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 If remuneration of donors were withdrawn, as proposed by the Human Fertilisation and Embryology Authority (HFEA), the capacity to maintain a clinical service would be in doubt.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.