Gamete retrieval in terminal conditions

There has been a growing interest and requests by patients facing intensive chemotherapy or surgically ablative procedures for gamete retrieval and pr eservation for future procreative efforts. There are technical difficulties in this area but little ethical discomfort. More troubling are the issues that arise with a terminally ill, incapable patient-one who is in a persist ent vegetative state or who is declared brain dead or who is neurologically devastated with no hope for recovery, but not yet in either of the above s tates-or with a person who has suddenly died. In these cases, the surviving spouse, partner, or family members may request gamete retrieval for future reproductive efforts. Discussion of this topic within the Ethics Consultation Service at the Univ ersity of Virginia demonstrated a need for development of insight derived f rom facts and ethical deliberation to help formulate a policy that would ap ply to such cases. A group was assembled with the expertise to explore the issue and to help f ormulate a policy that could be suggested for adoption by the hospital admi nistration. The group consisted of a urologist with experience in sperm ret rieval from terminally ill patients; the director of the laboratory support ing the assisted reproductive facility in the Department of Obstetrics and Gynecology; the chairperson of the Ethics Consultation Service (who is also a neonatologist); and 2 members of the Ethics Consultation Service, one a genetic counselor and the other an obstetrician-gynecologist with a master' s degree in biomedical ethics. Current literature was reviewed, the expertise of the urological member and the reproductive laboratory director was explored, and the insight of the members of the Ethics Consultation Service was added. We explored the techn ical aspects of both male and female gamete retrieval and preservation and the reproductive potential of these stored gametes. We present a review of the current literature on both the technical and ethical aspects of the top ic. Finally, we present a policy that we deem acceptable for adoption and t hat should be of value to other practitioners and facilities as they contem plate facing requests for gamete retrieval.