Abstract
Uterine factor infertility (UFI) is a condition that affects approximately 1.5 million women around the world. Advances in reproductive science have made it possible that uterine transplantation may be the first true treatment for women with UFI. While uterine transplantation is still in the experimental stages, the first successful live births from women who received a uterine transplant mark the real potential of this procedure. Although uterine transplant may offer an important new step for the management of women with UFI, it also poses important ethical questions that must be thoroughly considered and addressed before this procedure becomes a clinical reality. In this article, we review the major ethical issues associated with the study of and expected future clinical translation of uterine transplantation and propose a series of steps to reduce risks to all those involved in the process.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Grimbizis GF, Camus M, Tarlatzis BC, Bontis JN, Devroey P. Clinical implications of uterine malformations and hysteroscopic treatment results. Hum Reprod Update. 2001;7(2):161–74.
Oppelt P, Renner SP, Kellermann A, Brucker S, Hauser GA, Ludwig KS, et al. Clinical aspects of Mayer-Rokitansky-Kuester-Hauser syndrome: recommendations for clinical diagnosis and staging
Erman Akar M, Saygili Yilmaz E, Yuksel B, Yilmaz Z. Emergency peripartum hysterectomy. Eur J Obstet Gynecol Reprod Biol. 2004;113(2):178–81.
Brännström M, Diaz-Garcia C, Hanafy A, Olausson M, Tzakis A. Uterus transplantation: animal research and human possibilities. Fertil Steril. 2012;97(6):1269–76. doi:10.1016/j.fertnstert.2012.04.001.
Emanuel EJ, Wendler D, Grady C. What makes clinical research ethical? JAMA. 2000;283:2701–11.
Baykal B, Korkmaz C, Ceyhan ST, Goktolga U, Baser I. Opinions of infertile Turkish women on gamete donation and gestational surrogacy. Fertil Steril. 2008;89(4):817–22. doi:10.1016/j.fertnstert.2007.04.022.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.
Farrell RM, Falcone T. Uterine transplant: new medical and ethical considerations. Lancet. 2015;385(9968):581–2. doi:10.1016/S0140-6736(14)61792-X. This article is important as it is one of the first reviews that evaluate the ethical considerations related to uterine transplantation.
Brännström M, Johannesson L, Dahm-Kähler P, Enskog A, Mölne J, Kvarnström N, et al. First clinical uterus transplantation trial: a six-month report. Fertil Steril. 2014;101(5):1228–36. doi:10.1016/j.fertnstert.2014.02.024. This study provides a thorough description of all the trials of the uterine transplantation performed for the first time in the world, including patient selection, surgical techniques and outcomes of the transplantation.
Josephson MA, McKay DB. Considerations in the medical management of pregnancy in transplant recipients. Adv Chronic Kidney Dis. 2007;14:156–67.
McKay D, Josephson M. Reproduction and transplantation: report on the AST consensus conference on reproductive issues and transplantation. Am J Transplant. 2005;5:1–8.
Brännström M, Johannesson L, Bokström H, Kvarnström N, Mölne J, Dahm-Kähler P, et al. Livebirth after uterus transplantation. Lancet. 2015;385(9968):607–16. doi:10.1016/S0140-6736(14)61728-1. This study describes the very first successful uterine transplantation resulting in a live birth that was performed in Sweden.
Moore FD. Three ethical revolutions: ancient assumptions remodeled under pressure of transplantation. Transplant Proc. 1988;20:1061–7.
Moore FD. Ethical problems special to surgery: surgical teaching, surgical innovation, and the surgeon in managed care. Arch Surg. 2000;135(1):14–6.
Bueno EM et al. A multidisciplinary protocol for face transplantation at brigham and women’s hospital. J Plast Reconstr Aesthet Surg. 2011;64:1572–9.
Johannesson L, Enskog A. Experimental uterus transplantation. Best Pract Res Clin Obstet Gynaecol. 2014;28(8):1198–210. doi:10.1016/j.bpobgyn.2014.07.018.
Fageeh W, Raffa H, Jabbad H, Marzouki A. Transplantation of the human uterus. Int J Gynaecol Obstet. 2002;76(3):245–51.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
Sara Arien, Tommaso Falcone, Jed Adam Gross, Andreas Tzakis and Ruth Farrell declare no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Additional information
This article is part of the Topical Collection on Vascularized Composite Allografts
Rights and permissions
About this article
Cite this article
Arian, S.E., Falcone, T., Gross, J.A. et al. Key Ethical Considerations in the Study and Clinical Translation of Uterine Transplantation. Curr Transpl Rep 3, 410–415 (2016). https://doi.org/10.1007/s40472-016-0129-2
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40472-016-0129-2