Will uterus transplants eventually violate all natural boundaries?

The Cleveland Clinic this month announced it would begin a clinical trial of uterus transplants—taking uteri from dead women and transplanting them into healthy women in their twenties and thirties who have ovaries but lack a uterus (an uncommon problem accounting for 3 percent of female infertility).

Turkey and Sweden have been experimenting with uterus transplants involving living donors, and in September 2014 Sweden celebrated the first live birth following a transplant. But the Cleveland Clinic trial is the first in the U.S., and it raises unique ethical issues.

First, transplanting a kidney can save a life, but transplanting a uterus converts an essentially “well” person into a patient. It’s only the first step in a path to childbirth that requires multiple surgeries, including the transplant operation and removal of the transplanted uterus after one or two successful pregnancies. Pregnancy requires successful in vitro fertilization and a Caesarean section delivery. And if the woman’s body begins rejecting the transplanted uterus during a pregnancy, doctors would either have to remove the uterus or increase medications, both with dire consequences for the baby.

Second, doctor and medical ethicist Susan Haack notes research in this area “has violated all research protocols for procedures involving human subjects.” Doctors never successfully tested it on animal models before trying it with humans: Reports of five pregnancies and four births since 2012 don’t reveal the number of failures. A uterus transplant is a “costly, temporary procedure that poses grave threats to a woman’s health … and even greater threats to the life and health of any child born in such an experimental situation,” she said.

Haack, a retired Ob/Gyn with a masters in bioethics and divinity, said the sole purpose of the transplants is to give women “the experience of pregnancy.” That makes it “fundamentally different” from other “quality of life” transplants, such as cornea, face, or hand, explained Kavita Shah Arora and Valarie Blake in The Journal of Medical Ethics. Most persons probably would understand why physicians would “desecrate a corpse” to retrieve an organ to save the life of another person, but should they invade a deceased body to improve someone else’s quality of life regarding reproduction?

Haack is not optimistic the Cleveland Clinic trial will bear good fruit.

“It is only a matter of time before we try transplanting uteri into novel subjects, like men, and upsetting all natural boundaries—because we can,” she warned. “It is as if we are sneering in the face of our Creator, while proclaiming our freedom from His patronizingly imposed boundaries and limitations for our lives.”