The ethics of uterus transplantation: Moral challenges and recommendations for progress

Abstract

Uterus transplants, a form of vascularized composite allograft, have so far, up until January 2019, resulted in eight successful live births in Sweden and additionally two births in the USA, one birth in Brazil, one birth in Serbia/Italy, one birth in India, and one birth in China. Moreover, there are several ongoing pregnancies with expected deliveries in 2019. In the USA, initial attempts resulted in failures. One case in Cleveland and three out of four transplants in Dallas resulted in uterus removal due to complications. The ethical concerns regarding whether the pursuit of a pregnancy justifies the risks involved with the surgery must now be updated to acknowledge the successes and failures of these first attempts. Similarly, concerns regarding how the practice should ethically be pursued must now be characterized. These include how to ensure adequate qualifications of transplant teams, designing research trials and patient selection criteria to protect recipients, selecting informed and voluntarily consenting living and cadaveric donors, defining adequate metrics for a “successful” uterine transplant, ensuring a strategy for managing failure, and ensuring equal access for potential recipients.