Would you Consider a Uterine Transplant?

Written by: Leah Jeunnette, Ph.D.(c)

Would you consider a uterine transplant? Today, while there is greater focus on the use of surrogacy, it is not the only possible option for having a genetic child. As long as a woman has a fertilized egg (either through her own eggs and partner’s sperm, or donated egg or sperm), she can hire a surrogate to carry the fertilized egg to term and have a child that is possibly genetically related to her or her partner.

However, with the advanced medical technology that is available today, there is another alternative. A woman can have a uterine transplant and clinicians are hoping that this could lead to a successful pregnancy. In fact, however, several successful transplants have taken place in the past few years, but no successful pregnancy has been reported as of yet.

The transplantation of the uterus is a difficult surgery that requires the same careful consideration that other transplanted organs require. This means that there must be a donor. There are two possible sources for this donation. The first is the donation after death. When a woman dies, her uterus may be donated, as well as her heart, lung, liver, kidneys, etc.. She can indicate ahead of time her willingness to donate any organ or tissue. Additionally, her surrogate decision maker can choose to donate her organs or tissues. Second, a woman who is living but no longer uses her uterus can donate it. This could be a woman who has already undergone menopause or a woman who believes that she is done having children. The uterus is not a vital organ and, therefore, can be removed from a healthy individual.

Both of these types of uterine donations have been reported in the last year. The Sahlgrenska University Hospital in Gothenberg reported in September 2012 that two successful uterine transplants were done. Both were mother to daughter donations, and both mothers were past menopause. One recipient was born without a uterus and the other had her uterus removed due to cervical cancer. All four were reported to be doing well after the transplants. In April 2013, there was a report that a 22 year old uterine transplant recipient was pregnant. However, after 8 weeks, no fetal heart beat was detected. This pregnancy was the first of its kind to be reported.

The truth of the matter is that as time progresses, more uterine transplants will be reported. So, is having this uterine transplant ethical?

First and foremost, autonomy is highly regarded when dealing with any type of organ transplantation. The recipient (or surrogate decision maker) should have the absolute authority on whether or not to have this transplantation done. There should be no coercion or manipulation whatsoever involved in her decision making process. There should be clear autonomous choice for the donor as well. While the uterus is not a vital organ, this does not mean that a women who is no longer using her uterus to carry children (women in menopause) should give it up to a woman whose uterus does not function properly or to one with no uterus at all. In addition, with the autonomy comes the need for having effective informed consent. Informed consent for everyone involved is vital to having an ethical process in place.

Beneficence and non-maleficence should be considered regarding the purpose of this transplant. Is the ultimate goal to achieve pregnancy? Is the goal to better understand organ transplantation? The recipient should not be treated as only a means. This transplantation should be conducted with the best of intentions for the patient. At the same time, the idea of balancing doing good against doing no harm for the recipient and the donor must be done. The benefits, risks, and burdens of each case must be carefully considered. Additionally, it is important to keep in mind that uterine transplantation is still experimental. It is not the standard protocol. Transplantation is a serious procedure that requires constant post-transplant monitoring and anti-rejection medication even with a perfect match. There is no known timeframe for how long a transplanted uterus is functional. Only now, in the early stages of uterine transplants, are the actual benefits, risks, and results being recorded. As more are performed, more knowledge will be gained.

Currently, in response to these successful transplants, many healthcare facilities are moving forward by putting procedures into place before they start performing uterine transplants. For instance, in 2013, the Montreal Criteria for Ethical Feasibility of Uterine Transplantation was published. This report outlines what ethical and practical issues need to be considered before the transplant is performed.

Having a system in place is key to having an effective transplantation process, but nothing can happen without having a donor and a recipient ready to participate in the procedure. So back to the original question: would you consider a uterine transplant?