title: Ethical and practical considerations concerning perimortem sperm procurement in a severe neurologically damaged patient and the apparent discrepancy in validation of proxy consent in various postmortem procedures.
abstract: BACKGROUND
  Although sperm procurement and preservation has been become commonplace in situations in which infertility can be easily foreseen, peri- or postmortem sperm procurement for reproductive use in unexpected coma or death is not generally accepted. There are no laws and regulations for this kind of intervention in all countries and they may also differ from country to country. Intensive care specialists can be confronted with a request for peri- or postmortem sperm procurement, while not being aware of the country-specific provisions.
  
  
  METHODS
  A young male patient who suffered 17 L blood loss and half an hour of cardiopulmonary resuscitation was admitted to a university hospital for an ill-understood unstoppable abdominal bleed. After rapid deterioration of the neurological situation, due to severe post-anoxic damage, the decision was made to withdraw life-sustaining treatment. At that moment the partner of the patient asked for perimortem sperm procurement, which was denied, on the basis of the ethical reasoning that consent of the man involved was lacking. Retrospectively the decision was right according to Dutch regulations; however, with more time for elaborate ethical reasoning, the decision outcome, without the awareness of an existing prohibition, also could have been different.
  
  
  CONCLUSIONS
  Guidelines and laws for peri- or postmortem sperm procurement differ from country to country, so any intensive care specialist should have knowledge from the latest legislation for this specific subject in his/her country. An overview is provided. A decision based on ethical reasoning may appear satisfying, but can unfortunately be in full contrast with the existing laws.
authors.affiliation: Department of Intensive Care Medicine, Erasmus MC University Medical Centre Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands. j.epker@erasmusmc.nl
authors.forename: J L
authors.initials: JL
authors.lastname: Epker
authors.forename: Y J
authors.initials: YJ
authors.lastname: de Groot
authors.forename: E J O
authors.initials: EJ
authors.lastname: Kompanje
mesh_terms: D000328:Adult; D001926:Brain Death; D006801:Humans; D007258:Informed Consent / Q000941:ethics*; D007362:Intensive Care Units; D008297:Male; D009426:Netherlands; D037022:Posthumous Conception; D019727:Proxy; D013074:Sperm Banks; D013094:Spermatozoa; D009927:Tissue and Organ Procurement / Q000941:ethics; D015599:Trauma Severity Indices