I absolutely agree with Jannette that sick premies in the hospital are
different than full term babies or toddlers, and the healthcare and
risk considerations for use of human milk by each group is different.

The original post asked about policies **that are used in hospitals**
for full-term births, under birth circumstances like surrogacy, where
the intended parents are asking about use of known donor milk. As
such, I maintain that my view that what is good for the goose
("common-sense" risk-benefit analysis in the NICU) is good for the
gander ("common sense" risk-benefit analysis in the full-term nursery)
is still valid.

We should not conflate what is happening/what we require in the
hospital with what is happening between parents, informally. Nor did
my response to the original post make any such suggestion.

That said, we know parents have been sharing human milk since time
immemorial. Research by Perrin
(https://www.ncbi.nlm.nih.gov/pubmed/24490980), Palmquist
(http://onlinelibrary.wiley.com/doi/10.1), Reyes-Foster
(https://www.ncbi.nlm.nih.gov/pubmed/25973632), and others suggests
that parents take quite a bit of care and consideration into who gets
their milk, and whose milk they will accept, under altruistic
cooperative infant feeding arrangements.  And they are aware of risks
of milk use when the birth parent's own milk is not available for use,
for whatever reason.

We also know there is research out there by Keim
(http://pediatrics.aappublications.org/content/early/2013/10/16/peds.2013-
1687)
and others that cautions about the use of milk **purchased** on the
Internet from **anonymous** sellers who were not allowed to know (as
part of the design study) how to ship the milk, nor how it was to be
used. No wonder they found bacteria in the milk, shipped as it was to
a post office box, in the summer months (also part of the study
design). We cannot compare what is happening there, with the carefully
structured arrangements described by Perrin, Palmquist and
Reyes-Foster, where the recipient and donor become well-acquainted
with one another even if their first introduction was made possible by
social media.

In short, there is a lot of milk sharing going on in communities, and
a lot of milk sharing going on in hospitals.  The obligations, laws,
and ethics requirements in each setting are different. Parents deserve
to know the risks of use of shared milk, just as they deserve to know
the risks of use of formula when no human milk is available.

Liz Brooks JD IBCLC FILCA
Wyndmoor, PA, USA

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