Abstract
IntroductionIn 2014, Brännström and colleagues reported the first human live birth following uterine transplantation (UTx). Research into this treatment for absolute uterine factor infertility has since grown with clinical trials currently taking place across centers in at least thirteen countries worldwide.Sources of dataThis review summarizes and critiques the academic literature on ethical and policy issues raised by UTx.Areas of agreementThere is general agreement on the importance of risk reduction and, in principle, to the sharing and maintenance of patient data on an international registry.Areas of controversyThere are numerous areas of controversy ranging from whether it is ethically justified to carry out uterus transplants at all (considering the associated health risks) to how deceased donor organs for transplant should be allocated. This review focuses on three key issues: the choice between deceased and living donors, ensuring valid consent to the procedure and access to treatment.Growing pointsUTx is presently a novel and rare procedure but is likely to become more commonplace in the foreseeable future, given the large number of surgical teams working on it worldwide.Areas timely for developing researchUterus transplantation requires us to re-examine fundamental questions about the ethical and social value of gestation. If eventually extended to transgender women or even to men, it may also require us to reconceptualize what it is to be a ‘father’ or to be a ‘mother’, and the definition of these terms in law.
Highlights
IntroductionResearch into uterine transplantation (UTx) dates back to 1960. it was not until 2000 that the first modern attempt at human uterine transplantation took place, in Saudi Arabia
In 2014, Brännström and colleagues reported the first human live birth following uterine transplantation
The issues it addresses may usefully be categorised into the broad themes of: transplantation ethics; donation ethics; questions of access; child welfare; and ethical research design and practice
Summary
Research into uterine transplantation (UTx) dates back to 1960. it was not until 2000 that the first modern attempt at human uterine transplantation took place, in Saudi Arabia. 1 in 500 women worldwide are estimated to have uterine factor infertility,[6] with around 15,000 women of childbearing age in the UK having no womb.[7] The current options for women with AUFI who wish to have children are adoption or surrogacy Both can be lengthy, bureaucratic and expensive processes and, while altruistic surrogacy is legally permitted in the UK, not everyone considers it an acceptable option (for cultural, moral, or practical reasons). A wide-ranging ethical and legal literature has arisen in a short space of time The issues it addresses may usefully be categorised into the broad themes of: transplantation ethics; donation ethics; questions of access; child welfare; and ethical research design and practice. This review explores three particular concerns that have attracted most interest: the value of gestation, the choice between deceased or living donors, and access to treatment
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