Epistemic injustice and oocyte donation: a critical bioethical analysis of regulatory provision and donor care in Spain

Demand for donated oocytes has expanded across high-income countries, driven by delayed childbearing, the growth of cross-border reproductive care, and the use of donated oocytes in jurisdictions permitting gestational surrogacy. Meeting that demand requires healthy young women to undergo controlled ovarian stimulation and surgical retrieval, procedures that carry documented acute risks and whose long-term health effects remain uncertain. Spain performs the largest share of oocyte donation cycles in Europe, 37,618 of 80,641 reported cycles in 2018, and is therefore an instructive case. This is a conceptual and normative bioethical analysis of published material. It is not a systematic review, a qualitative meta-synthesis, or a secondary analysis of an existing dataset, and the authors did not access primary research material. We apply frameworks of distributive, relational, procedural and epistemic justice, together with the precautionary principle, to the Spanish and European regulatory framework, and read published donor accounts against explicitly stated conditions for the application of testimonial and hermeneutical injustice. Spanish and European law already require donor screening, traceability, limits on donation frequency, and notification of serious adverse reactions in donors, ovarian hyperstimulation syndrome among them; from 2027, Regulation (EU) 2024/1938 will add post-donation health monitoring. What these instruments do not provide is any record of donation in the donor’s own health history, or any mechanism by which longitudinal evidence about donor outcomes could be generated. We argue that this constitutes hermeneutical marginalisation rather than mere scientific uncertainty, because statutory anonymity forecloses the cohort assembly and collective self-interpretation through which interpretive resources are ordinarily produced. Of the published accounts examined, neither establishes testimonial injustice on the conditions we specify; we identify the ethical categories they do support. We set out four policy options: periodic risk-referenced review of compensation; defined post-retrieval clinical contact; independent representation in the consent process; and consent-based recording of donation in the donor’s own health record. Each is presented with its costs, its less restrictive alternatives and its foreseeable unintended consequences. The proposed duration of follow-up is offered as a provisional option rather than a determined standard. A small number of published accounts cannot establish prevalence or representativeness, and the conclusions are specific to the Spanish framework.