Ethical issues in uterine transplantation

Abstract

Despite a recent surge of bioethical attention, ethical analysis of uterine transplantation is still in its early stages, and many of the key ethical issues remain underexamined and unresolved. In this paper, we briefly review some key ethical issues associated with uterine transplantation (beyond those associated with organ transplantation more generally). We structure our discussion in terms of Beauchamp and Childress’ four principles of biomedical ethics: beneficence, non-maleficence, autonomy, and justice. Our review highlights some ethical questions that require further bioethical attention before uterine transplantation can be fully embraced as a potential treatment for absolute uterine factor infertility. We close by arguing that the costs and benefits of uterine transplantation need to be considered in the context of other possible treatments for absolute uterine factor infertility and alternative methods of family creation.

Uterus Transplantation as Infertility Treatment in Gynecological Cancer Survivors: A Systematic Review

“…Conversely, based on the UK criteria, recipients who already have children are excluded, even in cases of children who have been adopted or born via surrogacy arrangements, while the Swedish criteria appear to focus only on biological parenthood. These inconsistencies point towards the ethical complexity of developing inclusion and exclusion criteria for uterus transplantation clinical trials [ 36 , 37 ].…”

“…Other interventions include intense, continuous immunotherapy, major and prolonged transplantation surgery, and gestation with ongoing careful monitoring for graft rejection. Potential drawbacks are also psychological risks, such as guilt for graft failure, pregnancy loss, or prematurity, and possible disappointment with the reality of a physical pregnancy without innervation, cesarean delivery, and, finally, hysterectomy [ 37 ]. In the case of patients who received uterus transplantation due to previous gynecological cancer, these difficulties would be even greater in the context of a previous abdominal operation and its potential complications, such as adhesions, the existence of scar tissue, etc.…”

Uterine Transplantation and Fertility Preservation: A Hopeful Horizon for Cancer Survivors

“…Donors, recipients, partners, and unborn children must be considered in analyzing the ethical risks and benefits of UTx [19]. Additionally, the choice between brain-dead donors and living donors, as well as the risks for living donors, are important medical and ethical considerations [19,20]. Furthermore, the ethical and social value of gestation, the extension of UTx to transgender women or men, and the risks associated with immunosuppressive therapy and transplant surgery are also significant ethical considerations [21].…”

“…As UTx moves from the research phase to the clinical phase, it is crucial to review the ethical, legal, and social implications before widespread clinical practice [22]. The UTx presents a range of medical and ethical considerations, including the risks for recipients and donors, the ethical and social value of gestation, and the need for comprehensive risk assessment and data collection before the procedure can be widely adopted [19][20][21][22].…”

How useful is the category of ‘assisted gestative technologies’?

“…One thing that makes UTx ethically complex is that familiar principles of transplant ethics do not translate neatly to this context, given that the aims and benefits of UTx are so different to those of other organ transplants. How, for example, should we balance the expected harms and benefits of UTx for living donors and recipients when the transplant is neither lifesaving nor life-sustaining, but instead seeks to fulfil the recipient’s desire to become a parent?3 The analogies and disanalogies between UTx and solid organ transplantation are highly important here.…”