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D.I. Santos Piñero
University of Manchester, UK

Uterine transplantations (UTx) have been performed in 41 countries worldwide. Whilst every country varies in ethical considerations regarding the procedure, creating a variety of ethical dilemmas, no country has enacted a specific legal framework to address the complex nature of the procedure.

There are several ethical considerations surrounding UTx. The distribution of available uteri is a contentious topic. As with any other type of organ donation, there are a limited number of available uteri. Due to the fact that the uterus is a non-regenerative organ, its availability is further limited, as donation would render the donor infertile, therefore live donations are limited. When dealing with the issue of deceased donation, UTxs are often impractical, as retrieval of life-saving organs are prioritised. Uterus removals are often lengthy, which makes retrievals from deceased donors unlikely in most cases. Nonetheless, regardless of this, many professionals prefer deceased donations of uteri, as principally, it dismisses the harm that a hysterectomy would have on the donor. The right to procreate is also greatly linked to the issue of UTx. There have been arguments that not providing access to procreation through UTx could be seen as a breach of Article 8 ECHR. Access to UTx for transgender women is also a main ethical question in this topic. Whilst there has not been a UTx performed on a transgender woman, there is no ethical reason not to provide transgender women with uteri, and it is essential to question why cisgender women are prioritised in this procedure.

UTx varies greatly from other types of organ donations, as there are great consequences for both the donor and the recipient. The donor will have to go through a hysterectomy and will subsequently be infertile, as the uterus is a non-regenerative organ. The recipient, in turn, will have a need of immunosuppressive agents until they choose to have a hysterectomy themselves. Furthermore, the recipient is exposed to further risks such as ovarian hyperstimulation syndrome, ovarian bleeding, and hemoperitoneum. These consequences create a great ethical dilemma surrounding the principle of harm. Nonetheless, the principle of harm could be evenly balanced through the principle of quality of life, as the right to procreate for the recipient may outweigh the procedure’s level of harm.

Due to the complex nature of this type of organ donation and the ethical considerations that arise from the procedure, it is necessary to establish specific legislation pertaining to UTx before it becomes a routine procedure.