Should a dying man be allowed to let doctors harvest his sperm for possible use by strangers after death? Yes, say two medical ethicists in the United Kingdom.
Writing in an article published Jan. 20 in the Journal of Medical Ethics, Drs. Nathan Hodson and Joshua Parker said that such donations would be akin to the organ donor process.
"If it is morally acceptable that individuals can donate their tissues to relieve the suffering of others in 'life-enhancing transplants' for diseases, we see no reason this cannot be extended to other forms of suffering like infertility, which may or may not also be considered a disease," the team wrote.
Hodson is an ethicist at the University of Leicester, while Parker is at the Wythenshawe Hospital in Manchester, England.
The authors pointed to the situation for infertile couples in Britain, where demand for donor sperm currently outstrips supply. Giving men the option of adding sperm to the list of bodily items to be harvested and donated after death could help ease that problem, Hodson and Parker said in a journal news release.
Sperm can be collected after death either through electrical stimulation of the prostate gland or surgery, and then frozen until required, the ethicists said. Concerns about the possible transmission of "unhealthy" genes can be eased by doing health checks on both the donor and the sperm.
Dr. Nicole Noyes is chief of reproductive endocrinology and infertility at Northwell Health in Manhasset, N.Y. Reading over the new article, she said that posthumous use of donated sperm is something fertility specialists deal with in their practice.
"I have previously created children using gametes [reproductive cells] -- both sperm and eggs -- posthumously, meaning the person was deceased at the time the child was conceived and born," she said. "The person providing the gamete had consented to such, prior to becoming incapacitated with, for example, a terminal cancer or serious metabolic disease."
In her mind, as long as there is informed consent from the donor, and the sperm is considered free of communicable disease, "it would seem reasonable to allow that person to donate sperm with the intent to create a person," Noyes said.
Besides helping infertile couples create a baby, "it would certainly also provide a means for a dying person to feel his own self 'living on' or alternatively for passing his attributes on, particularly if lacking any genetically linked offspring of his own," Noyes said.
According to Hodson and Parker, evidence suggests that sperm collected after death can result in pregnancies and healthy children, even when retrieved 48 hours after death.
Noyes added that, once collected, frozen sperm has a long shelf-life. But ethical questions could emerge over time.
"One question that comes to mind is, what if no one wants the particular sperm -- how long should it be stored?" Noyes said. "Another question might be -- should there be a maximum duration on the storage on all samples or is crossing multiple generations fine? Once frozen, sperm is good 'forever' -- if not for decades, or even centuries."
And of course there is the issue of the donor's surviving family, she said.
Just as is the case for solid organs, families could still have the right to refuse sperm donation after death, the British team said, and expectations about the status of a child born from the use of such sperm would have to be clarified before donation.
"The important point is that considerations of the family, including a romantic partner surviving the deceased man, do not justify a blanket ban on the use of sperm collected after death, especially if the donor has specified a desire to donate," Hodson and Parker wrote.
But Noyes noted that rapid advances in technology are complicating matters.
"Traditionally, sperm donation has mostly been an anonymous process," she said, so children conceived with donor sperm had a tough time finding out who their biological father was. But with the advent of genetic-testing platforms, such as 23andMe and AncestryDNA, "anonymity can no longer be guaranteed," Noyes said.
And once a child conceived via donated sperm reaches the age of majority, she added, would he or she have any say in whether their father's sperm could be used to create half-siblings?
All of this means that the ethical landscape around sperm donation continues to evolve, Noyes said. "I am curious to watch this new chapter unfold and see how it will impact the people and the process of adoption and gamete donation," she said.
The U.S. National Institute of Child Health and Human Development has more on male infertility.