Uterus transplantation offers a novel treatment option for women with uterine factor infertility. While currently in the early clinical research phase, uterus transplantation will likely provide an alternative to adoption or gestational surrogacy, which is not permitted in some parts of the world. It uniquely allows for women with uterine factor infertility to experience the gestational component of motherhood and also to potentially share a genetic link with the offspring. Clinical research on uterus transplantation has been in process since the 1960s, and the first human live birth following transplant was reported in 2014. However, given the rapid clinical advancement, it is important to review the medical safety of the procedure and ethical dilemmas for the donor, recipient, and resulting child as well as the regulatory landscape that will ultimately guide clinical adoption. Given that uterus transplantation brings together the challenges of both assisted reproductive technology as well as organ transplantation as the world's first ephemeral transplant, it is important to discuss the ethical, legal, and social implications prior to moving from research to widespread clinical practice. Keywords: ethics, regulation, infertility
Ethical considerations in uterus transplantationOrgan transplantation has been performed since the early 20th century for a variety of reasons, including restoring function, saving life, and extending lives. Organ transplantation raises its own ethical considerations, including the use of cadaveric or living donors, allocation of scarce resources, use of medical and other criteria to determine eligibility, and informed consent.1-3 Improving the quality of a patient's life, rather than saving life itself, is a more recent goal and achievement of organ transplant (eg, hand, corneal, and face transplants) that presents further ethical considerations.1,3 For example, it is unclear how much risk is justified in the face of interventions aimed at improving quality of life rather than saving life. Uterus transplantation raises these same issues along with novel ones. For example, it is the first organ transplant with the goal being reproduction. Also, uterus transplantation is the first ephemeral organ transplant, or a transplant designed specifically for a short term, rather than the anticipated long-term nature of a transplanted liver or kidney, for example.As a transplant with reproduction as its goal, it necessarily raises ethical questions about technological aid of reproduction, including the rights of any reproductive donors, the interests of the child, commodification of women's bodies, the interests and goals of the mother, and the role of the state in regulating women's bodies and reproduction.