Should Deceased Donation be Morally Preferred in Uterine Transplantation Trials?

Nicola Williams

doi:10.1111/bioe.12247

Abstract

In recent years much research has been undertaken regarding the feasibility of the human uterine transplant (UTx) as a treatment for absolute uterine factor infertility (AUFI). Should it reach clinical application this procedure would allow such individuals what is often a much‐desired opportunity to become not only social mothers (via adoption or traditional surrogacy arrangements), or genetic and social mothers (through gestational surrogacy) but mothers in a social, genetic and gestational sense. Like many experimental transplantation procedures such as face, hand, corneal and larynx transplants, UTx as a therapeutic option falls firmly into the camp of the quality of life (QOL) transplant, undertaken with the aim, not to save a life, but to enrich one. However, unlike most of these novel procedures – where one would be unlikely to find a willing living donor or an ethics committee that would sanction such a donation – the organs to be transplanted in UTx are potentially available from both living and deceased donors.In this article, in the light of the recent nine‐case research trial in Sweden which used uteri obtained from living donors, and the assertions on the part of a number of other research teams currently preparing trials that they will only be using deceased donors, I explore the question of whether, in the case of UTx, there exist compelling moral reasons to prefer the use of deceased donors despite the benefits that may be associated with the use of organs obtained from the living.

Highlights

In recent years much research has been undertaken regarding the feasibility of the human uterine transplant (UTx) as a treatment for absolute uterine factor infertility (AUFI)
Late 2014 marked the end of a long and hard-fought race between teams of researchers across the world to perform the first successful experimental human uterine transplant (UTx), a procedure designed as a treatment option for women with absolute Uterine Factor Infertility (UFI)
A successful treatment for UFI has been called the last frontier[3] in reproductive medicine, allowing women with UFI the opportunity to become, social mothers as they already may via adoption or traditional surrogacy arrangements, or social and genetic mothers, 2 A

Summary

INTRODUCTION

Late 2014 marked the end of a long and hard-fought race between teams of researchers across the world to perform the first successful experimental human uterine transplant (UTx), a procedure designed as a treatment option for women with absolute Uterine Factor Infertility (UFI). Available at: http://www.news.com.au/lifestyle/health/ womb-transplants-coming-to-australia-in-2016-to-deliver-the-chance-ofa-pregnancy-to-women-without-a-womb/story-fneuz9ev-1227146047542 [accessed 29 June 2015]. Available at: http:// www.independent.co.uk/life-style/health-and-families/features/two-womenhave-given-birth-using-wombs-transplanted-from-their-mothers-butare-the-risks-involved-too-great-9901719.html [accessed 29 June 2015]. 15 A number of commentators, for example, have asked: whether the procedure might cater to a faulty belief that certain kinds of parenthood (gestational and genetic) are more worth seeking than others (social); whether the prospective benefits to recipients really outweigh the harms it risks to the recipient, donor and potentially the resulting child; whether the uterus transplant really caters to the desire to experience gestation and birth that it promises to, in light of the fact that current procedures at best result in gestation in an enervated uterus followed by caesarean section as opposed to vaginal delivery; whether the procedure is really a more desirable method of begetting a child than existing practices such as surrogacy; and whether, in light of the high costs involved and its status as a life-creating rather than life-sustaining treatment, it should receive public funding in nations with fully or partially socialized medical systems. Why is this the case? Why are the research teams currently unable to agree on such a foundational matter? Within this section, the reasons provided by researchers on both sides of the debate are outlined and examined

A preference for living donors

SHOULD DECEASED DONATION BE ETHICALLY PREFERRED IN UTX RESEARCH?

Harms to uterus donors

Are the harms to living donors in UTx justifiable?

Findings

CONCLUSION