Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Universiteitsweg 100, GA Utrecht, The Netherlands.
Department of Reproductive Medicine and Gynaecology, University Medical Center Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands.
Hum Reprod Update. 2018 Sep 1;24(5):615-635. doi: 10.1093/humupd/dmy016.
The demand for donor oocytes has increased dramatically over the years. Today people in need of ART with the use of donor oocytes can appeal to commercial or public donor oocyte banks. The introduction of oocyte banks has shed a new light on the practice of ART using donor oocytes. The establishment and maintenance of oocyte banks should be sensitive to the ethical considerations. However, it is currently unclear which ethical aspects have to be taken into account.
The aim of this article is to identify the ethical aspects of establishing and maintaining oocyte banks for third-party ART.
A systematic search was performed in July 2016 and February 2017 in both PubMed and Embase using a search string that combined synonyms for oocytes, donation or banking, reproductive care and ethics. We included a wide variety of English-language articles with a reasoned description of ethical aspects or moral considerations on oocyte donation or banking for third-party ART.
The practice of oocyte banking consists of three components, namely, the intake, storage and distribution of donor oocytes, and each is associated with multiple ethical challenges. The majority of the literature discusses ethical aspects with regard to the intake of donor oocytes, taking into account both the interests of the donor and those of the potential child. Ethical aspects related to the donor are the risks and psychosocial impact of donation, motivations and compensation in donor recruitment, and requirements for informed consent. Ethical aspects related to the potential child are 2-fold: first, the welfare standard and the selection of donors, and second, anonymity and disclosure. Ethical aspects of storing donor oocytes for ART are quality standards, confidentiality, issues of ownership and control, and international transport of donor oocytes. Ethical aspects of the distribution of donor oocytes concern the selection of recipients and the acceptability of treatment of 'non-traditional' families in particular, prioritization of recipients in case of scarcity, cross-border reproductive care, matching of recipients and donor oocytes, informed consent and counselling for recipients.
Our review demonstrates that multiple ethical aspects have to be taken into account when establishing and maintaining an oocyte bank. Yet, for many of these aspects there is no consensus regarding what approach should be employed. Remarkably, the existing literature focuses mainly on ethical aspects related to the intake of donor oocytes, while aspects related to storage and distribution of donor oocytes are less often addressed. An important gap in the existing literature should therefore be acknowledged. To conclude, our findings can serve as a starting point for clinicians in the field of ART, to conceptualize what challenges arise when establishing and maintaining oocyte banks for third-party ART. The review may also stimulate policy makers to set up a trustworthy and adaptive governance structure for the intake, storage and distribution of donor oocytes.
近年来，人们对供体卵子的需求急剧增加。如今，需要使用供体卵子进行辅助生殖技术（ART）的人可以向商业或公共供体卵子库寻求帮助。卵子库的建立为使用供体卵子的 ART 实践带来了新的曙光。卵子库的建立和维护应该对伦理问题敏感。然而，目前尚不清楚需要考虑哪些伦理方面。
本文的目的是确定建立和维护第三方 ART 用供体卵子库的伦理方面。
2016 年 7 月和 2017 年 2 月，我们在 PubMed 和 Embase 中使用了一个搜索字符串，该搜索字符串结合了卵母细胞、捐赠或储存、生殖护理和伦理的同义词，对两者进行了系统搜索。我们纳入了各种用英语撰写的文章，这些文章对第三方 ART 用供体卵子捐赠或储存的伦理方面进行了合理的描述，或提出了道德考虑。
卵子库的实践由三个部分组成，即供体卵母细胞的摄入、储存和分配，每个部分都与多个伦理挑战相关。大多数文献讨论了与供体卵母细胞摄入相关的伦理方面，既考虑了供体的利益，也考虑了潜在儿童的利益。与供体相关的伦理方面包括捐赠的风险和心理社会影响、招募供体时的动机和补偿，以及知情同意的要求。与潜在儿童相关的伦理方面有两个方面：一方面是福利标准和供体选择，另一方面是匿名和披露。ART 中储存供体卵母细胞的伦理方面涉及质量标准、保密性、所有权和控制权问题，以及供体卵母细胞的国际运输。供体卵母细胞分配的伦理方面涉及受者的选择以及特别是对“非传统”家庭治疗的可接受性、稀缺情况下受者的优先顺序、跨境生殖护理、受者和供体卵母细胞的匹配、受者的知情同意和咨询。
我们的综述表明，在建立和维护卵子库时，需要考虑多个伦理方面。然而，对于其中的许多方面，对于应该采用什么方法，还没有达成共识。值得注意的是，现有的文献主要集中在与供体卵母细胞摄入相关的伦理方面，而与供体卵母细胞储存和分配相关的方面则较少涉及。因此，应该承认现有的文献存在一个重要的空白。总之，我们的研究结果可以为 ART 领域的临床医生提供一个起点，让他们了解在为第三方 ART 建立和维护卵子库时会出现哪些挑战。该综述也可能促使政策制定者为供体卵母细胞的摄入、储存和分配建立一个值得信赖和适应性强的治理结构。
