Uterus transplantation with living donors ethically as problematic as altruistic surrogacy

In 2014, the first child to have been gestated in a donated uterus was born. Although research into uterus transplantation is still in an early phase, many see the donations as a success. Researchers at universities including Linköping University have studied ethical aspects of uterus transplantation. The results show that uterus transplantation with living donors is ethically just as problematic as altruistic surrogacy.

A number of research projects on uterus transplantation are under way around the world. Thus far, trials have resulted in the birth of ten children who were gestated in a transplanted uterus; eight of these were in Sweden. Being able to transfer a uterus from one woman to another, so that an infant is born, can be seen as a success in a medical sense. However in Sweden there has been little in the way of ethical discussion.

"If uterus transplantation is to take the step from trials to becoming a reality in the Swedish healthcare system, there must first be an ethical debate on the procedure. Our study doesn't arrive at an opinion as to whether uterus transplants should be carried out. But it shows that people must be aware of the parallels with altruistic surrogacy", says Lisa Guntram, researcher at Linköping University.

Women can be pressured

In 2016 a Swedish white paper on matters including altruistic surrogacy was published. It stated that altruistic surrogacy should not be permitted in Sweden. With this white paper as a starting point, Lisa Guntram analyzed the assumption that introducing uterus transplantation would be less problematic than altruistic surrogacy. The research was conducted together with Nicola Jane Williams from Lancaster University in the UK, and the results of the study have been produced in the journal Bioethics.

Guntram's and Williams' research shows that many of the arguments against altruistic surrogacy can be applied to uterus transplantation as a treatment for involuntary childlessness. Some of these include:

1.That the intervention can threaten the autonomy of the donor, and subject her to pressure.

The question here is whether the surrogate mother is actually participating of her own free will, and not as a result of pressure. In the Swedish trials, the donated uteruses come from a relative, in most cases the mother of the woman who is involuntarily childless. Consequently, some close relatives of involuntarily childless people can feel forced to donate, or be actively subject to external pressure.

2.That the intervention can lead to exploitation of women's bodies.

The surrogacy discussion has identified risks such as the exploitation of women's bodies, and that there may be secret compensation agreements. Similarly, there is a risk that with time, uteruses can become yet another organ, such as kidneys, on the black market.

3.That the research on the physical and psychological risks facing the child is inadequate.

As in surrogacy contexts, little is known of the consequences of uterus transplantation for the child, because so few children have been born as a result of such a transplantation.

The conclusion of Guntram's and Williams' study is thus that uterus transplantation is not necessarily less ethically complicated than altruistic surrogacy.

"If the arguments presented in the study are to apply to altruistic surrogacy, decision-makers should seriously consider whether they shouldn't also apply to uterus transplantation. If they feel that treatments should be assessed differently, they should express their reasoning very clearly", says Lisa Guntram at Linköping University.