As the techniques of uterus transplantation have evolved, culminating in a birth in 2014, the ethical debate has been enriched by several considerations. Uterus transplantation raises issues because of its unique features of being temporary, nonlifesaving, experimental, and expensive, with established alternatives.
Uterus transplantation entails risks for the recipient related to multiple surgeries and immunosuppression, yet studies have shown that women see infertility as a distressing element in their lives, justifying the risks. The alternative of surrogacy has its own ethical issues, and adoption does not provide for genetic progeny. Although patient decisions are susceptible to inconsistent reasoning, misconception of risks or wishful thinking, a carefully drafted and clearly explained informed consent can represent a valid ethical response in balancing risks and benefits. There is no evidence of increased risks for children born from uterus transplant. For living donors, the risks of hysterectomy are known and can be explained to facilitate proper informed consent. Allocation of deceased donor organs needs to be determined, as guidelines for other organs cannot readily be applied. Cost is an issue, as the procedure is expensive and not covered by insurance.
In this rapidly advancing field, a strong ethical foundation is needed to guide regulations and legislation.
Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center at Dallas, Dallas, Texas, USA
Correspondence to Giuliano Testa, MD, Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center at Dallas, 3410 Worth Street, Suite 950, Dallas, TX 75246, USA. E-mail: giuliano.testa@BSWHealth.org