The Ethics of Uterus Transplantation: Moral Challenges and Recommendations for Progress
Uterus transplants, a form of vascularized composite allograft, have so far, up until January 2019, resulted in eight successful live births in Sweden and additionally two births in the USA, one birth in Brazil, one birth in Serbia/Italy, one birth in India, and one birth in China. Moreover, there are several ongoing pregnancies with expected deliveries in 2019. In the USA, initial attempts resulted in failures. One case in Cleveland and three out of four transplants in Dallas resulted in uterus removal due to complications. The ethical concerns regarding whether the pursuit of a pregnancy justifies the risks involved with the surgery must now be updated to acknowledge the successes and failures of these first attempts. Similarly, concerns regarding how the practice should ethically be pursued must now be characterized. These include how to ensure adequate qualifications of transplant teams, designing research trials and patient selection criteria to protect recipients, selecting informed and voluntarily consenting living and cadaveric donors, defining adequate metrics for a “successful” uterine transplant, ensuring a strategy for managing failure, and ensuring equal access for potential recipients.
Absolute uterine factor infertility
Institutional review board
International Society of Uterus Transplantation
In vitro fertilization
Vascularized composite allograft
- Allen-West C. Level of oxytocin in pregnant women predicts mother-child bond. Association for Psychological Science; 2007. http://www.psychologicalscience.org/index.php/news/releases/level-of-oxytocin-in-pregnant-women-predicts-mother-child-bond.html.
- Baylor Scott & White Health. Uterine transplant clinical trial update—October 5, 2016. Baylor Scott & White Health; 2016. http://news.bswhealth.com/releases/uterine-transplant-clinical-trial-oct-5-2016.
- Glionna J. Twins rejected, surrogate birth mother sues. 2001. http://articles.latimes.com/2001/aug/11/local/me-33076.
- Grady D. Uterus transplants may soon help some infertile women in the US become pregnant. NY Times. 2015. http://www.nytimes.com/2015/11/13/health/uterus-transplants-may-soon-help-some-infertile-women-in-the-us-become-pregnant.html?_r=1.
- Grady D. Yeast infection led to removal of transplanted uterus. NY Times. 2016. http://www.nytimes.com/2016/04/09/health/yeast-infectionled-to-removal-of-transplanted-uterus.html?_r=2.
- In re Baby M, 537 A.2d 1227, 109 N.J. 396 (N.J. 1988).Google Scholar
- In re Marriage of Buzzanca, 61 Cal. App. 4th 1410 (Cal. App. 4th Dist. 1998).Google Scholar
- Lewin T. Surrogates and couples face a maze of laws, state by state. NY Times. 2014. http://www.nytimes.com/2014/09/18/us/surrogates-and-couples-face-a-maze-of-laws-state-bystate.html?_r=0.
- Mumtaz Z. Ethics criteria for uterine transplants: relevance for low-income, pronatalistic societies? J Clin Res Bioethics. 2012;S:1–5.Google Scholar
- Newman S. Why more people don’t adopt. Psychol Today. 2008. https://www.psychologytoday.com/blog/singletons/200810/why-more-people-don-t-adopt.
- Organ Procurement and Transplantation Network. VCAs from living donors. 2015. http://optn.transplant.hrsa.gov/resources/by-organ/vascular-composite-allograft/vcas-from-living-donors/.
- Parent B. Informing donors about hand and face transplants: time to update the uniform anatomical gift act. J Health Biomed Law. 2014;10:309–26.Google Scholar
- Saul S. New Jersey judge calls surrogate legal mother of twins. NY Times. 2009. http://www.nytimes.com/2009/12/31/us/31surrogate.html.
- Tribune News Service. Cleveland clinic says first uterus transplant in U.S. fails. Chicago Tribune. 2016. http://www.chicagotribune.com/lifestyles/health/ct-uterus-transplant-fails-20160314-story.html.
- Woessner J, Blake V, Arora K. Ethical considerations in uterus transplantation. Theor Med Bioeth. 2015;5:81–8.Google Scholar