By: Elizabeth Yuko, Ph.D.

Nine women in Sweden have successfully received transplanted wombs donated from relatives, in what was the first large-scale experiment to determine whether this procedure could someday result in pregnancy. Was this experiment ethical, and if so, should it continue?

The womb transplantation experiment began in September 2012 and each recipient – women, mostly in their 30s – was either born without a uterus, or had it removed as part of their treatment for cervical cancer. So far, none of the women are pregnant. Dr. Mats Brannstrom, chair of the obstetrics and gynecology department at the University of Gothenburg and leader of this initiative, has stated that he hopes to begin transferring embryos into some of the patients soon – possibly within months. The transplanted uteruses were not connected to the women’s fallopian tubes, meaning that in order to become pregnant, their eggs were first retrieved and embryos were created using in-vitro fertilization, which will later be implanted in the transplanted uteruses. Brannstrom did not clarify why the fallopian tubes were not connected.

In relation to the current experimental phase of the womb transplantation procedure, the principles of beneficence and non-maleficence must be considered, as the procedure could have potential risks and complications for both the donor and recipient. Firstly, the procedure involves the donor undergoing major surgery in order to donate an organ that is – unlike transplant surgeries for hearts, lungs and livers – is not required to sustain the life of the recipient. Unlike a previous attempt at a womb transplant in Turkey where the uterus came from a deceased donor, the transplanted wombs in the Swedish experiment all came from living donors – all of whom were relatives of the recipients. The donors – presumably otherwise healthy individuals – underwent the equivalent of a radical hysterectomy, only riskier, as a larger portion of the surrounding blood vessels must also be removed and transplanted in order to ensure adequate blood flood.  While receiving the donated uterus may, in fact, benefit the recipient if she is successfully and safely able to gestate and bear a child, there are no direct biological benefits for the donor to undergo this major surgical procedure.

As with any other organ donation situation, full informed consent of the donor is required before the procedure can take place. This must have taken place before the Swedish experiment, but for some it may be difficult to imagine a scenario in which donors were permitted to undergo major surgery for experimental treatment which did not result in an attempt to save lives. Others would argue that it is well within the donor’s right to autonomy to donate their womb to another person – in this case, a relative – who has a strong desire to gestate and bear children.

Additionally, as with any other transplant, the recipient also faces possible complications, including those related to the procedure itself, rejection of the organ, and the effects of the anti-rejection medication. The doctors in the Swedish experiment have determined that the recipients would only be permitted to undergo a maximum of two pregnancies before the transplanted womb is removed. This increases the number of highly invasive, potentially risky procedures the recipient must undergo to four: (1) egg retrieval prior to the womb transplant; (2) the womb transplant procedure: (3) the procedure to implant embryos; and (4) the recipient’s hysterectomy after up to two pregnancies. These procedures are in addition to what could be potentially complicated pregnancies. As this is still an experiment, the effects of the pregnancy on both the recipient and the embryo/fetus are unknown.

Several ethical concerns must be considered for both the donors and recipients in the Swedish experiment. First, should donors be permitted to undergo this procedure knowing that their donated organ is not required to save the recipient’s life? Is it within the donor’s right to autonomy to determine whether to take part in this experiment, despite the significant potential harms? Do the benefits for the recipient outweigh the possible risks of the several invasive and potentially risky procedures involved with womb transplantation and pregnancy? Are the risks worth a woman having the ability to gestate her own child, or should she consider adoption or surrogacy as alternatives?

While womb transplantation for the purpose of pregnancy in the recipient is an interesting and exciting reproductive prospect, the current experimental stage of development raises many serious ethical questions. It is important to consider all the risks – particularly to the donor – of a procedure that does not result in saving a life, before any further experimentation occurs.

Dr. Elizabeth Yuko is a bioethicist at the Center for Ethics Education at Fordham University, and coordinates the HIV Prevention Research Ethics Training Institute.