Bioethics Today Series: The Ethics of Uterus Transplantation

Today we continue our series highlighting reproductive medicine blog posts written by Lisa Campo-Engelstein, PhD, from the Alden March Bioethics Institute at Albany Medical College for BIOETHICS TODAY.  Dr. Campo-Engelstein's main research areas include reproductive ethics (particularly contraception, oncofertility, birth, and embry and parthenote research), gender and medicine, cancer ethics, and international bioethics (especially Costa Rica).  

BIOETHICS TODAY is the blog of the Alden March Bioethics Institute, presenting topical and timely commentary on issues, trends, and breaking news in the broad arena of bioethics. BIOETHICS TODAY presents interviews, opinion pieces, and ongoing articles on health care policy, end-of-life decision making, emerging issues in genetics and genomics, procreative liberty and reproductive health, ethics in clinical trials, medicine and the media, distributive justice and health care delivery in developing nations, and the intersection of environmental conservation and bioethics.

The Ethics of Uterus Transplantation

Author: Lisa Campo-Engelstein, PhD

BIOETHICS TODAY, November 20, 2014

In the last couple of years, the media has reported women undergoing uterus transplantations. Just last month, the media reported that the first baby was born from a transplanted uterus. While the woman’s identity remains unknown, she is a 36 year old Swedish woman who was born with ovaries, but not a uterus. She and her partner underwent IVF to produce embryos that could then be transferred into the transplanted uterus. This donor is a friend of hers who is 61 years old and had experienced menopause seven years beforehand. The quality of a woman’s uterus does not diminish over time, so she is able to successfully carry a pregnancy event postmenopausally (it is the quality and quantity of her eggs that leads to infertility and eventually menopause).  Both the woman and the baby are doing fine, according to media reports. However, the baby was born prematurely at 32 weeks because the women developed preeclampsia and the fetal heart rate became abnormal. It is not clear from the media reports whether the development of preeclampsia was related to the uterus transplantation.

Uterus transplantation raises a bunch of ethical issues. One critique of uterus transplantation, as well as other forms of assisted reproductive technologies, is that is not net medically necessary.   Rather, it is an elective procedure, as people can live without biologically reproducing. Yet this critique fails to acknowledge that much of medicine deals with quality-of-life issues and not necessarily life-or-death issues. Infertility is a serious quality-of-life issue, especially for women, who often find a diagnosis of infertility to be psychologically devastating. For many women, having biological children and the experience of pregnancy is extremely important to them and is intrinsically intertwined with their feminine identity.