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'Just' giving: PET's evening debate on gamete donation from the donor perspective

14 January 2013
Appeared 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.

17 June 2014 - by Kate Brian 
Produced by the National Gamete Donation Trust, 'Letters to my donor' is a collection of letters from parents who have undergone or who are undergoing IVF using donor sperm or eggs to their gamete donor...
18 March 2013 - by Sarah Norcross 
Over the past few months, the charity that publishes BioNews - the Progress Educational Trust (PET) - has been running a Wellcome Trust supported project about donor conception entitled 'When It Takes More Than Two'....
4 March 2013 - by Cait McDonagh 
Another full house for the final event of Progress Educational Trust's 'When it Takes More Than Two' series. This time attendees were invited to consider gamete donation from the perspective of the donor conceived...
11 February 2013 - by Richard Adams 
Re G (A Minor); Re Z (A Minor) 2013 (1) is a landmark High Court ruling in which, in the first known decision of its kind, two male sperm donors, known to the mothers, were granted permission to apply for contact with the children...
28 January 2013 - by Cait McDonagh 
The second debate in the Progress Educational Trust's project 'When It Takes More Than Two' took place at University College London last week. The debate, 'Receiving: The Recipient Parent Perspective', focused on the views of those who have received donor gametes to begin their families....
26 November 2012 - by Sarah Norcross 
Gamete donation is big business at the Fertility Show. Why do clinics from far and wide pay thousands of pounds to exhibit in London? The simple answer is to make money. But why come to the UK? Because in the UK there is a shortage of gamete donors, or at least a perceived shortage, that's why...
27 February 2012 - by Dr Marilyn Crawshaw and Walter Merricks 
It is now eight years since the HFEA first issued guidance to UK licensed treatment centres to respond as fully as possible to patients' requests for non-identifying donor information...
17 October 2011 - by Antony Starza-Allen 
A report on the donation of human bodily material for medicine and research has made several recommendations including removing the current cap on egg and sperm donor expenses in the UK...
30 September 2011 - by Dr Kamal Ahuja 
The Human Fertilisation and Embryology Authority (HFEA) has already made two decisions following its public consultation and review of gamete donation policies in the UK: first, intra-familial gamete donation can continue as before (subject to certain provisions); and second, the number of families which a single donor might help create remains limited to ten. The bigger question on compensation and benefit in kind to donors will not be answered until later this year...
12 April 2010 - by London Bridge Fertility, Gynaecology and Genetics Centre 
The regulations governing the reimbursement of donors and the withdrawal of donor anonymity in the UK have combined to ensure that there are insufficient egg donors to meet requirements...
Donors marginalised? Not so much ( - 15/01/2013)
It's interesting that you say "Sperm and egg donors may not receive much of the limelight, in an area where debate centres largely upon the donor-conceived and patients". As a donor-conceived adult it seems to me that very few people in the fertility world have any interest in the needs or wishes of donor-conceived people. There are so much evidence of this I could point to, the reduction in Department of Health funding for the voluntary contact register following donor conception pre-1991 (currently run by UK Donor Link, soon to be subsumed into the National Gamete Donation Service) being just one example. I do not know who my donor is because his right to anonymity is deemed more important than my right to an identity, even though that right is underpinned by Article 8 of the United Nations Convention on the Rights of the Child. That makes clear my place in the pecking order.
They're concerned about the welfare of others? ( - 17/02/2013)
The article above states that sperm and egg donors are alike in that they are "often motivated by and interested in the welfare of others."

I challenge this assertion.  Exactly whose welfare are donors concerned with?  

Are they concerned with the welfare of a sterile man or an infertile female?  If I donate a lung, it functions to help the recipient's body breath, not mine.  If I donate a gamete, it functions to reproduce my body, not the recipients.  A donated gamete continues to support the reproductive function of the donor's body.  A donated gamete results in the birth of the donor's offspring not the recipient's.  

Are egg donors concerned about the welfare of perfectly potent males they are reproducing with?  Are sperm donors concerned about the welfare of the perfectly fertile females that they reproduce with?  Are they concerned about those perfectly potent males and fertile females when they are themselves donors as well (double donation)?  Why is their welfare compromised if they are just as healthy as the donor and can reproduce?

Are donors concerned about the welfare of children in general?  What method would a donor use if they were tasked with finding someone to raise a newly born abandoned infant?  Would they assume that anyone willing to pay a fee would be a good parent because they want a baby so badly?  I bet not one donor would use the fee based criteria used by fertility clinics to select a person to raise a stranger's offspring.  But willingness to pay seems adequate criteria for assigning people to raise their own offspring.  I bet they'd want to follow up on the people raising the stranger's offspring since they were responsible for placing the child in their care - make sure the child was OK.  But in gamete donation that chance is lost.  They make people and ignore their responsibility to make sure that they are OK and well cared for.  They abandon their authority to do something about it if the child is not well cared for.  They allow themselves to become powerless to help their own children if need be.  

I discussed all that with Kris once on Olivia's blog and she said that the donor just has to trust that someone who wants a child that badly would be a good parent and my response was that no she did not just have to trust that someone would take good care of her offspring.  She could have chosen not to create offspring if she was not going to take care of them herself.  She was not forced to make a baby and then hand her or him off to chance.  

They would not trust their car to a stranger for a day just because they wanted to know what it was like to drive a car, but they'd give their offspring to a stranger to raise just because they wanted to know what it was like to have a child.

From the agreements they sign it is clear they are giving up custody and parental title over their offspring not their gametes.  The question is whose welfare is bettered by them not taking care of the children they put on this earth?
Yes, concerned ( - 16/07/2013)
I did make it plain to you that my choice was an active choice that I'd thought about and I accept responsibility for it.

At the same time, in a system which is anonymous at the point of treatment, where clinics are the ones doing the welfare check in parents, the donor has the option to trust that this is adequate and that parents are acting in good faith, or not do it. Or become a known donor, which you don't agree with either!
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