Positioning uterus transplantation as a ‘more ethical’ alternative to surrogacy: Exploring symmetries between uterus transplantation and surrogacy through analysis of a Swedish government white paper

Abstract

Within the ethics and science literature surrounding uterus transplantation (UTx), emphasis is often placed on the extent to which UTx might improve upon, or offer additional benefits when compared to, existing ‘treatment options’ for women with absolute uterine factor infertility, such as adoption and gestational surrogacy. Within this literature UTx is often positioned as superior to surrogacy because it can deliver things that surrogacy cannot (such as the experience of gestation). Yet, in addition to claims that UTx is superior in the aforementioned sense it is also often assumed (either implicitly or explicitly) that UTx is less fraught with ethical difficulties and thus should be considered a less morally problematic option. This article seeks to examine this assumption. Given that much UTx research has been performed in Sweden, a country where surrogacy is effectively although not currently explicitly forbidden, we do this through an analysis of the arguments underpinning a 2016 Swedish white paper which considered amending existing policy such that altruistic surrogacy arrangements would be permitted. By applying the white paper’s arguments for a restrictive position on altruistic surrogacy to the case of UTx using living altruistic donors we find that such arguments, if they hold in the case of surrogacy, apply similarly to UTx. We thus suggest that, for reasons of consistency, a similar stance should be taken towards the moral and legal permissibility of these two practices.

A survey of public attitudes toward uterus transplantation, surrogacy, and adoption in Japan

“…In many previous papers, UTx has been described as the only option to have a genetic link to the child when gestational surrogacy is prohibited. In addition, even when live donor UTx is performed, UTx is considered superior to surrogacy, since it is supposed to be a less morally problematic alternative to gestational surrogacy [15]. However, some authors are skeptical of the assumption that UTx is morally superior to gestational surrogacy [15].…”

“…In addition, even when live donor UTx is performed, UTx is considered superior to surrogacy, since it is supposed to be a less morally problematic alternative to gestational surrogacy [15]. However, some authors are skeptical of the assumption that UTx is morally superior to gestational surrogacy [15]. In addition, it has been reported that the perinatal risk during gestational surrogacy is not significantly different from that attributable to in vitro fertilization using fresh embryos [16, 17].…”

Clinical applications of uterus transplantation in China: Issues to take into consideration

“…Besides, participants felt that surrogacy and adoption posed significant risks to their emotional well‐being . Morally speaking, using living donors in UTx is superior to altruistic surrogacy for being less fraught with ethical and regulatory difficulties and quandaries than surrogacy . In 2017, a small questionnaire study in China showed that 25.8% of Mayer–Rokitansky–Kuster–Hauser syndrome patients prefer to choose UTx to get a baby, while 19.3% choose gestational surrogacy .…”

“…19,22 Morally speaking, using living donors in UTx is superior to altruistic surrogacy for being less fraught with ethical and regulatory difficulties and quandaries than surrogacy. 23 In 2017, a small questionnaire study in China showed that 25.8% of Mayer-Rokitansky-Kuster-Hauser syndrome patients prefer to choose UTx to get a baby, while 19.3% choose gestational surrogacy. 24 At present, a large web-based survey regarding human UTx among the Chinese public, AUFI patients and Chinese healthcare providers is underway (unpublished data), and the results are expected to provide a reference for the ongoing clinical trials on human UTx in China.…”

Ethical and policy issues raised by uterus transplants

“…For both living and deceased donation, there is a risk of uteri being obtained without sufficiently high-quality consent . For living donation, concerns center around the possibility of living related donors experiencing external pressures such as coercion or manipulation to donate from the recipient or other family members, 8 and that living unrelated donors may be offered incentives (financial or otherwise) that could constitute an autonomy-undermining inducement 31 . The design and implementation of robust consent procedures can reduce such risks, as in other donation contexts.…”