comment

Ethics of uterine transplantation

George F Winter
Freelance Writer and Fellow of the
Institute of Biomedical Science

160

terms of surgical technique, organ preservation[etc]there now exists justification to

consider another attempt at uterine transplantation in a human. In other words, ethical
issues can be addressed later, but not now.
The websites dismissal of adoption and
surrogacy as being fraught with moral,
ethical and financial difficulties invites the
inference that womb transplantation is not
similarly freighted with such concerns.
Some proponents argue that if a transplanted uterus were to jeopardise the
recipients life, it could simply be removed.
But what if it contains a viable fetus? Much
is made of the urge that some women have
to experience the joy of pregnancy and childbirth. But as Castanos et al (2013) suggest,
the experience of pregnancy may not meet
recipients expectations due to the need for in
vitro fertilisation, reduced sensation of pregnancy, absent labour and a caesarean delivery.
In any case, a consideration of adoption
confirms that you do not need to carry a child
in order to mother one, a view endorsed by the
title of a piece in the Huffington Post by Belkin
(2012). Given that womb transplants are not
life-saving, Belkin asks if they are worth the
abdominal surgeries in each donor-recipient
pair, the subsequent caesarean section, and
finally, the surgery to remove the uterus after
birth, obviating the need for the recipient to
take immunosuppressants for life.
Not so long ago uterine transplantation was
a distant prospect. That prospect has become

reality, and it is not too outlandish to consider

a further possibility: uterus transplants for
transsexuals. Consider those males who take
sex-change-related drugs and undergo extensive genital surgery in order to fulfil a wish to
be a woman. In my view, such individuals are
feminine but they are not female. Yet some,
having undergone genital surgery, might wish
to go the whole reproductive hog and have
a uterus transplant in order to have a child.
The surgical technology might not exist at
presentbut in the future?
Advocates of uterine transplant surgery
have so far failed to address a fundamental
issue. This is illustrated by a heading on the
Womb Transplant UK website: Why The
Need For Womb Transplants? Writing this
article, I want to have a custard cream, but I
dont need one. Many childless women may
express a genuine and heartfelt want for a
child, but they misuse the word need. It
seems harsh, but it is an important distinction to establish since the basic needs that
all people sharewater, nutrition, shelter
etcare often so fundamental as to generate
a right. The danger of not distinguishing
a want from a need is that a group of individuals, such as those lacking a womb, may
claim that they have a right to a uterine
transplant, when what they have in fact is a
deeply held want. To allow the terms want
and need to elide into one another adds
confusion to a debate that requires clarity,
without which it can only be a matter of time
before it is asserted that women without a
womb have a right to womb transplants.
As is often the case, where medical science
at the cutting edge is concerned, medical
scientists merely pay lip service to the question of ethics, leaving society to pick up the
BJM
pieces.
Belkin L (2012) Giving Birth With a Borrowed Womb
is Not What Makes You a Mother. http://tinyurl.
com/o49tg5l (accessed 6 February 2014)
Castanos R, Rogers W, Lotz M (2013) The Ethics of
Uterus Transplantation. Bioethics 27(2): 6573
Orange R(2014) Hopes for First Womb Transplant
Baby. http://tinyurl.com/oa9yzjr (accessed 17
February 2014)
Womb Transplant UK (2014) Why the Need for
Womb Transplants? http://tinyurl.com/p228w52
(accessed 6 February 2014)
British Journal of Midwifery March 2014 Vol 22, No 3

2014 MA Healthcare Ltd

ome debates are said to generate more

heat than light. But a heated debate is
often the best way to generate sufficient light to illuminate a contentious issue.
One such issue is that of uterine transplantation. In the UK, not only is one in
every 5000 females born without a womb, but
around 15000 women of child-bearing age
have no womb (Womb Transplant UK, 2014).
Progress in womb transplantation has
gathered momentum since 2000, when a
26-year-old woman in Saudi Arabia underwent the procedure. However, the uterus had
to be removed after 99 days because of circulation problems. But in January of this year,
Swedish researchers announced that a woman
who received a uterus from her mother in 2012
has had an embryogrown from her own
eggimplanted into her transplanted womb
(Orange, 2014). All being well, 2014 will be the
year of the worlds first child born to a woman
who received a womb transplant.
One question arises immediately: will the
infant be the child of the donor or recipient?
And if the donor had been a cadaver, how
much would the child be entitled to know
about the donor from whose womb he or
she issued?
So long as the technical feasibility of the
procedure can be establishedwhich is only
a matter of timeethical concerns will trail
in its wake. Thus, the Ethical Considerations
section of the Womb Transplant UK website
ignores misgivings that may be voiced by
society at large on whether uterine transplantation should go forward: Ultimately,
the decision to go forward will depend on the
judgment of the researchers, the participating
institution, and most importantly, the patient
to whom the transplant will be offered. This
is hardly an unbiased trio. And in the same
section, while it is acknowledged on the one
hand that: [o]ther ethical issues, particularly
related to the question of informed consent,
must still be more fully addressed, they are
discarded in the next sentence: However, in

Copyright of British Journal of Midwifery is the property of Mark Allen Publishing Ltd and
its content may not be copied or emailed to multiple sites or posted to a listserv without the
copyright holder's express written permission. However, users may print, download, or email
articles for individual use.