Uterus transplantation presents serious ethical problems from the perspective of both the recipient and the donor, and even the future baby. In this respect we have published several articles on this issue, read HERE.
The first uterus transplant was performed in Saudi Arabia in 2000, but the second was not carried out until 2011, in this case in Turkey. The first transplant in Europe was carried out in Sweden in 2014. So far, 70 uterus transplants have been performed worldwide and 14 children have been born.
In 2013, Mats Brännström of the University of Gothenburg was authorized to perform nine living donor uterus transplants, which were carried out in the spring of 2013. In five cases, the donors were the mothers of the recipients, while in the other four they were family or friends. Two of the transplants failed, but on 14 October 2014, as published in The Lancet, the first child was born from one of the transplanted uteri after a complicated pregnancy, a premature boy, weighing 1775 grams. In this particular case, the recipient of the uterus was a 35-year-old woman with Rokitansky syndrome (a congenital absence of the uterus, which occurs in 1 in 5000 women). The uterus was donated by a 65-year-old woman who had had two previous pregnancies. Read our article Uterus transplant, the birth of the first child. Ethical approach.
Up until 2017, all transplants had been done from living donors. The first uterus transplant from a deceased woman was performed in the United States in the same year.
On 5 October 2020, the first living-donor uterus transplant in Spain was performed at Hospital Clinic de Barcelona. From a medical point of view, uterus transplantation is a complex operation. Thus, in this case, it took 12 hours to remove the uterus from the donor and 4 for its implantation in the patient; notably, the surgical team consisted of 20 people.
From a technical point of view, transplantation is considered successful when the transplanted uterus is functional, which is confirmed if the woman menstruates and especially if she becomes pregnant. Not surprisingly, in vitro fertilization (IVF) must be used to achieve the desired pregnancy. In this particular case, the woman who was to receive the uterus had previously undergone IVF from which 11 embryos had been obtained, one of which was implanted.
Another objective medical problem is that this type of transplantation requires the use of lifelong immunosuppressants, so it is recommended that the transplanted uterus be removed after the first child is born. In the specific case of Barcelona, it seems that the uterus could be removed after the patient has her second child (if that is what she wants), which has not yet happened.
Regardless of the medical aspects discussed, uterus transplantation poses obvious ethical problems. As Federico de Montalvo, member of the UNESCO Bioethics Committee and chairman of the Spanish Bioethics Committee, points out, “uterus transplantation presents serious ethical problems from the perspective of both the recipient and the donor, and even the future baby”.
From a general point of view, the first aspect to be considered is that this practice entails the objectification of women, both the recipient and the donor, which is ethically unacceptable.
Moreover, in relation to the recipient, and also her partner, it can be a manifestation of personal selfishness, which takes precedence over any other consideration by trying to be parents at all costs, because to achieve this, the physical health of both the donor and the recipient is put at risk.
It is also difficult to accept this type of transplantation from a medical point of view because the uterus is not a vital organ like the heart, liver or kidney. Accordingly, it seems controversial to subject both women to a surgical operation which, as we have mentioned, carries potentially serious risks for donor and recipient.
Furthermore, such interventions can impair the physical integrity of the donor, without any improvement in her health, which, of course, is ethically difficult to accept.
From a general point of view, this practice can foster the possibility of commercial transactions of the uteri. In other words, it could become a business, which could certainly enable financially well-off women to buy wombs from poor women, who would use that resource to improve their quality of life. This would unquestionably be an obvious social injustice.
Finally, we believe that it would also open up the possibility of using this type of transplantation for transgender women (who are biologically male) and men, which would indeed add new ethical difficulties to those already mentioned.
Consequently, we believe that uterus transplantation is a surgical practice that must be considered with great caution, as it has obvious negative bioethical connotations, which makes its medical consideration very problematic.
Justo Aznar MED PhD
Bioethics Observatory – Institute of Life Sciences
Catholic University of Valencia