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The Ethics of Allocating Uterine Transplants

  • MICHELLE J. BAYEFSKY and BENJAMIN E. BERKMAN

Abstract:

In September 2014, a healthy male child was born in Sweden following a successful uterine transplantation (UTx). The event brought hope to many women without functional uteruses around the world. Having a child with a transplanted uterus is now possible, and as knowledge of the procedure proliferates and interest in UTx grows, it is important to begin thinking about how a scarce supply of uteruses will be allocated. This article represents a first discussion of the range of factors that must be considered in answering the allocation question. The primary issues addressed are (1) the motivation to seek treatment, (2) allocation by age, (3) child-rearing capacity, and (4) the amount of infertility treatment required. A set of eligibility and ranking criteria are presented. These criteria are not exhaustive but are intended to spark discussion about how uteruses can be allocated in a just manner.

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Notes

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4. See note 1, Brännström et al. 2015.

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8. See note 7, Priore et al. 2013.

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10. See note 5, Catsanos et al. 2013.

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14. It should be noted, however, that surrogacy has its own ethical challenges and is not universally available.

15. See note 12, Orentlicher 2012, at 12.

16. Adoption and surrogacy are both known to be difficult to access, due to a combination of socioeconomic and legal limitations. The adoption process is estimated to cost from $8,000 to $40,000, and surrogacy is estimated to cost at least $60,000 in the United States. (Although the UTx procedure and follow-up care are expensive as well, once the technique is sufficiently well established, it will likely be covered by insurance companies, like other forms of transplantation.) Furthermore, a majority of states do not explicitly permit surrogacy; surrogacy contracts are legally unenforceable, or surrogacy is prohibited altogether, which creates either legal uncertainty or an insurmountable barrier for those attempting to engage in surrogacy in those states.

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28. See note 18, Lefkowitz et al. 2012.

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32. See note 1, Brännström et al. 2015.

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37. We do not mean to imply that women who become mothers through surrogacy or adoption are any less mothers to their children, or even that they are not mothers in the exact same way as women who gestate their children with regards to many of the aspects of motherhood (e.g., responsibility and closeness). They have, however, become mothers through a different path, one that may correspond better or worse to the desires and life goals of different women.

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84. If we took into account ability to afford the treatments needed to become pregnant, we would be advantaging wealthier women who could afford all the treatments they need. Instead, we should develop a mechanism for obtaining low-interest loans for women in need of additional care. It is also possible that, in the future, the procedure will be covered by health insurance.

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Conflict of Interest Disclosures: All authors have no conflicts of interest to report.

Disclaimer: The opinions expressed herein are the authors’ and do not reflect the policies and positions of the National Institutes of Health, the U.S. Public Health Service, or the U.S. Department of Health and Human Services. This research was supported by the Intramural Research Program of the National Human Genome Research Institute, National Institutes of Health.

Keywords

The Ethics of Allocating Uterine Transplants

  • MICHELLE J. BAYEFSKY and BENJAMIN E. BERKMAN

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