Bioethics in Practice: The Ethics Surrounding the Use of Donor Milk

Donor milk is the recommended next best feeding option for preterm infant growth and development if a mother's own milk is not available.1,2 Healthcare providers have used donor milk since the 1900s.3 As early as 1910, mother milk donors were screened for communicable diseases, but the majority of milk distribution at that time was via wet nursing in which an infant was breastfed by a lactating woman who was not the infant's mother. In the 1970s, the United States and Canada had 53 formalized milk banks, but that number rapidly declined to less than 10 in the 1980s because of concerns about human immunodeficiency virus transmission. In 1986, the Human Milk Banking Association of North America (HMBANA) was officially named a nonprofit organization to standardize donor screening and donor milk processing/distribution.3 The first standardized guidelines for donor milk banking were available in 1990 and have been revised using current evidence as it emerges. Today, 26 HMBANA milk banks are operating across the United States and Canada with several more under development. Mothers' Milk Bank of Louisiana at Ochsner Baptist Medical Center is one of the 5 developing HMBANA milk banks. In the commercial market, several for-profit milk banking companies have emerged in the United States such as Prolacta and Medolac. These 2 companies use different criteria than HMBANA milk banks for milk processing and distribution and for compensating donor mothers.4 Numerous ethical debates about donor milk banking processes have emerged regarding respect for human dignity, beneficence, and justice for donor mothers and infants receiving donor milk