Ethical challenges in reproductive donation tourism: a qualitative study of clinicians' perspectives in Iran

Reproductive donation tourism is a complex phenomenon with profound ethical implications which also affects Iran. However, studies in this context are limited. This study explores the ethical challenges associated with donor-based reproductive tourism from the perspective of Iranian clinicians, focusing on how they interpret these challenges within Iran's legal, religious, and institutional context.

A conventional content analysis study was used to explore the ethical concerns in donation-related reproductive tourism perceived by clinicians in Iran. Twenty-two experts who were actively involved in the field of infertility treatment, were recruited purposefully from ART centers in Tehran and the Ministry of Health of Iran in 2025. Data collection was done through in-depth, semi-structured interviews. Analysis was carried out by MAXQDA.24 software and the Graneheim and Lundman approach. A conceptual model was also proposed to explain the interaction of challenges involved in this phenomenon.

Data analysis resulted in four themes: (1) Legal and structural heterogeneity of countries; (2) Clinical uncertainty and physical and genetic concerns in reproductive donation; (3) Synergistic moral, psychological, identity, social, and cultural-religious implications and secrecy in reproductive donation; (4) Justice, commodification, exploitation and demand in fertility tourism. These challenges can raise concerns related to justice, exploitation, commodification, and the rights of donor-conceived children.

This treatment method in Iran is surrounded by multidimensional and interwoven concerns that mutually reinforce each other. These findings indicate that reproductive donation tourism is not merely a legal and clinical issue but one that raises significant ethical concerns, requiring careful consideration of fundamental principles of medical ethics in both national and international policy-making. Therefore, developing and sharing integrated international legal and ethical frameworks to support ethically responsible and regulated reproductive care, is essential.