The rapid integration of genomic technologies into assisted reproduction is transforming how genetic risk is identified and managed in donor conceptions. However, regulatory frameworks remain fragmented and poorly aligned with these developments. Drawing on a comparative analysis of 30 jurisdictions around the world and informed by our experience with the high prevalence of the germline TP53 c.1010G>A (p.Arg337His) variant in certain regions in Brazil, this commentary identifies two broad approaches to the governance of genetic risk, revealing substantial variation in how it is addressed.