Uterus Transplant Raises Hope as Well as Ethical Concerns

Imagine this scenario in the near future.

A woman who doesn’t want children has her uterus surgically removed. Her uterus is donated to a woman born without a womb.

The donated uterus is transplanted into her abdomen so she can get pregnant using in vitro fertilization.

It turns out that future is upon us.

Uterus transplants have already been done in Sweden. The first attempt at such a surgery in the United States was announced this week.

And at least two other medical institutions in this country have started pilot programs for uterus transplants.

For Sara Krish, a 33-year-old Los Angeles woman who had her uterus removed during cancer surgery three years ago, this medical advancement is nothing short of a miracle.

“Most of us want to have that feeling — that feeling of carrying another human being,” Krish told Healthline. “To know I could possibly get that back feels like an absolute blessing.” 

There are, however, ethical concerns arising with this latest scientific breakthrough.

Among the concerns is the fact a uterus transplant is not done to save a life, and it’s temporary as the uterus is removed after a woman is done having children. There’s also the plan to use live donors.

Dr. Mark Surrey, a leading fertility specialist and the co-founder of the Southern California Reproductive Center, said he personally doesn’t have any serious ethical concerns, but these are all issues the medical community must consider.

“It’s not a question of can we do it. It’s a question of should we do it,” Surrey told Healthline.

What’s Involved in These Transplants?

Nine women in Sweden have already had successful uterus transplants.

Five of them have delivered children, the first one occurring in October 2014.

On Monday, doctors at the Cleveland Clinic in Ohio announced that in late February they had transplanted a uterusinto a 26-year-old Texas woman who was born without a womb. The donor had died a few hours before the transplant.

However, Cleveland Clinic officials announced on Wednesday they were forced to remove the transplanted uterus because the patient had developed complications.

It was the first of 10 planned uterine transplants in the clinic’s pilot program.

Baylor Scott & White Health in Dallas and Brigham and Women’s Hospital in Boston have also started pilot programs.

The criteria for these transplants are quite specific.

In the Baylor program, for example, the recipient needs to be between 20 and 35 years old with working ovaries. She must be a nonsmoker, cancer-free for at least five years, have no history of diabetes, and is negative for HIV, herpes, and other sexually transmitted diseases (STDs).

The donor must be 40 to 65 years old, cancer-free for at least five years, clear of any STDs, and had at least one full-term delivery,

All the women who receive a uterus transplant will need to freeze their eggs before the surgery. They will then need to wait for a year after the operation for in vitro fertilization.

Fertilized eggs will be implanted one at a time until a pregnancy occurs, and the women would have cesarean deliveries to avoid excess stress on the transplanted uterus.

The women face the usual potential complications from an organ transplant, including bleeding and infection.

They will be given antirejection drugs as long as the uterus is inside them. After they are finished having children, the uterus will be removed.

None of the medical facilities with pilot programs could provide anyone for comment. One Baylor doctor did explain his institution’s motivation to The Dallas Morning News in late January.

“This is about adding hope,” said Dr. Colin Koon. “It’s about offering an alternative to have children for women who thought they would never be able to have children.”

It’s estimated 3 percent to 5 percent of women of childbearing age worldwide are infertile because they were born without a uterus, or the organ had been damaged or removed. There are an estimated 50,000 women in the United States that fall into this category.

The Ethical Issues

There are a host of issues surrounding uterus transplants.

The overriding concern is if medical science should be providing procedures designed to improve the quality of life as opposed to saving someone’s life.

That same argument has been brought up regarding facial and hand transplants, and Johns Hopkins University’s plans to provide penis transplants.

For uterus transplants that concern is complicated by the fact there is the alternative of a surrogate carrying a woman’s fertilized eggs.

“The procedure is amazing and it’s nice to be able to do it,” said Surrey, “but the question, again, is should you do it.”

Dr. Charles Burton, a neurosurgeon who is a board member and past president of the Association for Medical Ethics, said his organization has no official position on these types of transplants.

The group’s main concern, he said, is whether a patient has received enough information before the transplant is performed.

“A uterus transplant is innovative and creative,” Burton told Healthline. “Our most important concern is to make sure there is adequate informed consent.”

Burton added that this kind of transplant is elective surgery and he hopes these kinds of procedures don’t take away resources from other more vital medical treatment.

In addition, there is the concern that a medical institution will perform such surgeries as a marketing tool as opposed to helping people or moving science ahead.

“There has to be a balance,” Burton said.

There’s also the question of live donors. The health of those donating needs to be considered. In addition, even though it’s illegal to sell an organ in the United States, other countries allow people to put a price on an organ such as a kidney.

“It’s a really murky area. There’s a trade off here,” he said.

Burton does say uterus transplants can improve the quality of people’s lives, a goal of the medical profession

In addition, the transplants could lead to other helpful discoveries, such as what happened when technologies such as Velcro and microwave ovens advanced during the space program.

For Krish, however, the possibility of a uterus transplant is much more emotional.

When she lost her uterus after being treated for cervical cancer, Krish thought she had lost her ability to get pregnant and bear her own children.

“After the surgery, I just saw [pregnancy] as something that was gone,” she recalled. “There was a very dark three weeks there.”

The pilot programs have rekindled her hope. Krish said having a surrogate carry her baby just wouldn’t be the same. She wants to feel the connection between herself and a baby inside her.

“This is the way it’s meant to be,” she said.

Krish has 18 of her frozen eggs standing by in case she does get the chance.

And for those who would question the need for someone to borrow a uterus so they can get pregnant, Krish has a simple message.

“They don’t know how it feels to lose that choice,” she said.