Uterus Transplantation: The Ethics of Using Deceased Versus Living Donors

Abstract

Research teams have made considerable progress in treating absolute uterine factor infertility through uterus transplantation, though studies have differed on the choice of either deceased or living donors. While researchers continue to analyze the medical feasibility of both approaches, little attention has been paid to the ethics of using deceased versus living donors as well as the protections that must be in place for each. Both types of uterus donation also pose unique regulatory challenges, including how to allocate donated organs; whether the donor / donor's family has any rights to the uterus and resulting child; how to manage contact between the donor / donor's family, recipient, and resulting child; and how to track outcomes moving forward.

DUETS (Dallas UtErus Transplant Study): Complete report of 6‐month and initial 2‐year outcomes following open donor hysterectomy

“…Specific concerns raised about the acceptability of living donor, as opposed to deceased donor, hysterectomy include unknown risks of this novel procedure and the long operative times reported in the Swedish trial . As more living donor uterus transplants are done, more can be learned about the types and rates of complications as well as operative efficiency.…”

Clinical pregnancy after deceased donor uterus transplantation: Lessons learned and future perspectives

“…Endometrial receptivity array, which is a voluntary test, was not performed because the recipient refused the procedure even after a detailed explanation and recommendation that this test be performed. Low donor age might reduce the risk of pre‐eclampsia in pregnancy after UTx, and this factor might therefore increase the widely discussed ethical dilemmas of this experimental treatment . The first child from an LD‐transplanted uterus in Sweden was born in the 32nd week of gestation because of pre‐eclampsia and pathological cardiotocography.…”

“…Therefore, the success (or failure) of one research team could influence the success of others, and finally, the success of the method itself. Presently, it appears ethically justifiable to proceed with DD UTx when establishing a uterus transplant trial . Despite the experimental nature and the few UTx performed worldwide, a previously suggested international registry of recipients, donors (both living and deceased) and children born has not yet been developed.…”

What Are Good Guidelines for Evaluating Uterus Transplantation?

“…Uterus allocation could be based on a first-come, first-served basis; motherhood status; child-rearing capacity; likelihood of being able to carry a pregnancy to term; or age. 22,23,24 Some of the ethical principles that govern the allocation of solid organs do not map neatly onto UTx. To promote the equitable allocation of organs, the OPTN relies heavily on the principle of utility, whereby an action or practice is deemed morally right "if it promotes as much or more aggregate net good than any alternative action or practice."…”

“…25 Yet assessing the recipient's capacity for child-rearing-which could be seen as resembling social worth assessments-is part of the UTx evaluation recommended by some scholars and practitioners. 22,24 Someone deemed unworthy of the social role of being a parent would be rejected. Such assessments could be riddled with judgments about what makes a good parent and easily could lead to ranking of potential recipients based on suitability for child-rearing.…”