May I have your uterus? The contribution of considering complexities preceding live uterus transplantation

Abstract

Uterus transplantation combined with in vitro fertilisation (IVF) (henceforth called UTx-IVF) as a treatment for infertility caused by an absence or malfunction of the uterus is advancing. About 50 transplantations have been conducted worldwide and at least 14 children have been born—9 of them by women taking part in a Swedish research project on UTx-IVF. The Swedish research protocol initially stated that the potential recipient must ‘have her own donor’ who is preferably related to the recipient. But what does it mean to ask someone for a uterus? What challenges does this question instigate? And what norms may it enact? In this article, I explore how 10 women—who have considered, and sometimes pursued, UTx-IVF—describe their experiences of searching for a donor. I aim to show how an analysis of such accounts can help us unpack some of the specific relational and gendered dimensions of UTx-IVF and by doing so enrich discussions of risks, benefits, care and support in UTx-IVF. Drawing on research in social sciences and medical humanities that has demonstrated how assisted reproductive technologies and organ donation can provoke social and familial conundrums, with respect to such topics as embodiment and identity, I present three patterns that describe different dimensions of the interviewees’ quest for a uterus donor. I discuss the negotiations that took place, how expectations unfolded and how entanglements were managed as the interviewees considered asking someone for a donation. Such an examination, I suggest, contributes to make care and support more attuned to the experiences and entanglements that UTx-IVF entails for those pursuing it. This will become increasingly important if (or when) UTx-IVF becomes part of general healthcare. To conclude, I problematise responsibilities and relational challenges in medical innovation, and in this way provide insights into how the ethical debate over UTx-IVF can broaden its scope.

Keeping it in the family: reproduction beyond genetic parenthood

“…Some current practices rely explicitly on the facilitation of some family members' access to others' bodies for reproductive purposes. Wives have had sperm collected from their comatose or deceased husbands, 23 adult daughters may expect their mothers to donate their uterus to them, 24 and mothers may feel they need to provide eggs for their daughters to be able to use in the future. 25 These cases are complicated by a number of ethical factors that go beyond what we are discussing here.…”

Uterus transplantation: from research, through human trials and into the future

“…Another major theme in ethical discussions of UTx concerns the importance of obtaining adequate informed consent from potential donors and families, whether LD or DD ( Dickens, 2016 ) For LDs, a thorough discussion of the risks, benefits, and alternatives are readily apparent prerequisites including emphasis that LDs revoke all parental rights to any resulting children gestated from the donated uterus, and that a future relationship with the child is by no means guaranteed ( Bruno and Arora, 2020 ). Indeed, since most LDs thus far have been close relatives of the recipients, special attention must be paid to social pressures and emotional burdens inherent in asking someone to be a uterus donor ( Guntram, 2021 ). Minimizing and ideally eliminating any possibility of coercion is a highest priority ( Arora and Blake, 2015 ).…”

Ethics of live uterus donor compensation

“…The first reason why the issue of compensation remains thorny for uterus donors relative to other kinds of organ donors or third-party service providers in ART is because there are risks unique to UTx, compared with the anticipated benefits, which ought to give us pause when it comes to questions about monetary incentivization especially. Although uterus donation gives one the opportunity to help those who are involuntarily childless 67 like other ART methods, UTx carries greater health risks for donors compared to other ARTs.…”