Uterus Transplant Births: Ethics, Risks, and Patient Rights

Introduction

Women without functioning uteruses now have a real chance of fulfilling their dreams of motherhood through a radical new surgical procedure: the uterus transplant. Mats Brännström, the Swedish doctor who was the first in the world to deliver babies from transplanted uteruses, had successfully delivered approximately half a dozen such babies by late 2017 ("First Baby from a Uterus Transplant in the U.S. Born in Dallas" 1). In the United States, the first baby born from a transplanted uterus arrived in December 2017 in Dallas. As promising as it is, a uterus transplant birth is a relatively risky medical procedure that has raised questions about the efficacy and ethics of this remarkable intervention. However, as long as full disclosure is made to patients who make their decisions autonomously and with informed consent, transplanted uterine deliveries should certainly be an option for women.

There are several strong arguments in favor of offering this medical option to women who wish to pursue it. The strongest is the ethic of patient autonomy. A woman who has access to a medical procedure, who is fully informed about its pros and cons, and who makes her decision with the awareness and support of her medical team has every legal and ethical right to choose that option. The treatment exists, and despite being risky, it represents one of the most exciting new developments in assisted reproductive technologies.

Arguments in Favor of Uterus Transplant Births

Additional reasons for healthcare workers to participate in this procedure include the promotion of new research that could improve the technology and techniques involved. Furthermore, the option to carry her own child can alleviate the psychological suffering many women experience when they are unable to become a biological mother.

Both utilitarian and deontological arguments support the use of transplanted uteruses as a viable assisted reproductive technology. Deontology promotes the duty of the healthcare worker to support patient autonomy and individual choice. Utilitarian ethics demonstrate how the technology creates the greatest good for the greatest number and maximizes the happiness of the patient and her family. In sum, the rewards outweigh the risks.

Arguments Against Uterus Transplant Births

The first argument against uterine transplant births is safety. To host the transplanted uterus, the mother must take immunosuppressant drugs, which when taken over the long term could cause health damage and may even present a small risk to the fetus (Sherratt 1). Second, concerns have been raised about whether this is an expensive treatment option available only to the wealthy. A third argument is whether demand for the procedure might fuel a black market in uteruses. Finally, some observers question whether uterus transplants might reduce the number of babies being adopted.

Conclusion

The question of whether we should be delivering babies from transplanted uteruses is best resolved through an assessment of costs and benefits, as well as risks and rewards. Uterus transplant is a relatively new procedure, and so it does raise pertinent questions about health and safety. Those questions have been squarely addressed by the small number of physicians qualified to perform this procedure. When women and their families are fully aware of the risks involved, they can take steps to minimize and mitigate those risks by following their doctors' guidance. Not all women will have access to — or even interest in — this costly process, but those who do will gain access to the tremendous experience of carrying their own child, something they would never have been able to achieve otherwise.