well informed and doing it for the right reasons. The relationship between the patient and the donor was also a theme that emerged from the third presentation by Erika Tranfield, cofounder of donor matching website Pride Angel.
Tranfield highlighted the advantages to patients of using a known sperm donor. It gave them more of an idea about the donor's personality and characteristics - not so much in relation to genetic inheritance, as in relation to the more elusive concept of choosing the right donor. Compatibility, it seems, is important.
Choice was a theme that followed in the next presentation by Dr Lucy Frith, senior lecturer in Bioethics and Social Science Healthcare Ethics at the University of Liverpool, who discussed conditional gamete donation. Current UK law allows conditional donation via the specifying of conditions in the consent form, but this raises difficult questions. Dr Frith asked, for example, whether people are more likely to place conditions upon the use of their gametes under a non-anonymous system.
Finally, Dr Allan Pacey, senior lecturer in andrology at the University of Sheffield, provided a historical view of donor screening from the first medical sperm donation in 1884 (which said little about donor screening), to the HIV fears of the early 1980s and the first national screening programmes in the late 1980s. From a medical perspective, sperm carries health risks, which add to the array of considerations in the donation process. Awareness is key across the board, it seems.
Two themes in particular emerged from the lively discussion that followed, deftly handled by Professor Scott. On being questioned about the importance of money as a motivational factor, although Fearon had earlier indicated the payment of expenses was of significant importance to donors, Smith said that on the whole payments of reasonable expenses seem to make no difference to sperm donations. Dr Pacey confirmed that in his view, more than half of sperm donors are not motivated by money, and refuse it when offered.
The second theme picked up by the audience was whether there had been a perceived change in the nature of donations following the removal of anonymity. Smith responded that the main difference was that people coming forward were older and more informed. This is an interesting cultural shift brought about by a change in law, which - as the presentation on conditional donation revealed - deserves more attention and research.
Sperm and egg donors may not receive much of the limelight, in an area where debate centres largely upon the donor-conceived and patients. But if not for donors coming forward, much of the good that happens in fertility clinics would simply not be possible.