Uterus transplantation: ethical considerations

Abstract

Purpose of review Uterus transplantation (Utx) offers women with absolute uterine factor infertility the opportunity to carry their own pregnancies. As Utx transitions from an experimental to standard clinical procedure, we review the status of the ethical issues applicable to the stakeholders involved. Recent findings With more than 65 Utx procedures reported to date, evidence is accruing that enables the chance of success – a live birth – for the recipient to be weighed against the risks the recipient incurs through the Utx process, as well as risks to living donors undergoing surgery, to children exposed in utero to immunosuppressants and the uterine graft environment, and to third parties related to uterus procurement from multiorgan deceased donors. Experience has also informed aspects of recipient and donor autonomy that must be safeguarded. Summary Clinical trial results provides a basis for weighing the interests of the stakeholders implicated in Utx, and so can inform transplant centers’ and regulatory bodies’ development of policies and protocols that will determine access to Utx and allocation of organs, together with other considerations of justice. Additional evidence, particularly on long-term outcomes, is needed, and new questions can be expected to arise as access to and indications for Utx broaden.

Uterus transplantation: from research, through human trials and into the future

“…Ethical disagreements exist around the inclusion criteria for potential donors and recipients relating to age, length of waiting time, relationship status, and prior children ( da Graca et al , 2021 ). As UTx becomes a more routine procedure, demand for available uteri will likely outstrip supply ( Romanis and Parsons, 2022 ).…”

A Patient-Centered Website (Within Reach) to Foster Informed Decision-making About Upper Extremity Vascularized Composite Allotransplantation: Development and Usability Study

“…VCA raises many ethical issues, particularly regarding informed consent [10]. Informed consent concerns differ by VCA type given that the information to be disclosed about the risks, potential benefits, and alternatives differs, for example, for UEs, face, and uterus, as does the level of vulnerability that VCA candidates may experience [11][12][13][14][15][16]. In the context of UE VCA, a key ethical concern is that limited psychosocial data are available, which translates to limited information being publicly available.…”

Uterus Transplantation as a Surgical Innovation

“…Following the success of the first trials led by Brännström and colleagues in Sweden, UTx programmes have been introduced in a number of countries over the past decade (Brännström, Belfort, and Ayoubi 2021 ; Testa et al 2020 ). Many report growing acceptance of UTx as a potential treatment for women with AUFI (Jones et al 2021 ; Brännström, Kvarnström, and Dahm-Kähler 2020a , b , c ; da Graca et al 2021 ). As more women seek to undergo UTx, there is evidence of increasing acceptance of the procedure and a shift in ethical discourse about UTx to focus on issues of informed consent from living donors (LD) and transplant recipients, and on equity of access to the procedure (Richards et al 2019 ; Ngaage et al 2020 ; Kristek et al 2019 ).…”

“…The recognition of UTx as a surgically innovative procedure has significant implications for countries and clinician-researchers when designing and implementing UTx trials. In this paper we explore these implications and argue that ethical scrutiny of proposed UTx trials is essential in order to protect participants and to support free and informed decision-making in a setting of considerable uncertainty and varying practices (da Graca et al 2021 ; Balayla 2016 ; Williams 2016 ; Hammond-Browning 2019 ; Daolio et al 2020 ; O’Donovan, Williams, and Wilkinson 2019 ). In particular, we highlight the need for international cooperation that will facilitate consolidation of knowledge and help to support the responsible translation of new innovations in the field such as the use of robotic assisted surgery.…”