An Opinion Piece
Open Donation: Its’ Time Has Come!
Elaine R. Gordon, Ph.D.
AFA Mental Health Advisory Council
The tide regarding anonymity in donation practices is turning as reproductive options become more available and known. It is time to reexamine the policies currently in place and question whether they truly serve the families being created. Up until very recently anonymity and secrecy has been encouraged in donation practices. These procedures have been put in place by agencies and medical programs and not by mental health practitioners.
There is a trend starting to emerge that is reconsidering the wisdom of closed donation arrangements. More and more recipients are demanding access to additional information regarding their donors and are also asking for the opportunity to actually meet. Although many agencies and medical practices have been reluctant to change current anonymity policies, they are inadvertently being forced to respond to the demands of a more enlightened patient community wanting the option of a non-anonymous donation arrangement.
HISTORY REPEATS ITSELF…
Many reproductive practitioners and agencies have largely ignored the legacy of adoption. Closed adoptions are now considered a thing of the past. Birthparents and adoptive parents meet and get to know one another. They are afforded the respect to arrive at a mutually satisfying arrangement regarding future contact and adoption plans. Such arrangements provide birthparents with the opportunity to select parents they feel good about, making a very difficult situation somewhat better. It also provides intended parents with a fuller and richer adoptive story to tell their child and the dignity to understand the birthparents plight.
Sperm banking has followed a similar course with secrecy and anonymity being of paramount importance. More recently, we have witnessed a change in sperm banking policies due to client demand. Recipients are no longer satisfied with a computer generated profile describing the attributes of the donor. Sperm banks are competing to offer more information about their donors, which include photos, audiotapes, and open- identity options for when the offspring come of age.
Egg donation, the newest reproductive option on the block, has more or less followed in the wake of anonymity policies being considered the best option. Very few programs grant non-anonymous donation options where donor and recipients actually meet in person. The more prevalent scenario is anonymity whereby intended parents are led to believe that there is no other option. Yes, a profile is provided as well as pictures offered by some agencies and donor egg programs. There are even some programs that have videotapes of donors available. However, many of these programs are reluctant to offer an open donation arrangement option.
Too many working in the field of reproductive medicine have created policies that may very well undermine what the psychological community believes to be in the best interest of the child. Many of these policies are, perhaps, not as well thought out as we might have hoped. Such programs continue to respond to the fear and shame they sense their patients carry and honestly believe they are protecting not only the intended parents but also the children created through donation. Instead of educating these patients and giving them options to truly examine what makes healthy psychological sense, they have been somehow convinced into believing that anonymity is best for all involved.
When reviewing the research to date on the ‘best interest of child’, one cannot assume or support secrecy and anonymity as the wisest choice. There is a fair amount of evidence suggesting that it undermines the integrity of the family when relevant information is being held back whether this is done inadvertently or deliberately. It encourages parents to hide from their reproductive truths, which can harm relationships among family members.
Despite the fact that many parents are coming to understand that disclosing a child’s reproductive beginnings is healthy, they are caught off guard when their children ask questions about what the donor is like. Parents can’t ‘really’ say because they were not offered the opportunity to actually meet their gamete provider. How can you “know” a donor or have a gut sense of that individual if you have not actually met that person? To take it a bit further, who is the best person to select one’s donor? It is the recipient. To choose a donor based on a few pictures and a profile is selling intended parents short.
PRO AND CON ARGUMENTS…
Although there has been a shift toward more openness in donor arrangements, it remains the less offered option. Many agencies and medical offices discourage open arrangements and you have to wonder why. Is it because it is more work, that they truly believe open arrangements are not in the best interests of either the donor or intended parents, or are they responding to the fear and shame of the recipients? Whatever the reason, more and more recipients are making inquiries about open arrangements only to be discouraged or told “no” in very polite terms.
Recipients have been historically advised that in anonymous donation:
•The child will fare better.
•Confusion will be minimized.
•The family’s legitimacy would not be challenged.
•The parents would have a sense of entitlement as the authentic parent.
•The donor would intrude into the family’s life.
•The donor threatens to lay claim to the child at a later date.
•It is easier to deny the “gift’.
•The parents would not see their child as theirs due to being haunted by the image of the donor.
None of these concerns have been substantiated and only feed into a recipient's vulnerability and feelings of inadequacy. In fact, open donation has many advantages, which although not empirically validated offers another perspective on openness in gamete donation.
Open arrangements offer the opportunity to:
•Face one’s fears regarding non-genetic parenting.
•Develop a richer birth story to the offspring.
•Take responsibility in selecting the ‘right fit’ donor.
•Know donor on a more intimate level than what one gets from a profile.
•Have a greater sense of your donor as a known entity.
•Share mutual responsibility in the donation arrangement.
•Demystify the donation experience.
•Humanize the donation experience.
•Minimize the “fantasy” gamete provider.
APPLES TO APPLES OR IS IT ORANGES?
Too often we confuse the facts of adoption with those of gamete donation. Although, there are many similarities there is one major difference, which will ultimately impact a child’s sense of loss. This distinction has to do with intent. The intention of a birthmother is vastly different that than of a gamete donor. Birthmothers do not deliberately get pregnant in order to place a child. The pregnancy is usually the result of a mistake, a miscalculation, or a lapse of one kind or another. The birthparents are placed in the position to reconcile by taking an emotionally wrenching situation and make it less so by finding a good home for the child they are carrying. With adoption the predominant psychological issue is the concept of loss… loss for the birthparent and loss for the adoptee.
In donation, the circumstances regarding intent are quite different. Donation does not have anything to do with a mistake or lapse. A donor’s intent from the start is to help someone else have a child. They are not losing anything but offering their gametes to another. There is nothing to grieve on the part of the donor and there is no shame involved. Therefore, the story a gamete recipient recounts is much different than the one an adoptive parent shares. It is a happier story to tell.
COMING TO TERMS…
Whichever side of the fence you stand on regarding open arrangements, one thing we know is that want-to-be parents are not given the opportunity to make their own decision regarding which option is best for them. There is no universal vehicle for counseling and educating. The current focus on anonymity creates a subtle coercive component. If anything, many recipients are given a gentle take it or leave it attitude regarding the donation option offered with no recourse nor discourse.
Non-anonymous donation is a forthright and honest approach to standing up to the disappointment of the loss of fertility and embracing another option with dignity and integrity. This does not mean open arrangements are easy. They require one to embrace an alternative means of having a child with one’s eyes wide open and not from a place of denial. Consider this as a possibly rewarding endeavor, one that is, in fact, in the best interest of the entire family. Children may derive a sense of security and comfort when they know their parents met and selected their donor. They are relieved to know that the donor met and choose their parents as well. It supports the notion that the reproductive decision was collaborative where all parties were in accord and informed.
The tide is changing as more opportunities for open arrangements are becoming available. However, it is slow moving as was the concept of disclosure prevailing over secrecy. It was only when the negative fallout from these family secrets became evident did the psychological community rethink the impact secrets have on families and their children. We now see that open adoptions are heralded to be in the best interests of the adoptees. Hopefully, will not be long before gamete donation programs see will see the importance to the offspring created of having more information available to them regarding their donor and move toward offering the option of a non-anonymous arrangement. Although open donations are growing in popularity, they are not yet at the forefront of the reproductive options made available to want-to-be parents.
