In 1970 the first publication of, “Our Bodies, Ourselves (OBOS),” emerged, sparking a new beginning of woman taking charge of their health and bodies. Their goal was to empower woman to be educated and informed not only for the political aspect, but to become their own health experts. (ourbodies) Since then, woman have not stopped moving forward and outspoken about their health, in some cases all the way to the Supreme Court.
With a new discovery, science has now provide a way for woman with a nonfunctioning or nonexistent womb, to have babies where before there was no other way be able to reproduce. This is via a womb transplant. A womb transplant is no exception for women’s issue ethically questioning the risk of such a procedure. The procedure is not just an ethical question if it should be done, but does this now lead into if this would ever be an option for men or transgender to carry babies and deliver babies? Would we now be able to gender select? If women have the right to decide if they want to abort a baby, can they also have the right to a womb transplant to have a baby?
A womb transplant is simply that, a woman receives a womb either from a living or deceased donor. (Time) This modern medical marvel enables woman and hopefully many more to come in the future, to bare children where there was previously no hope. But, such modern miracles do not come without a cost. When it comes to women’s health and reproduction rights, ethical questions always come into play.
Vincent, the first child born following a uterine transplant, was born in Sweden in 2014. This marked the end of a long and hard-fought global race to perform the first “successful” human uterine transplant. Swedish research trials recently reported there have now been six healthy live births via womb transplants. These are the only successful human attempts so far, but globally teams are seeking to emulate the success of Sweden. Clinical trials of uterine transplantation are underway in North America, Europe and Asia. (indy)
Unlike the transplantation of other vast organs, womb transplantation is not intended to save life, but to create it. If women can receive womb transplantations, some have queried whether the procedure may also work in trans women and, even more controversially, in men. Mats Brannstrom, who led the Swedish trial, has said his inbox is now inundated: “I get emails from all over the world on this, sometimes from gay males with one partner that would like to carry a child”. (indy)
While in theory a womb transplant in trans women and men may be possible, in practice there are anatomical barriers that would have to be overcome due to differing shapes of the pelvis, which in trans women is much narrower than those in cis women. But there is no reason to think such barriers might not be overcome.
In the UK, the Gender Recognition Act 2004 gives trans women who have gender reassigned the same rights as their female counterparts. So if womb transplantation becomes clinical treatment in the UK for women who are unable to gestate, could a trans woman claim, under this legislation, that she too has a right to a womb transplant? (indy)
While some have advocated the “reproductive needs” of trans women, who may have strong desires to experience gestational motherhood, it has also provoked opposition. Julie Bindel reportedly stated: “This is not about transgender rights – it’s about a twisted notion as to what constitutes a ‘real woman’.” A debate is now needed on whether it can be claimed that there is a right to gestate under the umbrella of procreative liberty or the right to a private family life. And if such a right to gestate does exist, does it apply only to those born female, or trans women and men also? With the controversy surrounding this procedure, it could possibly be another women’s health or reproductive issue that makes it way to courts as new and unknown issues could arise as more transplants begin to occur. Especially, if insurance companies get involved.
In light of womb transplant technology, we need to address whether or not there is a right to gestate, not whether or not the NHS should fund it – the question that has so far dominated media coverage. Finite public resources should not be invoked as a smokescreen to mask prejudices towards gender reassigned individuals to whom parliament has given clear rights. If it is decided that women should be allowed womb transplants on the NHS, it follows, given the legislation enacted by parliament, that trans women also have that right. In terms of the overblown hype over cisgender men becoming pregnant, even if womb transplantation in a male body becomes scientifically feasible, it would only be possible for men to carry a pregnancy if an IVF embryo was implanted into the womb. In the UK, assisting a male to become pregnant does not fall within the specified activities for which a licence can be granted to a fertility clinic when “bringing about the creation of embryos in vitro” under the Human Fertilisation and Embryology Act 2008. Therefore, implantation of an IVF embryo in order to assist a man to experience pregnancy, in the absence of a licence, would be liable to imprisonment or a fine upon conviction.
Almost 40 years ago, the birth of Louise Brown, the world’s first “test-tube baby”, prompted ethical and legal discussions and debates. As womb transplants move from science fiction to science fact, it is clear that reproductive science continues to propel us into uncharted territories and tests the very essence of legal and ethical principles, such as the right to procreative liberty and the right to private and family life. Does this encompass a right to gestate? It is clear that not all would interpret such a right, if there is one, as encompassing unisex gestation. (indy)
In many European countries, including Sweden, using a surrogate to carry a pregnancy isn't allowed. Life-saving transplants of organs such as hearts, livers and kidneys have been done for decades and doctors are increasingly transplanting hands, faces and other body parts to improve patients' quality of life. Womb transplants — the first ones intended to be temporary, just to allow childbearing — push that frontier even farther and raise some new concerns. (USA)
Some experts have raised concerns about whether it's ethical to use live donors for an experimental procedure that doesn't save lives. But John Harris, a bioethics expert at the University of Manchester, didn't see a problem with that as long as donors are fully informed. He said donating kidneys isn't necessarily life-saving, yet is widely promoted. About one in girl in 4,500 is born with a syndrome, known as MRKH, where she doesn't have a womb. (USA)
He said removing a womb for donation is like a radical hysterectomy but it requires taking a bigger chunk of the surrounding blood vessels to ensure adequate blood flow, raising the risk of complications for the donor. Smith said British officials don't consider it ethical to let donors take such chances for an operation that isn't considered life-saving. After a maximum of two pregnancies, the wombs will be removed so the women can stop taking the anti-rejection drugs, which can cause high blood pressure, swelling and diabetes and may also raise the risk of some types of cancer. (USA)
Richard Paulson, president of the American Society for Reproductive Medicine, said eight children had already been born to women after transplants. He told a meeting in San Antonio, Texas: “There’s plenty of room to put a uterus in there. Men and women have the same blood vessels.” That being said, the male pelvis is shaped differently than the female’s pelvis. The transgender would have to deliver via caesarean section. Paulson also said that transplanting a uterus into a man who identifies as a woman, would spark a huge ethical debate. Not only the ethics of right or wrong and messing with Mother Nature, but also for the long-term health risk that could be involved. Our western society may not be ready for such things.
He also said the next step would to be trials involving transgender women to help them become natural mothers. Such options are not allowed in the UK. But, earlier this year, UK academics called for a debate on whether transgender women should be considered for womb transplants. Liverpool University medical ethics lawyer Dr Amel Alghrani said new technology now makes it possible for them to have children of their own. (sun)
For the first time in the United States, a woman who was born without a uterus gave birth to a baby. The landmark birth took place at Baylor University Medical Center at Dallas, a part of Baylor Scott & White, TIME reports exclusively (TIME)
The recipients in the clinical trial are between the ages of 20 to 35, and the donors must be between ages 30 to 60. “When you donate a kidney, you do it to help someone live longer and get off dialysis,” says Dr. Testa. “For these women, they are donating an experience.” (TIME)
Uterus transplants are expensive, with some estimates putting the cost at up to $500,000. Like other infertility treatments, it’s very rare that an insurance company would cover the procedure, which is largely viewed as elective. Then, the question would be, should it get to the point where insurance would pay for such a procedure, what would that look like? How much control would the insurance companies have? This brings about another ethical question that could fall under the Duty Theory. If someone proceeds with this costly and elected procedure and then develops serious complications during the pregnancy, who covers the cost? Complications cost additional bills in which the person may not be able to pay for the medical bills, yet it is the duty of the medical care team to provide care. Baylor covered the cost of the first 10 transplants in the clinical trial, but the medical team is now seeking funding—largely through donations from institutions and private donors—in order to continue. The team says many more transplants need to be done before it could be provided as a standard treatment. “The reality is that it’s going to be very difficult for many women to afford this,” says Testa (TIME)
On NPR, All Things Considered , host Kelly McEvers did an interview with Dr. Johannesson and Dr. Testa on the debated womb transplant procedure. Dr. Liza Johannesson, along with her colleague, Dr. Testa are part of the the Baylor team from Sweden that delivered the first womb transplant baby. Dr. Johannesson said the procedure could be compared to a hysterectomy, but little bit more complicated than a simple hysterectomy. The procedure takes about five hours to remove the uterus from the donor, then five hours to place into the recipiant. Then, it takes time to know if the womb will function correctly and take to the body. After that, the recipient must have periods showing that it will be able to function correctly so that an embryo can be implanted, and then finally you have a pregnancy and then you have to wait the nine months before you have a baby. “So the actual success is one and a half years down the line. That's very rare in transplants.” (NPR)
These transplants are not always successful and have potential for great emotional distress, which leads into the question of ethics. The procedure is considered to be risky and still in the experimental stages, so how much information can be provided for a something so experimental for the ‘informed consent’? So many women so desperately want to have a baby that they may be willing to take huge risk. Dr. Testa tells NPR that this type of thing is really going into uncharted waters which makes thing complicated. She states, “I think that we go through years of studying to understand what we do, and to achieve mastering the things we do. And then we pretend that in ten minutes we can explain something to anybody. … I don't think it's really possible.” (NPR) The doctors do their best to explain what they know in the simplest of terms so that the patients can make an informed decision.
What are the risk and complications that could arise for the baby? Dr. Johannesson addressed this issue with more confidence. She stated that since so many pregnancies and births have occurred after a liver or kidney transplant that the medical field has good knowledge of what they could expect after a uterus transplant in consideration of the use and effects of immunosuppressive drugs. We now know a lot of the effects with the drugs have on pregnancies, the babies, and on recipients and which immunosuppressive drugs you should not take during pregnancy. (NPR) Obviously, kidneys are necessary and some women have been on them during their pregnancy after a kidney transplant and delivered a healthy baby. However, it really is still too soon to know how this will all go with a womb transplant. Even with the lack of research, the transplants are still moving forward.
The Albany Medical College states an opinion on our western medicine and ethics this way, “Especially in the US, reproductive medicine is seen as the “Wild West” because much of it is unregulated and new, experimental procedures often take place outside of approved channels, such as IRBs or clinical trials.” The argument is that this is such an experimental procedure and we do not know of all the short and long-terms implications and that it targets vulnerable people desperate to have a baby. On the flip side, this would also allow participants to be a part of a trial that could provide them with something that previously was not an option. This could also have potential to eliminate the controversy of surrogacy that is not allowed in some countries. (AMC)
This is a challenging and difficult issue as it very much involves the emotional, mental, physical, and financial aspects of a life-changing decision. As you look back in history, you could see how many of our modern and routine medical procedures that are performed today, also once highly controversial issues were. We can only imagine what the future will be for womb transplants. “Ethics in Allied Health” study guides addresses some questions having to do with organ transplants that would also apply to womb transplants. Such as, who should get priority when organs are available? Should the doctors give priority to the younger patients, or the ones who have the better chance of greater results? In 1984 the National Organ Transplant Act established the Organ Procurement and Transplant Network (OPTN). This organization is there to be sure there is fair allocation of the organs for transplant. OPTN allows the public to be able to contribute to the discussion of proposed changes to the organ allocation rules. So where does womb transplant fit into the OPTN or does it need to? As of now, with the transplant being so new, womb transplants are not addressed with the OPTN. However, if this moves forward as many believe it will, uterus transplant will be added as a transplant with a waiting list along with adding new rules and principles for this specific type of transplant.
As a mother of four and one miscarriage, I can understand the desire and want to have a child of my own. I also know the pain of the loss of fetus. There are many highs and lows of pregnancies and I can only imagine the stress and anticipation of someone who has a transplant and the waiting to see if it is going to work. The cost for the procedure is so extreme; I would think that this would only add to the stress, especially if the transplant doesn’t work. That being said, if someone believes that they can handle the outcome, however that turns out and feels like they can carry the financial burden, then, they should have the right to take the risk. When it comes to the laws and ethics of a medical issue, the law should always be followed and the treatment should always be ethical. With such a new procedure, these elements are still being worked out, causing some controversy along the way. Are we opening Pandora’s Box once we start transplanting wombs into men or transgender? When it comes to our own bodies, we need to do our best to take care of ourselves and live by our own conscience within the law and ethics.
This is such a new procedure that naturally it will have conflicting opinions on the how, why and when it should take place, if even at all. At this point it is hard to predict the future of the womb transplant. It certainly is changing the few lives of those who have successfully given birth. This very well could become a common medical practice just like anyone going to the doctor for fertility drugs. Consider in the past 100 years ago when a doctor would actually perform some sort of surgery right in a person’s home. If that happened today, it would be on the front page of every press media and television. What is unknown and foreign today can evolve into normal practice in the future. I believe womb transplants are no exception. Now that we have success with the transplant, I think very little could stop it from moving forward, even if it would be considered illegal at some point. Hopefully, law and ethics can come together to make this modern miracle possible and less costly. This gives hope to many women, men and transgender for that which is in our DNA, the desire to be part of and have a family. When it comes to our bodies and our health, we should speak up and cherish our health.
Ourbodiesourselves.org
https://www.independent.co.uk/life-style/health-and-families/medical-law-expert-on-womb-transplants-unisex-pregnancy-and-the-right-to-gestate-a7832936.html
https://www.usatoday.com/story/news/world/2014/01/13/womb-transplant/4456975/
https://www.thesun.co.uk/news/4839905/womb-transplant-men-can-have-babies/
http://time.com/5044565/exclusive-first-u-s-baby-born-after-a-uterus-transplant/
pennfoster study guide
https://www.npr.org/sections/health-shots/2017/12/05/568453168/first-baby-born-to-u-s-uterus-transplant-patient-raises-ethics-questions
http://www.amc.edu/bioethicsblog/post.cfm/the-ethics-of-uterus-transplantation
The Ethics of Uterus Transplantation