Moving the Womb

Abstract

Moving the Womb Arthur L. Caplan (bio), Constance Perry (bio), Lauren A. Plante (bio), Joseph Saloma (bio), and Frances R. Batzer (bio) Recently, a team of physicians at the New York Downtown Hospital announced they had received approval from their institutional review board to attempt the first uterus transplant in the world from a cadaver donor.1 Teams in the United Kingdom and Sweden have also publicly stated their interest in trying uterus transplantation in women. Transplantation always involves serious risks for recipients, stemming both from the solid organ transplant surgery itself and from the immunosuppressive drugs that transplant recipients will have to take for the rest of their lives. These risks, however, have been generally viewed as acceptable by surgeons, third-party payers, government regulators, and patients because the success rate is high and the benefit of receiving a heart, kidney, lung, or liver-continued life-is self-evident. The point of a uterus transplant would not be to save a life, however. Uterus transplants would be attempted only to improve the recipient's quality of life: they would allow her to give birth. This very different risk-benefit calculation raises many ethical questions that should be thoroughly aired and understood before the procedure is attempted. The Need Thousands of women in the United States cannot bear children. Disease, accidents, complications from earlier pregnancies, and congenital malformations can impair a woman's uterine function, and some women simply do not have a uterus at all. But not all women who cannot bear children are flatly barred from parenthood. In some states in the United States and in other nations, there has been for many years an active market in surrogate mothers-women who will "rent" their wombs for a fee to other women so they may bear children. Gestational surrogacy is not an option for all women who do not have a functioning uterus, however. It is illegal in some states and in some countries, and, even in states where it is legal, many ethical and legal uncertainties surround the practice. Some religions, including Islam, have specific prohibitions against surrogacy. It can also be very expensive, yet it may not even satisfy a woman's need to have her own baby. Many women wish to bear their children themselves as part of the parenting experience. Various cases of older women who have utilized donor embryos or donor sperm and egg to become pregnant, despite great risks to themselves and their potential children, show how strong this desire can be.2 Women who want to experience pregnancy and those for whom gestational surrogacy is out of reach (whether for religious or financial reasons) form a group who are willing, even eager, to subject themselves to experimental uterine surgery. Their eagerness puts these women-and those seeking to recruit them-at risk of the "therapeutic misconception": they need to be frequently and emphatically reminded that the women who first receive uterus transplants are subjects in a research study, not patients getting a new treatment. It is unlikely that they will benefit by delivering a baby. Their motivation for participating ought to be that they will shed light on the safety and practicality of uterus transplants. The Experience So Far Only one known uterus transplant using a living donor has been attempted in humans. Physicians at the King Fahd Hospital in Saudi Arabia performed the operation in 2002. The donor was a forty-six-year-old woman, and the recipient was a twenty-six-year-old who had undergone a hysterectomy. Doctors had to remove the transplanted uterus after three months due to circulatory problems.3 A number of attempts have also been made with different kinds of animals. The team of transplant researchers at New York Downtown Hospital has been experimenting with uterus transplants in pigs and rats for five years. The transplanted uteri reportedly survived and functioned for several months in the pigs, producing normal menstrual cycles.4 However, none of the animals were able to become pregnant, and the researchers do not know why. A few attempts have been made to transplant uteri in sheep and monkeys, but no pregnancies have resulted. A Swedish team that has been [End...