A welcome step forward: on the recommendations regarding fertility and birth in Israel

Two weeks ago, the Israeli Ministry of Health (MOH) published recommendations regarding fertility and birth and its legislation (1).

I applaud this attempt to review and improve upon existing laws and MOH regulations (some of which are not consistent with international commitments) and to codify them. In particular, I welcome the attention brought to much-neglected issues, including the right of people conceived as a result of donated gametes to information regarding their donor. Other areas examined include surrogacy by gay men and posthumous reproduction (reported in BioNews 659).

At the same time, I wish the convention of the Public Committee had received greater publicity, and that they had reached out to those most affected by this: the donor conceived; their families; and donors. Not everyone trawled through the MOH website during the short timeframe provided for submissions to the Public Committee, certainly not the majority of those most affected.

I chanced upon the MOH website notice a few days beyond the deadline, and immediately submitted an application, having previously submitted a lengthy position paper (2) which, however, I suspect was never read by the folks at MOH, or if so, shelved. It certainly does not appear in the bibliography of the MOH report, nor do any of the 77 references cited (with the exception of actual laws referred to within the report).

Rather, the circumscribed MOH reference section deals predominantly with issues of surrogacy, including articles by some of the very people who have, as it happens, also researched donor families.

That said, I would like to congratulate the MOH Public Committee for recommending a 'dual track' of sperm donation. This makes it possible for Israeli men to become willing known donors, for mothers to choose such a donor for their children, and for donor conceived people to trace their ancestry should they so desire.

If accepted by the Knesset's Committee for Labor, Welfare and Health, this will be an important milestone in the cessation of discrimination in Israel against the donor conceived. Hopefully additional steps will follow, now that twenty years later, we are back to the original 'interim' recommendations of the Aloni Committee, which were subsequently withdrawn (3, 4). One such step concerns the right of people conceived as a result of egg donation to information about their donor.

Moreover, it is my deep conviction this dual track should be augmented by the setting up of a mechanism whereby anonymous donors can voluntarily provide information about themselves to their curious offspring, such as exists in the UK for donations that took place before the abolishment of anonymity (2, 5).

Meanwhile, Israeli donors and recipients should be informed of recent research findings of offspring needs, and encouraged to register voluntarily with the US-based, worldwide Donor Sibling Registry (DSR), which offers a welcome page in Hebrew (6). The modest fee required for those registering with the search engine is a small price to pay for the donor's chance to bring some peace of mind to his or her offspring, and to alleviate some of their own curiosity.

This leads to the need for unique but non-identifying donor codes in Israel, such as exist in the US (2, 5). When both parties are armed with a code, posting on the voluntary register becomes that much easier. To date, the DSR has led to over 9,000 matches. So many thousands of people are now able to contact their donor families and assuage the omnipresent existential questions they lived with regarding their identity and biological roots.

The DSR provides a medical page where both donor and donor family can share important medical information. Research has shown how meaningful this can be to all concerned: offspring, parents, and yes, donors (5).

Posting on the DSR makes it possible for basic attachment and interpersonal needs to be met. This deep longing for a connection with one's donor family, when mutually sought, can also facilitate the circumvention of accidental incest (and associated genetic mishaps), especially in a country the size of a postage stamp.

People conceived as a result of assisted reproduction, whose right to information regarding their biological parent/donor was bartered away by others in the interest of anonymised procreation (see 7-9 in this regard) need not suffer a second blow. In my estimation, the current practice of deliberately avoiding issuing such donor codes (once briefly provided by some sperm banks) so as to prevent contact among half-siblings is unnecessarily cruel and deeply unethical. Donor conceived people have every right to search for each other.

To the best of my knowledge, the Public Committee discussed none of this, but it is perhaps not too late to take this into account.

Lastly, further consideration and elaboration of the emotional welfare of children born as a result of surrogacy agreements or posthumous reproduction and of their basic rights, would be most welcome (for example, see 10-11).