A team of Swedish surgeons from Sahlgrenska University Hospital in Gothenburg have performed a mother-to-daughter uterus transplant for the first time. The operation was carried out over the weekend of 14-15 September 2012. The uteruses of two mothers were transplanted into their daughters, who were aged between 30 and 40 years. One of the recipients had been born without a uterus and the other had hers removed due to cervical cancer. Even though the donors were already menopausal, this did not mean that their uteruses were unable to carry an embryo to full term and birth.

However, these operations are not the first uterus transplants performed in the world, as in 2002, a Saudi Arabian woman underwent a transplant, although it had to be removed three months later due to thrombotic complications. Uterus transplants from deceased donors have also been performed in Turkey.

Mats Brännström, professor of Obstetrics at the hospital where the transplant was carried out, said that a team of 10 surgeons had been training in this surgical procedure for several years on animals, in order to acquire the experience necessary to perform it in humans.

At a press conference, the surgeons responsible for the transplant said that the four women, the two mothers and two daughters, had tolerated the surgery with no further complications. Nevertheless, stated Dr. Brännström, while the operations had been a success, the overall success could not be confirmed until the women, after becoming pregnant, were able to give birth to two healthy children.

This uterus transplant project is the result of an extensive research programme that began in 1999, aimed at trying to resolve the problem of infertility in women without a uterus. Naturally, during the biomedical research phase, the researchers worked initially with animals, especially mice, achieving pregnancies and births of healthy animals. The group then took a further step forward in performing the same techniques in pigs, sheep and primates (BMJ 345; e6357; 2012).

But, regardless of the technical aspects of uterus transplantation that have been discussed, the following question must be asked: is this transplant ethical?

Ethically, it is accepted that not all organs can be donated. The brain and gonads should not be transplanted, as this would affect the personal and procreative identity of the human being created, aspects that medicine has an obligation to protect.

However, the uterus does not seem to be included in these types of organs, since although it is part of the reproductive system, it does not participate in the definition of the genetic identity of the human being conceived; therefore, we are of the opinion that there are no ethical problems for uterine transplant, as long as it follows the ethical rules that govern all types of transplants, which are basically: a) the informed consent of the donor and recipient, after making both parties aware of the potential risks of the technique; b) to respect the ethical regulations governing transplants between living persons; c) that there is a reasonable probability that the pregnancy can continue to term, regardless of the procreative technique used (something that has not been achieved so far), in order to verify that any children born do not have medical problems, especially low birth weight and preterm birth; and d) to comply with the principle of proportionality, which should govern all medical procedures, and which in this case refers to the risks to which the uterus donor and recipient are subjected, and the benefits that might be obtained with this transplant (Justo Aznar).