Ethics of uterus transplantation


by Giuliano Testa

May 29, 2016

We think of transplantation as a procedure that restores life. These are vital surgeries for patients who unfortunately have lost function in their liver, lungs, heart or other organs.

What’s fascinating to me about uterus transplant is that we’re not restoring life, but giving life, which is an entirely new dimension for the field of organ transplantation. We want to give hope to women who previously thought they’d never have a chance to become pregnant and carry a child full-term.

Though not lifesaving, a uterus transplant could dramatically improve a woman’s quality of life. Swedish gynecologist Liza Johannesson will tell you what motivated her to get involved in uterine transplant research at Sahlgrenska University Hospital in Gothenburg is meeting women in their early teens who discover they were born without a uterus and can’t bear a child.

“You only have to meet one of these patients to be inspired to work with this,” she said. “It’s definitely about the patients.”

Infertility is a major issue for thousands of women across the world. For those with uterine factor infertility caused by congenital absence or removal of the uterus, traditional assisted-reproduction technologies may not be feasible. Although adoption and surrogacy provide opportunities for parenthood, both options pose logistical challenges and may not be acceptable due to personal, cultural or legal reasons.

The level of finesse and technique required to do a uterus transplant, combined with the ethical considerations, level of difficulty and potential for complications are very similar to what we encounter with living donor liver transplants. Baylor University Medical Center at Dallas is uniquely positioned to perform this procedure, with an experienced transplant group and a team of adult, pediatric, neonatal and obstetric specialists accustomed to managing high-risk, complex patients. The Baylor Annette C. and Harold C. Simmons Transplant Institute is one of the nation’s top transplant programs and has a long history of developing new procedures, new ways of doing known procedures, and new ways of treating patients.

The decision to take on this clinical trial was discussed at length. As a medical ethicist, the first thing I wanted to ensure was that we’re doing the right thing. The trial underwent three ethics reviews: first from the Baylor Scott & White Health ethics committee, then the ethics review board, and finally from Baylor University Medical Center leadership. There was no opposition, or we wouldn’t be where we are today.

We know the risks of immunosuppression drugs and the risks of the surgery. We’ve worked hard to make sure our patients thoroughly understand and have considered these risks. Patients also meet with social workers to evaluate their ability to cope with the stress of donation and being a transplant recipient, and to help to identify the subjects’ support network and the resources available. A psychologist conducts more in-depth evaluation and assessment of the donor and recipient psychosocial history.

“We are honoring the ethical principle that drives medicine today, which is autonomy and respect for human beings.”

As long as the risks are known and the person can make an autonomous decision regarding undergoing the procedure, we are honoring the ethical principle that drives medicine today, which is autonomy and respect for human beings. I think that is the basis for the transplant program here and every procedure done at Baylor University Medical Center.

This is not a lifesaving procedure. This is a life-giving procedure. We hope that it reveals new horizons for ways we can help the patient and creates new avenues for research.

About the Author

Giuliano Testa, MD, FACS, MBA, is the Surgical Chief of the Abdominal Transplant Program and the Surgical Director of the Living Donor Liver Transplant Program at the Baylor Annette C. and Harold C. Simmons Transplant Institute. He is a recognized authority in the field of living donor liver transplantation and living donor intestinal transplantation with a new interest in uterus transplantation.

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