Uterine Transplants?

Inspired by Kim Krawiec's example, I thought I'd share a topic from my course on Social Regulation of the Body:

Should surgeons transplant a uterus into a woman who was born without a uterus or has had a hysterectomy and wants to become pregnant? The debate reminds us that efforts to promote family values often neglect the interests of the infertile.

Transplanting life-extending organs, like hearts, livers, lungs and kidneys, has become well-accepted, but ethicists have raised additional questions about transplantation for life-enhancing body parts like faces and hands. It's one thing to assume health risks for the possibility of a longer life, but are the risks of being a transplant recipient justified by improvements in the quality of life?

As surgeons contemplate uterine transplants, the closer scrutiny can make sense--for example, what risks are posed to the child from the drugs that the woman must take to prevent her body's immune system from rejecting the transplanted uterus? (Proponents of uterine transplants, like Dr. Giuseppe Del Priore, observe that kidney and other organ transplant recipients who take the same drugs have become pregnant and given birth without harm to their children.) We should be careful before adopting a new kind of transplantation.

On the other hand, it's troubling to see scholars question uterine transplants on the ground that giving birth to one's own child is not that important an interest. According to an ethics professor, "tons of people have perfectly normal lives without gestating a biological child." Yet, the alternative for the woman lacking a functioning uterus is to have children with the participation of another woman. This may work for many women, but the legal battles that can follow gestational surrogacy illustrate the risks of that alternative, as well as the significant role that gestation plays in forming motherhood.

Many women may be perfectly  happy despite losing their ability to carry a pregnancy, but that should not lead us to dimiss the interests of those women who very much want to become mothers after pregnancy. Indeed, when infertility is a consequence of cancer or its treatment, some cancer survivors describe the loss of fertility as causing as much emotional pain as the cancer itself. Our society often discriminates against the infertile out of a tendency to dismiss the impact of infertility on personal well-being. 

There are many important reasons why women want to bear their own children. Women may want to have children with their chosen partner and without the involvement of third parties (an interest considered in this article). They may want to benefit from the ties with their children that develop during pregnancy. For these and other reasons, we should be careful not to be overly skeptical of uterine transplants. 

[cross-posted at Health Law Profs blog]

Comments

[Kim Krawiec]

Great post, David. And a fascinating question. I'd love to know more about your course and possibly see a reading list if you're willing to pass it on at some point. Best, Kim

[Becca Rausch]

I'd also like to see a reading list if possible.

When you cover this topic, do you also discuss the source of the transplanted uterus? Does the uterus come from a recently deceased woman, the same way a heart would be sourced for transplant, or can another living woman (perhaps someone who has a healthy reproductive system but no interest in bearing her own children) donate her uterus to the recipient, similar to a kidney or liver transplant? How much of a woman's personhood is tied up in her reproductive organs, contemplated from both the donor and recipient perspectives, and might live donors shift norms?

Consider the planned mother-daughter live donation in Sweden
http://abcnews.go.com/Health/w_ParentingResource/daughter-undergo-transplant-mothers-womb/story?id=13830608#.TywcIko31cE

versus the successful deceased donor transplant in Turkey
http://rt.com/news/first-uterus-surgery-success-845/

Also, do you discuss the social values of reproduction versus the social values of self-sufficiency as a foundation for distinctions between concerns about various types of "life-enhancing" transplants (i.e., uterus v. hand)?

Interested in hearing comments on these issues, as well as what students may have said. Thanks for the great post.