HealthLawProf Blog

Editor: Katharine Van Tassel
Creighton University School of Law

Thursday, October 9, 2014

Uterus Transplants?

While controversial among some ethics experts, uterus transplantation has been performed several times, most commonly in Sweden. A few weeks ago, a mother for the first time gave birth to a baby gestated in a transplanted uterus.

Should we worry about uterus transplants? Transplanting life-extending organs, like hearts, livers, lungs and kidneys, has become well-accepted, but observers have raised additional questions about transplantation for life-enhancing body parts like faces and hands. As long as transplant recipients have their new organs, they must take drugs to prevent their immune systems from rejecting the transplanted organs. The risks can be substantial. For example, the immunosuppressive drugs put people at an increased risk of cancer. It is 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?

We always should worry about risks from novel treatments, but the risks seem quite tolerable for uterus transplantation. Over time, scientific advances have reduced the side effects from immunosuppression. The risks are not as serious as they used to be. In addition, a transplanted uterus can be removed after childbirth, avoiding the need for long-term immunosuppression that exists with other kinds of transplants. Finally, we generally allow patients to weigh the benefits and risks of medical treatment for themselves. Absent a disproportionate balance between risks and benefits, it is not appropriate for society to usurp health care decision making from patients. Hence, face and hand transplants are becoming more common even though they do not prolong life.

Of course, with uterus transplants, we also have to worry about the risks to the child from the drugs that the mother must take to prevent her body's immune system from rejecting the transplanted uterus. On that score, we have reassuring data. Recipients of kidneys, livers, and other organs take the same immunosuppressive drugs as do recipients of a uterus transplant, and more than 15,000 children have been born to transplant recipients since the 1950’s.

Though not definitive, the data are generally reassuring. While children exposed to immunosuppressive drugs during pregnancy are more likely to have a premature birth and low birth weight, they do not appear to be at elevated risk of physical malformations or other serious side effects. Moreover, it is generally difficult to argue that people should not reproduce because of the health risks to their offspring. Procreation is a right of fundamental importance and should be recognized for all persons, even if they may pass a serious disease to their children. Thus, for example, it is acceptable for women to reproduce when they are infected with HIV or carry the gene for a severe inherited disorder.

Can't women rely on gestational surrogacy instead of a uterus transplant? This may work for many women, but not in locales where gestational surrogacy is prohibited. Moreover, 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.

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 uterus transplants. 

[cross-posted at PrawfsBlawg and orentlicher.tumblr.com]

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