Distributive justice in the allocation of donor oocytes.

Due to the shortage of oocyte donors, the waiting lists are lengthening. This raises the ethical question of how the available oocytes should be distributed among candidate recipients. The paper clarifies the ethical structure of the allocation process to find a set of rules that generates decisions that are acceptable for all people involved. The selection includes two steps: admission to the waiting list and ranking of those on the list. The following criteria can be used to decide about the admission of candidates: success rate, health risks, age, parental competence, nationality, primary versus secondary infertility, and capacity to pay. Four criteria may function to rank recipients who should have first priority for receiving oocytes: waiting time, medical urgency, phenotypic matching, and synchronization. The introduction of a point system is defended because it allows balancing of the different ethical principles involved and because it installs an objective system of operating rules which avoid favoritism and personal biases.