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Thursday, September 20, 2012

The Ethics of Uterus Transplants



Clinicians at Gothenberg University in Sweden reported  this week that they have carried out uterus transplants with two women, actually four since their mothers were the uterus donors. This is a very long way to go in order to have a child.

Researchers have been investigating this kind of transplant with monkeys and baboons for some time now, but there have been efforts at human transplantation too.  In 2011, Turkish clinicians carried out a uterus transplant, and it has been successful enough that the woman experiences menstruation (No author, 2011).  To date, however, she has not had a child.

In February of this year, a study group offered “The Montreal Criteria for the Ethical Feasibility of Uterus Transplantation in Women” (Lamarck et al. 2012). According to this group’s standards, clinicians must ensure that the woman is medically able to sustain the transplant and that she have uterine factor infertility, namely that she lacks a uterus altogether or that she has a demonstrated inability to gestate.  She must also be competent to make a make a free choice to agree to the risks of the transplant, and this choice must not be the result of some psychological disorder. The woman must also appear to be a suitable candidate for motherhood, namely not show any signs of maternal unfitness. 

One of the most interesting proposed criteria for uterus transplantation is this:  the woman must have either (a) a personal or legal reason to avoid surrogacy and adoption as a way of having children or (b) or her goal must be the experience of gestation.  By itself, this standard is broad enough to permit any woman who wants a transplant – and meets the other criteria – to have one.  In other words, any reason important to the woman is reason enough.

In April of this year, the Gothenburg group signaled their readiness to undertake uterus transplantation (Brännström et al.), and their first efforts involved a woman who lost her uterus to cancer and a woman who was born without a uterus, and their mothers as living donors.

The Gothenberg group did not disclose whether the women receiving the organs had a capacity to have children in other ways.  If they did, clinicians might have been able to retrieve ova from them and use IVF in order to help them have children. This option might not always work, of course, since it has its own failure rates and requires a surrogate mother. 

If the women lack their own ova, however, even if gestate their children – if the transplants succeed and pregnancy occurs –they will be doing so with children that are not their own genetically. Most people seem to want to have children that are genetically related to them, unless they can’t. Some people are generous enough to adopt children who have no genetic relationship at all to them, but others would rather have no children than adopt. In the Gothenberg cases, gestation seems to be as important as anything else.

Ironically, these transplants come at a time when some feminists have been trying to liberate women from gestation altogether. For example, Anna Smajdor has argued for strong research commitments to the development of artificial wombs (Smajdor, 2007). She calls for ‘priority’ for this research, without saying priority over what, but she argues that pregnancy is “barbaric” and the sooner women are beyond its reach the better. 

As I say, uterus transplants are long way to go toward having a child and, especially if the goal is primarily to experience gestation. In the Swedish cases, four women assumed a lot of risk: two in donating their uteruses and two in having uteruses transplanted into their bodies.  That’s a lot of pre-operative psychological evaluation, a lot of pre-operative medical evaluation, surgery, and post-operative recovery. I’m all in favor of autonomous choice with regard to choices about having children, but a healthy dose of feminist skepticism toward gestation is in order here. And that’s all the more true when other options for having children exist.

References

Brännström M, Diaz-Garcia C, Hanafy A, Olausson M, Tzakis A. 2012. Uterus transplantation: animal research and human possibilities. Fertility and Sterility (97) [Jun]: 1269-1276. Epub: Apr 28 2012.

Lefkowitz A, Edwards M, Balayla J.  2012. The Montreal Criteria for the Ethical Feasibility of Uterine Transplantation. Transplant International (4):439-47. Epub: Feb 23.

No Author.  2012. First uterus transplants from mother to daughter are reported. New York Times, Sept. 18. At: http://www.nytimes.com/2012/09/19/world/europe/sweden-first-uterus-transplants-from-mother-to-daughter-are-reported.html

No Author. 2011. Nurse hopes to have world’s first baby from a transplant womb donated by her own mother. Daily Mail. Oct. 18. At:  http://www.dailymail.co.uk/health/article-2050401/Married-nurse-hopes-worlds-baby-womb-transplant-donated-MOTHER.html

Smajor, A. 2007. The moral imperative for ectogenesis. Cambridge Quarterly of Healthcare Ethics (16): 336-345.

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