Non-directed postmortem sperm donation: how practicable?

Hodson and Parker claim that their approach ‘offers a potential means of increasing the quantity and heterogeneity of donor sperm’. The increase in quantity, they argue, would help to alleviate the suffering to infertile individuals or couples by significantly increasing the likelihood of having a child, while the increase in heterogeneity would make it easier to accommodate the ‘deep desires’ that intended parents have for a child (eg, physical characteristics that would help the child to fit into the family). In addition, the fact that sperm would be taken postmortem means that being a deceased donor is far less complicated than being a live donor (no visits to clinics, etc), thus removing a significant obstacle to registration as a donor. Hodson and Parker conclude that in the absence of strong countervailing arguments, there is a strong ethical case for allowing non-directed postmortem sperm donation.

But there are a number of practical problems that cast doubt on the central empirical claim underlying Hodson and Parker’s argument:

(N) Allowing (voluntary) non-directed postmortem sperm donation offers a potential means of significantly increasing the quantity and heterogeneity of donor sperm, thereby significantly increasing the likelihood of the birth of children whose characteristics conform to the “deep desires” of their new parents.

Because (N) is an empirical proposition, one needs to look at the realities of postmortem sperm retrieval and sperm donations based on such retrieval to assess it for plausibility. We are more familiar with conditions in Australasia, so that’s what our comments will be based on—other countries may be better resourced in relevant ways, although all are likely to have some of the same structural problems (we exclude countries where sperm donors are paid).

 Consider, to begin with, the situation of live donors. Assessment of a live donor requires health checks where genetic conditions and infectious diseases are excluded and past reproductive performance is evaluated. Men with a poor semen sample may well not be included in the donor pool. Things are trickier with a deceased donor. Evaluating the man’s history of prior reproductive performance does take into account the level of the sperm’s possible deterioration. (Sperm deteriorates depending on the length of time following death and the conditions in which the body was kept.) Additionally, the process that has led to the man’s death may well have meant the man was unwell prior to death, and in the face of significant illness, sperm production often slows and sperm quality may be affected. So grading the sperm is crucial in the case of sperm retrieved postmortem.

Unfortunately, the reliability of such an assessment depends crucially on the method of extraction. For example, sperm retrieved from the testis—the easiest and most direct method of extraction—often has not yet developed the capacity to swim, which makes grading difficult. In fact, Hodson and Parker do not even mention this method. The only methods they mention are electroejaculation and the surgical technique of an incision in the scrotum allowing aspiration of sperm from the vas deferens. But these methods have their own problems. First of all, vibroejaculation is a very rare technique occasionally used for retrieving sperm from a ‘brain dead’ patient on life support. Sperm retrieved this way would have the capacity to swim, but it would be very uncommon for a unit to have the right equipment and staff trained in vibroejaculation. Similarly, aspiration of sperm from the vas deferens or epididymis may result in sperm with very good motility, but this is not a commonly performed procedure in IVF units. For Hodson and Parker’s policy to work as intended, it would at the very least require increased training in this method, and not just increased training in certain specialised clinics but anywhere in the country where there might be deceased men who have signed on as sperm donors.

As things stand, the vast majority of sperm retrieved from patients after their death (in Australasia at least) is likely to be by either testicular sperm aspiration, open testicular biopsy or en bloc resection of the whole testis. Such sperm will sometimes be poor and sometimes good, but, overall, sperm retrieved this way is not as easy to grade (or as plentiful) as ejaculated sperm. In particular, it is not subject to an objective grading measure such as that used for semen analysis. While there is reason to think that standardisation of this technique, in particular the version focusing on whole testes, would lead to good outcomes,2 it is important to note that the procedure is currently uncommon and so difficult to standardise. As things stand, it is hard enough for a petitioning partner to find an IVF unit that is willing to collect sperm, let alone choose the level of experience of the person doing the procedure. (The average fertility specialist will have never removed someone’s testes in the past.)

All this casts doubt on the first part of (N). Such uncertainty about the quality of donor sperm gives rise to two sources of doubt about the second part of (N), the inference from a significant increase in the quantity and heterogeneity of donor sperm to a significantly greater likelihood of children being born this way. First, if quality is indeed compromised that will affect the likelihood of successful conception from the use of the sperm (as it is, the chances of conception from reliably graded donor sperm are not high). Second, any woman choosing such sperm would have to be made aware of all the variables around the collection of the sperm. Women put considerable time, emotional energy and money into procuring sperm, and being unable to give them any reassurance about the quality of the sperm is likely to make them reluctant to use it—especially if we allow for the added cost that might be involved. (The procedure required to collect the sperm usually requires a skilled operator such as a urologist or fertility specialist, as well as considerable laboratory time for processing and freezing. The cost of each collection in relation to the number of babies which could be conceived is likely to be considerable.)

Concluding thoughts

Of course, things could improve markedly. Maybe a policy change in favour of non-directed postmortem sperm donation would lead to a substantial number of men registering as potential donors, as well as an upskilling of staff involved in sperm retrieval, resulting in improved quality of retrieved sperm and greater confidence on the part of potential recipients. But such an outcome is uncertain, and in any case would take time and be costly (it is hard to see such a policy change becoming a funding priority in the foreseeable future, giving the COVID-19 crisis). Our doubts on this score are reinforced by some of the broadly ethical concerns that have been expressed about such a policy. Thus, consider the status of having a biological father who was deceased at the point of becoming a father. It is surely unclear how this status might affect the child, especially compared with children born from live sperm donors who may be able to make contact with their biological father. It is also unclear how many next of kin, armed with the power of veto over the deceased man’s wish to be a donor, would accede to this wish if it precludes their having any links to the child. Hodson and Parker are optimistic, but until there is more certainty around such issues it is doubtful that authorities will give their imprimatur to such a policy change or invest in the changes needed to make it work.