Posthumous sperm retrieval (PSR) is a procedure in which spermatozoa are collected from the

testes A testicle or testis (plural testes) is the male reproductive gland or gonad in all bilaterians, including humans. It is homologous to the female ovary. The functions of the testes are to produce both sperm and androgens, primarily testost ...

of a human corpse after

brain death Brain death is the permanent, irreversible, and complete loss of brain function which may include cessation of involuntary activity necessary to sustain life. It differs from persistent vegetative state, in which the person is alive and some au ...

. There has been significant debate over the ethics and legality of the procedure, and on the

legal rights Some philosophers distinguish two types of rights, natural rights and legal rights. * Natural rights are those that are not dependent on the laws or customs of any particular culture or government, and so are ''universal'', ''fundamental'' and ...

of the child and surviving parent if the

gamete A gamete (; , ultimately ) is a haploid cell that fuses with another haploid cell during fertilization in organisms that reproduce sexually. Gametes are an organism's reproductive cells, also referred to as sex cells. In species that produce t ...

s are used for

impregnation Fertilisation or fertilization (see spelling differences), also known as generative fertilisation, syngamy and impregnation, is the fusion of gametes to give rise to a new individual organism or offspring and initiate its development. Proce ...

.Orr, RD; Siegler, M (2002) Is posthumous semen retrieval ethically permissible? '' J Med Ethics 2002;28:299–302'' Cases of post-mortem conception have occurred ever since human

artificial insemination Artificial insemination is the deliberate introduction of sperm into a female's cervix or uterine cavity for the purpose of achieving a pregnancy through in vivo fertilization by means other than sexual intercourse. It is a fertility treatmen ...

techniques were devised, via sperm donation to a

sperm bank A sperm bank, semen bank, or cryobank is a facility or enterprise which purchases, stores and sells human semen. The semen is produced and sold by men who are known as sperm donors. The sperm is purchased by or for other persons for the purpose ...

after the death of the donor. While religious objections have been made even under these circumstances, far more censure has arisen regarding invasive retrieval from fresh

cadaver A cadaver or corpse is a dead human body that is used by medical students, physicians and other scientists to study anatomy, identify disease sites, determine causes of death, and provide tissue to repair a defect in a living human being. Stud ...

s or patients either on

life support Life support comprises the treatments and techniques performed in an emergency in order to support life after the failure of one or more vital organs. Healthcare providers and emergency medical technicians are generally certified to perform basic ...

or in a

persistent vegetative state A persistent vegetative state (PVS) or post-coma unresponsiveness (PCU) is a disorder of consciousness in which patients with severe brain damage are in a state of partial arousal rather than true awareness. After four weeks in a vegetative sta ...

, particularly when the procedure is carried out without explicit consent from the donor.

Cases

The first successful retrieval of sperm from a cadaver was reported in 1980, in a case involving a 30-year-old man who became brain dead following a motor vehicle accident and whose family requested sperm preservation.Rothman, CM (1980) "A method for obtaining viable sperm in the postmortem state." '' Fertil. Steril. 1980;34(5):512.'' The first successful conception using sperm retrieved post-mortem was reported in 1998, leading to a successful birth the following year.Strong, C; Gingrich, JR; Kutteh, WH (2000), "Ethics of sperm retrieval after death or persistent vegetative state," ''

Human Reproduction Human reproduction is sexual reproduction that results in human fertilization to produce a human offspring. It typically involves sexual intercourse between a sexually mature human male and female. During sexual intercourse, the interaction betwee ...

2000;15(4):739–745'' Since 1980, a number of requests for the procedure have been made, with around one third approved and performed. Gametes have been extracted through a variety of means, including removal of the

epididymis The epididymis (; plural: epididymides or ) is a tube that connects a testicle to a vas deferens in the male reproductive system. It is a single, narrow, tightly-coiled tube in adult humans, in length. It serves as an interconnection between the ...

irrigation Irrigation (also referred to as watering) is the practice of applying controlled amounts of water to land to help grow crops, landscape plants, and lawns. Irrigation has been a key aspect of agriculture for over 5,000 years and has been develo ...

or aspiration of the

vas deferens The vas deferens or ductus deferens is part of the male reproductive system of many vertebrates. The ducts transport sperm from the epididymis to the ejaculatory ducts in anticipation of ejaculation. The vas deferens is a partially coiled tube w ...

, and rectal probe electroejaculation. Since the procedure is rarely performed, studies on the efficacy of the various methods have been fairly limited in scope. While

medical literature Medical literature is the scientific literature of medicine: articles in journals and texts in books devoted to the field of medicine. Many references to the medical literature include the health care literature generally, including that of de ...

recommends that extraction take place no later than 24 hours after death,

motile Motility is the ability of an organism to move independently, using metabolic energy. Definitions Motility, the ability of an organism to move independently, using metabolic energy, can be contrasted with sessility, the state of organisms th ...

sperm has been successfully obtained as late as 36 hours after death, generally regardless of the

cause of death In law, medicine, and statistics, cause of death is an official determination of conditions resulting in a human's death, which may be recorded on a death certificate. A cause of death is determined by a medical examiner. The cause of death is ...

or method of extraction. Up to this limit, the procedure has a high success rate, with sperm retrieved in nearly 100% of cases, and motile sperm in 80–90%.Shefi S et al. (2006) "Posthumous sperm retrieval: Analysis of time interval to harvest sperm", ''Human Reproduction 2006;21(11):2890–2893'' There is currently little precedent for successful insemination using sperm harvested after 36 hours. New technologies are being researched that could make this a routine reality, in turn creating new ethical dilemmas. If the sperm is viable, fertilisation is generally achieved through

intracytoplasmic sperm injection Intracytoplasmic sperm injection (ICSI ) is an in vitro fertilization (IVF) procedure in which a single sperm cell is injected directly into the cytoplasm of an egg. This technique is used in order to prepare the gametes for the obtention of emb ...

, a form of ''in vitro'' fertilisation. The success rate of ''in vitro'' fertilisation remains unchanged regardless of whether the sperm was retrieved from a living or dead donor.

Legality

The legality of posthumous sperm extraction varies from jurisdiction to jurisdiction. Generally, legislation falls into one of three camps: a full ban, a requirement of written consent from the donor, or implied consent obtained from the family.

Areas with full bans

Following the 1984 Parpalaix case in France, in which the widow of deceased cancer patient Alain Parpalaix obtained permission from the courts to be inseminated with her husband's spermatozoa after his death, the Centre d’Etude et de Conservation du Sperme Humain (Center for the Study and Preservation of Human Sperm) petitioned the courts successfully for a full ban on posthumous insemination,Bahadur, G (2002) "Death and conception", ''Human Reproduction Oct 2002;17(10):2769–2775 in line with the country's ban on ''in vitro'' fertilisation for post-

menopausal Menopause, also known as the climacteric, is the time in women's lives when menstrual periods stop permanently, and they are no longer able to bear children. Menopause usually occurs between the age of 47 and 54. Medical professionals often ...

women. Similar legislation exists in Germany,

Sweden Sweden, formally the Kingdom of Sweden,The United Nations Group of Experts on Geographical Names states that the country's formal name is the Kingdom of SwedenUNGEGN World Geographical Names, Sweden./ref> is a Nordic country located on ...

, and the Australian states of

Victoria Victoria most commonly refers to: * Victoria (Australia), a state of the Commonwealth of Australia * Victoria, British Columbia, provincial capital of British Columbia, Canada * Victoria (mythology), Roman goddess of Victory * Victoria, Seyche ...

Western Australia Western Australia (commonly abbreviated as WA) is a state of Australia occupying the western percent of the land area of Australia excluding external territories. It is bounded by the Indian Ocean to the north and west, the Southern Ocean to t ...

and

Taiwan Taiwan, officially the Republic of China (ROC), is a country in East Asia, at the junction of the East and South China Seas in the northwestern Pacific Ocean, with the People's Republic of China (PRC) to the northwest, Japan to the northeast ...

Areas requiring written consent

Guidelines outlining the legal use of posthumously extracted

s in the

United Kingdom The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom (UK) or Britain, is a country in Europe, off the north-western coast of the continental mainland. It comprises England, Scotland, Wales and Nor ...

were laid out in the

Human Fertilisation and Embryology Act 1990 The Human Fertilisation and Embryology Act 1990 is an Act of the Parliament of the United Kingdom. It created the Human Fertilisation and Embryology Authority which is in charge of human embryo research, along with monitoring and licensing fertili ...

. The Act dictates that explicit written consent by the donor must be provided to the

Human Fertilisation and Embryology Authority The Human Fertilisation and Embryology Authority (HFEA) is an executive non-departmental public body of the Department of Health and Social Care in the United Kingdom. It is a statutory body that regulates and inspects all clinics in the United ...

in order for extraction and fertilisation to take place. Following the 1997 case of '' Regina v. Human Fertilisation and Embryology Authority'', the terms of the Act were extended to

coma A coma is a deep state of prolonged unconsciousness in which a person cannot be awakened, fails to respond normally to painful stimuli, light, or sound, lacks a normal wake-sleep cycle and does not initiate voluntary actions. Coma patients exhi ...

tose patients, and so theoretically

assault An assault is the act of committing physical harm or unwanted physical contact upon a person or, in some specific legal definitions, a threat or attempt to commit such an action. It is both a crime and a tort and, therefore, may result in crim ...

charges could be (but in this case were not) brought against doctors for overseeing or performing the procedure. There are few other jurisdictions that fall into this category. New York senator Roy M. Goodman proposed a bill in 1997 requiring written consent by the donor in 1998, but it was never passed into law.

Areas requiring implied consent

In 2003,

Israel Israel (; he, יִשְׂרָאֵל, ; ar, إِسْرَائِيل, ), officially the State of Israel ( he, מְדִינַת יִשְׂרָאֵל, label=none, translit=Medīnat Yīsrāʾēl; ), is a country in Western Asia. It is situated ...

Attorney General In most common law jurisdictions, the attorney general or attorney-general (sometimes abbreviated AG or Atty.-Gen) is the main legal advisor to the government. The plural is attorneys general. In some jurisdictions, attorneys general also have exec ...

Elyakim Rubinstein Elyakim Rubinstein ( he, אליקים רובינשטיין, born June 13, 1947) is a former Vice President of the Supreme Court of Israel. Beforehand, he served as the Attorney General of Israel from 1997 to 2004. Rubinstein, a former Israeli dipl ...

published several guidelines outlining the legal situation of posthumous sperm retrieval for the purpose of later insemination by a surviving female partner. The guidelines specified firstly that only requests by a partner (married or otherwise) of the deceased would be honoured – requests by other members of the donor's family would be denied. While extraction of the sperm was guaranteed following a request by the partner, permission to use the sperm was to be determined case by case, a court of law deciding on the basis of the effect on the presumed wishes of the donor, and the effect of the procedure on the donor's dignity. If it could be demonstrated that the deceased took definite steps towards parenthood (implied consent), use of extracted sperm by the female partner would generally be permitted.Landau, R (2004) "Posthumous sperm retrieval for the purpose of later insemination or IVF in Israel: an ethical and psychosocial critique", ''Human Reproduction 2004 19(9):1952–1956''

No legislation

Many other countries, including Belgium and the

United States The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country primarily located in North America. It consists of 50 states, a federal district, five major unincorporated territo ...

, have no specific legislation regarding the rights of men on gamete donation following their death, leaving the decision in the hands of individual

clinic A clinic (or outpatient clinic or ambulatory care clinic) is a health facility that is primarily focused on the care of outpatients. Clinics can be privately operated or publicly managed and funded. They typically cover the primary care need ...

s and

hospital A hospital is a health care institution providing patient treatment with specialized health science and auxiliary healthcare staff and medical equipment. The best-known type of hospital is the general hospital, which typically has an emergency ...

s. As such, many medical institutions in such countries institute in-house policies regarding circumstances in which the procedure would be performed.Se
guidelines
provided by

Cornell University Cornell University is a private statutory land-grant research university based in Ithaca, New York. It is a member of the Ivy League. Founded in 1865 by Ezra Cornell and Andrew Dickson White, Cornell was founded with the intention to teac ...

to various

New York New York most commonly refers to: * New York City, the most populous city in the United States, located in the state of New York * New York (state), a state in the northeastern United States New York may also refer to: Film and television * ...

hospitals for an example.

Ethics

Several ethical issues surround the extraction and use of gametes from cadavers or patients in a

. The ones most often debated concern religion, consent, and the rights of the surviving partner and child if the procedure results in a birth. Some major religions prohibit posthumous sperm retrieval, including

Roman Catholicism The Catholic Church, also known as the Roman Catholic Church, is the largest Christian church, with 1.3 billion baptized Catholics worldwide . It is among the world's oldest and largest international institutions, and has played a ...

Instruction on respect for human life in its origin and on the dignity of procreation

Congregation for the Doctrine of the Faith The Dicastery for the Doctrine of the Faith (DDF) is the oldest among the departments of the Roman Curia. Its seat is the Palace of the Holy Office in Rome. It was founded to defend the Catholic Church from heresy and is the body responsible f ...

, February 22, 1987. Retrieved June 28, 2007. and

Judaism Judaism ( he, ''Yahăḏūṯ'') is an Abrahamic, monotheistic, and ethnic religion comprising the collective religious, cultural, and legal tradition and civilization of the Jewish people. It has its roots as an organized religion in the ...

.Grazi, R V; Wolowelsky J B. (1995) "The Use of Cryopreserved Sperm and Pre-embryos In Contemporary Jewish Law and Ethics", ''Assisted Reproductive Technology-Andrology, 8:53–61'' Roman Catholicism proscribes the procedure on much the same grounds as ''in vitro'' fertilisation, namely the rights of the unborn. Judaic strictures are based on the

halakhic ''Halakha'' (; he, הֲלָכָה, ), also transliterated as ''halacha'', ''halakhah'', and ''halocho'' ( ), is the collective body of Jewish religious laws which is derived from the written and Oral Torah. Halakha is based on biblical commandm ...

prohibition on deriving personal benefit from a corpse, and in the case of those in a persistent vegetative state, their categorisation as ''gosses'' (dying person) prohibits anyone from touching or moving them for anything that does not relate to their immediate care. Consent of the donor is a further ethical barrier. Even in jurisdictions where explicit or implicit consent is not required, there are occasions in which clinicians have refused to perform the procedure on these grounds. If no proof of consent by the donor can be produced, implied consent, often in the form of prior actions, must be evident for clinicians to proceed with the extraction. Sperm retrieval is rarely carried out if there is evidence that the deceased clearly objected to the procedure prior to his death. Finally, if the procedure is performed and results in a birth, there are several issues involving the legal rights of the child and its mother. Because posthumous insemination can take place months or even years after the father's death, it can in some cases be difficult to prove the paternity of the child. As such,

inheritance Inheritance is the practice of receiving private property, titles, debts, entitlements, privileges, rights, and obligations upon the death of an individual. The rules of inheritance differ among societies and have changed over time. Officiall ...

and even the legal rights of the child to marry (due to the possibility of

consanguinity Consanguinity ("blood relation", from Latin '' consanguinitas'') is the characteristic of having a kinship with another person (being descended from a common ancestor). Many jurisdictions have laws prohibiting people who are related by blood fro ...

between partners) can be affected. For this reason, several countries, including

and the

, impose a maximum term for the use of extracted sperm, after which the father will not be legally recognised on the child's

birth certificate A birth certificate is a vital record that documents the birth of a person. The term "birth certificate" can refer to either the original document certifying the circumstances of the birth or to a certified copy of or representation of the ensuin ...

References

{{reflist Medical aspects of death Fertility medicine Ethically disputed medical practices Reproductive coercion