The right to know one’s genetic origins should not be recognised as a moral right because it protects no important interest. The knowledge of one’s genetic origin is neither sufficient nor necessary for the construction of one’s identity. The suffering of some donor-conceived people is based on the misconception that this knowledge is necessary. The empirical evidence generated by psychological research on donor-conceived families has shown convincingly that not knowing that one is donor conceived and knowing about one’s donor conception but not knowing one’s donor does not lead to significant differences in psychological well-being and family functioning. A new argument by some people who favour donor identifiability is that donor anonymity can no longer be guaranteed. Although correct, this fact has no implications for the normative claim about the right to know. If anonymity was agreed between donor and recipients, this agreement should be respected even when, or especially when, it can be broken.

Belgium regulates research on human embryos, including germline modification, mainly through the 2003 Law regarding Research on Embryos In Vitro and the 2007 Law regarding Medically Assisted Reproduction and the Disposition of Embryos and Gametes. It allows the creation of embryos for research when the research goal cannot be reached by research on supernumerary embryos. The lawmaker only recognizes a gradual difference between embryos created for reproduction and later used for research and embryos specifically created for research purposes. The general rule in research is that no research can be performed for eugenic goals, i.e., selection or improvement of non-pathological characteristics of the human species. Everything that is not prohibited by the law is allowed. The conclusion, supported by the parliamentary debate, is that germline genome editing is permitted for corrective purposes (meaning elimination or correction of genetic diseases), if approval of the local ethics committee and the Federal Commission on scientific research on embryos in vitro is obtained.

Introduction

This chapter provides an overview and analysis of the phenomenon of transnational donation, an aspect of donation practices which has grown both in prevalence and significance over the past decade. After defining what we mean by ‘transnational donation’, we interrogate this phenomenon from different perspectives in three different sections. The first section surveys the empirical evidence and available data on transnational donation and cross-border reproductive care (CBRC), first with regard to the movements of patients and second with regard to the movements of gametes across borders. The second section analyses the potential regulatory approaches that may be developed as a response to transnational reproduction, investigating in turn the pros and cons of coerced conformity, international harmonization and moral pluralism. The final section evaluates the three main ‘dangers’ of CBRC – to safety, to autonomy and to justice – and analyses the ethical force, accuracy and strength of each of these arguments.

What is ‘transnational donation’?

Transnational donation is one aspect of the newly emerging, and rapidly developing, phenomenon of CBRC. CBRC refers to movements across national borders to seek or facilitate infertility treatments. Within this broader phenomenon the term ‘transnational donation’ is reserved specifically for the pursuit of treatments involving the use of donor gametes. Although CBRC covers a wide range of assisted reproductive technologies (ARTs) – for example, pre-implantation genetic diagnosis (PGD) – infertility treatments involving donation make up a large subset of the CBRC market. This is because ARTs involving donor gametes are subject to great diversity between jurisdictions with regard both to the level and nature of regulatory control and to the availability of necessary resources (see Chapter 5, Chapter 6, and Chapter 7). It is the prevalence of such diversity, even among countries in close geographical proximity to one another, that drives transnational donation and makes it a very significant aspect of the broader CBRC phenomenon.

This volume offers a survey of the practices of reproductive donation and a discussion of the social and ethical issues that these may raise. Our focus is on collaborative, or third-party reproduction. Here a child is not conceived through sexual intercourse by the parents, but rather the conception is likely to take place in a clinic with others involved in providing the eggs, sperm, embryo or sometimes the uterus in which the fetus grows. Typically in collaborative reproduction, roles are separated, so that these third-party progenitors do not become parents and usually play no part in the lives of the children they help to create. Indeed, it is often the case in collaborative reproduction that the children are unaware of the part that others have played. Within the technologies and practices of assisted reproduction, a child can have up to five progenitors: a social mother, a social father, a biological father (sperm provider), a biological mother (egg provider) and a surrogate (gestational) mother.

There are a number of different reasons why people may turn to collaborative reproduction. It can provide a means of overcoming infertility. So where, for example, a man’s sperm is defective or not produced in sufficient quantity, or a woman no longer has viable eggs because of her age, gametes (egg or sperm) from a third party can provide a substitute. Without such collaborative reproduction, their only other possibility of having a child would be to adopt. The main difference, obviously, is that an adopted child is not a blood relative of either parent.

Introduction

Patients and clinics are constantly searching for donors. The increasing gap between supply and demand in most countries shows beyond doubt that the current systems are unable to attract a sufficient number of donors. The first suggestion for a solution is always the same: let’s pay. However, payment for body material is, at least in Europe, generally rejected on ethical grounds. Several alternative modes of compensation are currently applied. Still, the efforts made by clinics and/or governments to increase the donor pool are fairly limited. In order to curb commercialization, a number of countries do not allow clinics to take their own initiatives to attract donors. This entails that the task lies completely with the government. However, compared to the campaigns for blood and organs, governments show very little interest in organizing widespread awareness campaigns for gamete donation. Moreover, the rare campaigns that are set up are so little advertised that they might as well not be done. Only seldom are special organizations (such as the National Gamete Donation Trust in the UK) set up to alleviate the shortage of gamete donors. The most likely explanation for this reticence is that most governments and responsible institutions are not convinced of the moral status of the procedure and as a consequence do not want to associate themselves with this topic.

The practice of gamete donation is a complex system in which multiple ethical rules, legal restrictions and medical facts intermingle. Things are further complicated by the fact that there are many different types of donors. The different categories are based on dimensions with ethical, social and psychological consequences: gamete type (oocyte and sperm donors), anonymity (known, identifiable and anonymous donors) and remuneration (volunteer, commercial and patient donors) (Purewal and van den Akker, 2009). Given space restrictions, we will focus on the major findings and trends.

If one message jumps out of this book, it is the complexity of reproductive donation. There is a huge variety of cultural, legal and moral rules regarding third-party reproduction. The regulatory systems constantly evolve as the world in which they function evolves. This evolution can be seen in changes as diverse as modifications in value hierarchies (children’s rights versus parental rights), techno-scientific developments (egg banking after vitrification), expansion of the world wide web (donor offspring looking for their donor siblings) and low-cost airlines (reproductive tourism). Moreover, due to globalization and internationalization, systems infect each other across large distances. The abolition of donor anonymity in Sweden was picked up by Australian states and returned to Western Europe. Continually legislators are setting up social experiments by modifying the legislation of assisted reproduction. However, we will only learn from these experiments if we spend time and effort analysing and interpreting them. The wealth of information to be gathered from the different systems worldwide should enable us to better rule our own practice, to better predict what will happen if we alter things and to better reach the moral goals we have set.

The proximate endeavour of this book was to provide a state of the art of the scientific information on donation. The ultimate goal was to use this information to help with the adaptation of the normative systems that currently regulate the practice. Many legislations are not (or not always) based on the scientific evidence. As a consequence, the laws may have unforeseen, unwanted and/or unintended consequences. The introduction of the identification requirement for donors can illustrate this point. Donors who know that they will become identifiable to their donor children are reluctant to accept the current maximum limit on donor offspring. A considerable number of them limit their donation to one or two families. So while a reduction in the number of donors was predicted, the overall effect on the availability of gametes for use in the clinic is greater than predicted.