Financing uterus transplants: The United States context

Abstract

The first baby has successfully been born by uterus transplantation (UTx) in the United States and the procedure is swiftly becoming a viable clinical option for patients with uterine factor infertility (UFI). This raises a practical ethical question: should health insurers finance UTx and what issues should they consider in coming to this decision? The article lays forth some of the factors that shape the decision over whether to finance UTx in the United States, including what procedures must be covered, whether UTx is more like organ transplantation or infertility treatment (which are treated differently in the United States), and the benefits and alternatives of the procedure. Then, the article explores arguments around why UTx should be financed, or at least considered along with other important medical needs. The paper argues that UTx ought to be considered along with other competing claims for healthcare services. In countries that generously cover other infertility services, it may logically follow that medical services that enable gestation should be insured when the healthcare system covers services to conceive. In the United States, however, many groups have long suffered inadequate access to medical care, in the context of infertility and more broadly. U.S. healthcare may need to be made more widely equitable, before covering UTx is seen as financially or politically possible.

Recognizing the Vulnerable: Perspectives, Attitudes, and Interests of Women With Uterine Factor Infertility Towards Uterus Allotransplantation

“…All women had health insurance, and the majority (9, 90%) of women believed that UTx should be covered by health insurance. The lay public is also in agreement that UTx should be considered along with other competing claims for healthcare services [19]. However, current US healthcare is faced with inadequate access to numerous healthcare services.…”

“…However, current US healthcare is faced with inadequate access to numerous healthcare services. An argument can thus be made that equitable access to other services, especially non-elective procedures, may need to be achieved before UTx coverage is seen as financially possible [19]. This can potentially create discordance, as there is a vulnerable patient population that strongly desires the procedure (and with more financial means than the average American to achieve it), in a system that does not make the procedure financially accessible.…”

Options for acquiring motherhood in absolute uterine factor infertility; adoption, surrogacy and uterine transplantation

“…72 These criticisms have also been specifically deployed against publicly funding UTx in countries with socialised medical care 73,74 and in insurance-based or mixed systems. 75 In this context, it has been argued that UTx improves on other options, such as surrogacy, only by satisfying personal desire to experience gestation and childbirth and that these are insufficient to justify the high financial cost associated with UTx, which has been estimated at almost €100,000 in European economies. 76 These arguments, however, can be challenged.…”

“…It is also claimed that by providing UTx, undesirable attitudes towards parenthood might be reinforced and discriminatory social biases perpetuated; specifically, pronatalism (bias in favour of reproduction), gestationalism (bias in favour of gestational parenthood) and geneticism (bias in favour of genetic parenthood) 72 . These criticisms have also been specifically deployed against publicly funding UTx in countries with socialised medical care 73,74 and in insurance‐based or mixed systems 75 . In this context, it has been argued that UTx improves on other options, such as surrogacy, only by satisfying personal desire to experience gestation and childbirth and that these are insufficient to justify the high financial cost associated with UTx, which has been estimated at almost €100,000 in European economies 76 …”

Uterine transplantation and IVF for congenital or acquired uterine factor infertility: A systematic review of safety and efficacy outcomes in the first 52 recipients

“…UTx is considered more socially and individually acceptable by women of reproductive age than surrogacy and adoption [46][47][48], and it is at the forefront of the motherhood options considered by AUFI women [49,50]. Although several ethical [51][52][53][54][55], psychological [56,57] and social [58][59][60][61][62] issues are actively being debated, overall there is great interest among both LDs and potential recipients towards participating in a UTx trial [63,64].…”