The Montreal Criteria for the Ethical Feasibility of Uterine Transplantation

Abstract

Summary Absolute uterine factor infertility (UFI) refers to the refractory causes of female infertility stemming from the anatomical or physiological inability of a uterus to sustain gestation. Today, uterine factor infertility affects 3–5% of the population. Traditionally, although surrogacy and adoption have been the only viable options for females affected by this condition, the uterine transplant is currently under investigation as a potential medical alternative for women who desire to go through the experience of pregnancy. Although animal models have shown promising results, human transplantation cases have only been described in case reports and a successful transplant leading to gestation is yet to occur in humans. Notwithstanding the intricate medical and scientific complexities that a uterine transplant places on the medical minds of our time, ethical questions on this matter pose a similar, if not greater, challenge. In light of these facts, this article attempts to present the ethical issues in the context of experimentation and standard practice which surround this controversial and potentially paradigm‐altering procedure; and given these, introduces “The Montreal Criteria for the Ethical Feasibility of Uterine Transplantation”, a set of proposed criteria required for a woman to be ethically considered a candidate for uterine transplantation.

Ethics Criteria for Uterine Transplants: Relevance for Low-Income, Pronatalistic Societies?

“…Physicians do not agree that utx is superior to surrogacy or adoption as far as risk and expediency [13] but it is the only way in which a woman with UFI could possibly have the experience of carrying a pregnancy. It should be noted that the transplanted uterus will not be enervated, meaning that the recipients will not be able to feel the pregnancy.…”

“…Lefkowtiz et al [13] expanded Nair's criteria to include health system capacity. Their proposed "Montreal Criteria for the Ethical Feasibility of Uterine Transplantation" addresses the ethical issues that should be considered prior to undertaking the procedure regarding the recipients, donors, and the treating health care team (Figure 1).…”

“…Currently a clinical trial in Sweden is underway [2] and the first mother-to-daughter transplants have been attempted with no resulting surgical complications. It is believed, because the research is showing promising results in animal models [44], that utx will become a reality and will eventually become the 'gold standard' to treat UFI [13,45].…”

“…Other questions refer to donor safety, social impact, and management of health care services, especially with regards to access and cost. A growing body of literature is addressing these issues [9][10][11][12][13].…”

Public funding of uterine transplantation

“…1 Indeed, while its clinical and scientific merits have been recently established, 1 a number of social, economic and ethical concerns remain. [2][3][4] In particular, the question whether uterine transplants should be publicly funded remains a source of debate and controversy. 5 In an insightful essay by Nicola Williams and Stephen Wilkinson, the authors address the question from the opposing premise: are there any compelling reasons for the state not to fund UTx?…”