Sunday, March 20, 2016

Is Uterus Transplantation Ethical?

I am not a woman.  I cannot contemplate the physical and emotional experience of carrying a pregnancy and birthing a child.  I imagine that it is a singular experience that is as deep and awesome today as it has always been.  We have all seen the explosion in reproductive technology with in vitro fertilization, surrogate mothers, fertility agents and other emerging techniques.  This process, beyond the high costs, can create anguish for those who are on this journey.

I have felt in many instances that the ethical ramifications of some of these techniques are minimized or dismissed.  Sadly, we often do stuff because we can, not because we should.  Do we really think we can stop human cloning?

Recently, a woman in Cleveland had a cadaver uterus placed during an extremely demanding 9 hour operation on 2/24/16.  This was the first time this was performed in the United States.  Only a handful of these operations have been performed worldwide.  This woman, who has adopted children, was born without a uterus and yearned to carry a pregnancy.  As this operation was part of a clinical trial, I assume that it was paid for out of grant funds.  Shortly after surgery, a complication developed and the uterus was urgently removed. 

Transplanting a Uterus and our Ethics?

A uterine transplant is not a one day affair.  To prepare, the recipient’s eggs are harvested and then embryos are created and frozen.  Then, the complex process of finding a donor is triggered.  The donor organ is harvested and must be transported to the recipient.  Then, the all-day transplant surgery occurs.  The patient is then kept on anti-rejection drugs.   A year later, the embryos are implanted.  Deliveries are performed by Caesarean sections.  After the desired number of pregnancies, the uterus is removed so that the anti-rejection drugs can be withdrawn.

The cost of all this is unfathomable, assuming that no complications occur that would require additional care.  It is certainly possible that a woman could go through the entire process and not carry a baby to term.  Indeed, very few successful pregnancies have occurred worldwide.

I request that readers contemplate the following concerns regarding uterine transplant.
  • Can society justify this massive cost for a procedure that is not necessary to save a life or cure a disease?
  • Is it ethical to risk a healthy patient’s life with highly complex surgery even if she consents to it?
  • Is it ethical to maintain anti-rejection drugs, which has risks of severe complications, for years to preserve the transplanted uterus?
  • Is there a right to pregnancy that the medical profession is obligated to satisfy regardless of the financial, emotional and ethical costs? 
If this technique gets perfected, then it might become possible to implant a uterus in a man.  Then, perhaps, I will have the opportunity to experience the profound wonder that has eluded my gender since the beginning of time. 



2 comments:

The Medical Contrarian said...

Excellent points raised. I expanded upon this in my blog as well:

http://georgiacontrarian.blogspot.com/2016/03/uterus-transplants-and-other.html

I am very surprised the entire protocol was approved by the IRB at the Clinic.

Anonymous said...

Society already incurs massive costs for surgeries which are not necessary to save a life or cure a disease. Penile implants, breast implants, all sorts of cosmetic surgeries. But also the huge rise in mastectomies which are not going to statitically improve survival, but are done because the patient is scared.

Patients lives are risked daily in procedures which are not necessary. Liposuction comes to mind. It has horrific complication rates.

You cite the emotional costs of pregnancy, but not the emotional costs of no pregnancy, which are much greater. A better question is whether insurance should cover this or not, compared to the hundred thousand or so that a surrogate pregnancy would cost. I would argue this is quite different from IVF, which saves the insurers money, and more like cosmetic surgery.

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