Running Head: UTERINE TRANSPLANTATION

Uterine Transplantation

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Uterine Transplantation

The notion of uterine transplant offers an incredible form of treatment for the women

who suffer from uterine infertility. According to Petrini, Gainotti, Morresi, & Nanni Costa

(2017), uterine transfer has been performed on women who have absolute uterine infertility

factor (AUIF). The uterus donors can either be living or deceased. Uterine transplant will give

the women the ability to experience the period of gestation as an aspect of motherhood.

Therefore, given the nature of this form of transplant, it is essential that the medical safety of the

patients, including the safety of the procedure. This paper analyses the ethical and legal

implications of uterine transplant and as well as how the insurance companies will approach the

cost of this procedure. The paper will also look into the implications of uterine transplant on

transgender women and cisgender as well as on the concept of unisex pregnancies.

Ethical Implications of Uterine Transplants

Uterine transplantation has raised a lot of ethical questions. The procedure has moved

from the research phase to the clinical phase thus necessitating ethical reviews for all of the

involved parties. The parties include the donor, the recipient and the potential child that will be

born in the future. The issue of donors is one of the most important ethical implication. Arora,

Woessner, & Blake (2015) explain that it is possible to use both living and deceased donors.

However, they identify that living donors were commonly used in the research done by

Brännström et al. Furthermore, the use of living donors may be banned in some parts of the

world while in other parts, deceased donors are preferred.

The rule of Rescue is also an essential implication in the transplantation of the uterus.

According to this rule, the organs that have been harvested from cadaver donors should only be

used as an intervention to save lives. Additionally, the organs have been justified that they
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should also be used to enhance the quality and not quantity of life. However, in this context, the

ethics rule explains that human beings have a duty to save life that is endangered whenever it is

possible. Therefore, organs that have been donated should be given the priority if they have the

ability to save lives and as such, uterus transplant is given a lower priority in the society as it

does not save lives.

Transplant from donors should only be conducted if the donor expressed the desire when

they were alive. This ethical concept is due to the public’s familiarity of the procedure as well as

the unique legal and ethical concerns. In addition, more research should be carried out in order to

comprehend the distinctive issue of donation of a reproductive material from a deceased person.

The research should also look into the laws that surround surrogate approval for donation from a

cadaver.

There is also the concern for medical safety in instances where a living donor is being

used. The medical safety concerns include hysterectomies that may cause thrombosis, major

blood loss, adverse anesthetic reactions, injury to bowel or bladder, and even death. The donor

should also give consent that is free from coercion and they should also be tested in order to

ensure psychological as well as medical suitability. The donor should also comprehend both the

benefits and the risks that are associated with the transplant. Both the donor and the recipient

should be made to understand the consequences that may befall both of them as well as the

effects of the procedure on their future health. Insurance coverage is also a concern for that

should be clear to both the donor and the recipient. If the donor is living, they are allowed to

have donor advocates who are meant to protect the donor and also ensure that the donor can

discontinue at any stage without having to give the reasons to the recipient.
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Aside from concerns for the donor, there are a number of concerns for the recipient of the

uteri. The recipient is required to undergo two additional surgeries even if the transplant surgery

was successful. The surgeries include a cesarean section during the delivery of the child as well

as a postpartum hysterectomy which is meant to avoid the need for lifelong immunosuppressive

therapy. However, it is unclear how the responsiveness of pregnancy in patients of the transplant

as compared to natural conceiving mothers. For instance, it is unclear if the patient will

experience foetal movement or contractual sensations even though they may experience morning

sickness, enlarging and swelling of the uterus (Arora, Woessner, & Blake, 2015). Therefore,

although uterus transplant aims at providing the experience of pregnancy, there may be varying

sensations for the patients as compared to those who conceive spontaneously.

Legal implications of uterine transplants

A detailed clinical report of a successful uterus transplant and live birth that occurred in Sweden

provides a detailed guide for such practices. The law allows both family members and friends to

act as living donors. On the other hand, donations from other parties, for instance, unrelated

sources our deceased women are a bit difficult to conduct as there is need for several tests to be

done to ensure that the organs match and the donor has no hidden intentions. Additionally, it is

illegal to sell human organs in many countries including the United States and this law is enacted

under the Uniform Anatomical Gift Act. However, some practices such as surrogacy are allowed.

It is also difficult to follow the law when doing a uterine transplant as this is one of the areas that

is not well explained in the constitution. For instance, principles that are set aside by UNOS are

difficult to put into practice because uterine transplant is considered to be neither lifesaving nor
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life extending, therefore, conducting such a procedure will require a wide consultation from

various specialists (Schiff, 2018).

How insurance companies will approach the cost of this procedure

Currently, there are few insurance companies that cover assisted productive technologies

such as IVF and they are usually done in a maximum of two cycles. Hence, uterine transplants

are expected to be more expensive because they can cost up to $300,000 and both the recipient

and the donor will be required to stay at the hospital for a long time. It is also expected that

insurance companies will not rush into covering this operation hence making it available to the

wealthy individuals while the middle and lower-class individuals will not benefit as they will not

be able to afford it. The people who will be affected most are the trans-patients who are already

finding it difficult to get to afford hormonal treatments and necessary surgeries as most insurance

companies consider them to be cosmetic and only cover for those who are deemed to be

“medically necessary.” (Nathalie, 2017).

Could a womb be transplanted into a transgender woman – or even cisgender (non-

transgender) men

The main aim of conducting a uterus transplant is to restore fertility to the recipients.

Theoretically, it is possible to perform uterine transplant to trans patients. However, there are

barriers that need to be overcome such as different pelvic shapes, the transplant itself is

complicated to perform, and need for hormone supplementation. As a result, any transgender

who will attempt to give birth in future will only do so in the caesarian section, that is if the

transplant was successful. The practice is also expected to bring issues of ethical debate as most
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people are not likely to support the idea of transplanting a uterus to someone who was born a

man because of the complications involved which may endanger the lives of both the babies and

their mothers (Alghrani, 2017).

Could pregnancy soon be unisex?

Bernstein et al (2017) explains that there is need to ensure that the uterus will be able to

function normally during pregnancy, even though it is possible to carry out the procedure.

Concerns such as inadequate blood flow during pregnancy as well as in pre-eclampsia.

Furthermore, there are other baseline medical risk that are associated with using a transplanted

uterus irrespective of the gender of the recipient. He further adds that since there is no difference

between pregnancy in transgender woman and cisgender woman then there is no difference

between carrying a child to term between transgender woman and a cisgender man via uterine

transplant. Therefore, if this concept is true, then pregnancy will be unisex since a man will be

able to use his sperm to fertilize a donor egg and carry his child to term.

The implications of this procedure and the large number of babies and children awaiting
adoption
The absolute uterine factor infertility has been identified as the same as the absence of a

uterus or presence of one that is not fully functioning. Adoption or surrogacy are among the few

options that are available to patients with this condition. Additionally, surrogacy and adoption

are linked with financial, ethical, religious, psychological and legal issues. Therefore, uterine

transplant may offer a worthwhile solution in the near future if the procedure advances (Kumar,

Patil, Shah, & Srivastava, 2016). However, Belluz (2016) identifies a dilemma whereby this

transplantdeals with reproduction and not a vital organ such as heart or kidney. She further adds

that the procedure is risky and unnecessary when there are other available options such as
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surrogacy. In addition, Bernstein et al (2017) explains that a surrogate uterus would be more

preferable as compared to a transplanted uterus when viewed from the perspective of the future

child since a surrogate uterus does not put the future child through risks that are unnecessary as

compared to a transplanted uterus.

Conclusion

It is clear that even though uterine transplant may prove to be beneficial in the future, there are

a number of concerns that have to be addressed. These concerns have major implications on all the

parties involved. These concerns are of different contexts such as financial, legal, ethical as well as the

social concerns. With the presence of uterine transplant, pregnancy may become unisex as men will be

able to fertilize a donor egg and carry their child to full term. In addition to that, the introduction of

uterine transfer will lower the rate of adoption and surrogacy since people will be able to conceive

children with the help of a transplanted uterus. On the other hand, the procedure may not be easily

available if it is not covered by the insurance companies. The procedure is very risky and there is a

possibility that some insurance companies may not be willing to cover the costs. As a result, the

procedure will only be available to those who can afford it. Therefore, since uterine transplant is a fairly

new concept that is still in the clinical phase, it is essential to address all the concerns such as consent,

the benefits and risks to all the parties involved, the exit strategy for both the donor and the recipients

as well as the legal implications for all the parties involved.

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References

Alghrani, A. (2017, July 10). Medical law expert on womb transplants, unisex pregnancy,

and the 'right to gestate? Retrieved from http://theconversation.com/medical-law-

expert-on-womb-transplants-unisex-pregnancy-and-the-right-to-gestate-80581

Arora, K. S., Woessner, J., & Blake, V. (2015). Ethical considerations in uterus

transplantation. Medicolegal and Bioethics, 2015(5), 81-88. doi:10.2147/mb.s64947

Belluz, J. (2016, April 11). Uterus transplants are extremely risky. Doctors should keep

doing them anyway. Retrieved from https://www.vox.com/2016/3/10/11194466/first-

uterus-transplant

Bernstein, M., Blumenthal-Barby, J., Caplan, A., Chevinsky, J., Elster, N., Klugman, C., …

Magnus, D. (2017, May 12). Uterine Transplantation – for Men? | Bioethics.net.

Retrieved from http://www.bioethics.net/2017/12/uterine-transplantation-for-men/

Dickens, B. M. (2016). Legal and ethical issues of uterus transplantation. International

Journal of Gynecology & Obstetrics, 133(1), 125-128.

doi:10.1016/j.ijgo.2016.01.002

Kumar, S., Patil, S., Shah, S., & Srivastava, N. (2016). Uterine Transplantation: An Option

beyond Surrogacy. MGM Journal of Medical Sciences, 3(3), 141-143.

doi:10.5005/jp-journals-10036-1110

Martinez, M. (2017, November 4). 'You could do it tomorrow?: How soon is 'soon? for trans

women wanting to give birth? Retrieved from https://www.sacbee.com/news/nation-

world/world/article182774231.html

Nathalie, F. (2017). Transplanting the womb: an examination of the ethics and potential of

uterine transplantation. Senior Capstone Projects.

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Petrini, C., Gainotti, S., Morresi, A., & Nanni Costa, A. (2017). Ethical Issues in Uterine

Transplantation: Psychological Implications and Informed Consent. Transplantation

Proceedings, 49(4), 707-710. doi:10.1016/j.transproceed.2017.02.013

Schiff, L. C. (2018, July 7). Uterine Transplants: Legal Perspectives on Reproductive

Technology | The Legal Intelligencer. Retrieved from

https://www.law.com/thelegalintelligencer/2018/07/07/uterine-transplants-legal-

perspectives-on-reproductive-technology/?slreturn=20180712083502