Uterine transplantation: legal and regulatory implications in England

Vali, Saaliha; Jones, Brynmor; Saso, Srdjan; Fertleman, Michael; Testa, Giuliano; Johanesson, L; Alghrani, Amel; Smith, J. R.

doi:10.1111/1471-0528.16927

Cited by 6 publications

(8 citation statements)

References 49 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For individuals registered as DDs, explicit consent from family or another representative is still often legally required for uterus donation, mirroring practices for transplants such as limbs and the face ( Vali et al , 2022 ). Uterus transplantation from LDs enjoys a larger track record of clinical success compared with DD-UTx ( Brännström et al , 2023 ) but raises more ethical complexities given the risks of this complex surgery ( Kirby, 2021 ).…”

Section: Ethics Of Uterus Transplantationmentioning

confidence: 99%

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

Brännström

Racowsky

Carbonnel

et al. 2023

Human Reproduction Update

View full text Add to dashboard Cite

Women suffering from absolute uterine factor infertility (AUFI) had no hope of childbearing until clinical feasibility of uterus transplantation (UTx) was documented in 2014 with the birth of a healthy baby. This landmark accomplishment followed extensive foundational work with a wide range of animal species including higher primates. In the present review, we provide a summary of the animal research and describe the results of cases and clinical trials on UTx. Surgical advances for graft removal from live donors and transplantation to recipients are improving, with a recent trend away from laparotomy to robotic approaches, although challenges persist regarding optimum immunosuppressive therapies and tests for graft rejection. Because UTx does not involve transplantation of the Fallopian tubes, IVF is required as part of the UTx process. We provide a unique focus on the intersection between these two processes, with consideration of when oocyte retrieval should be performed, whether, and for whom, preimplantation genetic testing for aneuploidy should be used, whether oocytes or embryos should be frozen and when the first embryo transfer should be performed post-UTx. We also address the utility of an international society UTx (ISUTx) registry for assessing overall UTx success rates, complications, and live births. The long-term health outcomes of all parties involved—the uterus donor (if live donor), the recipient, her partner and any children born from the transplanted graft—are also reviewed. Unlike traditional solid organ transplantation procedures, UTx is not lifesaving, but is life-giving, although as with traditional types of transplantation, costs, and ethical considerations are inevitable. We discuss the likelihood that costs will decrease as efficiency and efficacy improve, and that ethical complexities for and against acceptability of the procedure sharpen the distinctions between genetic, gestational, and social parenthood. As more programs wish to offer the procedure, we suggest a scheme for setting up a UTx program as well as future directions of this rapidly evolving field. In our 2010 review, we described the future of clinical UTx based on development of the procedure in animal models. This Grand Theme Review offers a closing loop to this previous review of more than a decade ago. The clinical feasibility of UTx has now been proved. Advancements include widening the criteria for acceptance of donors and recipients, improving surgery, shortening time to pregnancy, and improving post-UTx management. Together, these improvements catalyze the transition of UTx from experimental into mainstream clinical practice. The procedure will then represent a realistic and accessible alternative to gestational surrogacy for the treatment of AUFI and should become part of the armamentarium of reproductive specialists worldwide.

show abstract

Section: Ethics Of Uterus Transplantationmentioning

confidence: 99%

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

Brännström

Racowsky

Carbonnel

et al. 2023

Human Reproduction Update

View full text Add to dashboard Cite

show abstract

“…The graft is then fixed and immobilized by attaching uterine ligaments to pelvic counterparts (32). A key component of successful transplantation is the vascular anastomosis for the graft's blood supply (33). 7 The recipient is given long-term monitoring and kept on a regimen of immunosuppressives and antibiotics to maintain the graft, including before and during implantation and gestation.…”

Section: Current Status and Promisementioning

confidence: 99%

“…The difficulty with such a goal is that UTx involves an ephemeral graft intended to be removed after successful and sufficient gestational use. The aim of therapeutic beneficence through body completeness is troubled by the risk of the recipient maintaining a harmful immunosuppressant regime and refusing to have a hysterectomy, as is their right once the graft is in situ (33). While UTx can be reimagined as a permanent QoL transplant to achieve body completeness, this is adding to risks and harms while potentially diminishing the importance of gestation in the justification of UTx.…”

Section: Revised Criteriamentioning

confidence: 99%

For Women Only? Reconsidering Gender Requirements for Uterine Transplantation Recipients

Wagner

2023

bioethics

View full text Add to dashboard Cite

Uterine transplantation is an experimental procedure currently available only to cisgender women recipients suffering from absolute uterine factor infertility. Clinicians, researchers, and advocates have advanced the possibility of providing these quality-of-life transplantations to transgender women. This article examines the ethical and practical implications of removing sex- and gender-based requirements entirely for uterine transplantation recipients. Given the significant costs and risks, and the modest quality-of-life benefits, ethical arguments against offering uterine transplantations to people who do not identify as women but are otherwise suitable recipients are dubious and prejudicial. Successful uterine transplantations with non-women recipients could potentially diminish the socio-cultural connection between uterine functionality and womanhood, which is a key motivation for women now seeking this high-risk procedure.

show abstract

“…AUFI has been estimated to affect one in 500 women of reproductive age, which equates to 30,000 women in the United Kingdom alone, although, only a minority of these would be eligible and have the desire to undergo UTx ( 14 ). The uterus is not currently part of the opt out system for organ donation which was introduced in the United Kingdom in 2020 and therefore requires separate consent from family members after the donor’s death ( 16 ). While 785 DBD retrievals were undertaken between April 2021–2022, only 43% were undertaken in females and only 35% were between the ages of 18–50 ( 17 ).…”

Section: Introductionmentioning

confidence: 99%

Attitudes, knowledge, and perceptions among women toward uterus transplantation and donation in the United Kingdom

Vali,

Jones,

Sheikh

et al. 2023

Front. Med.

View full text Add to dashboard Cite

ObjectiveTo assess the motivations and perceptions of the general public in the United Kingdom toward donating their uterus for Uterus Transplantation after death (UTx).DesignA cross sectional study.SettingA 32-item electronic questionnaire.PopulationOne hundred fifty nine females over the age of 16 living in the United Kingdom, consented and took part in the study.Main outcome measuresThe motivations and perceptions toward UTx among the general public including the willingness to donate and barriers preventing donation.ResultsOne hundred fifty nine women completed the questionnaire. The majority had never heard of UTx (n = 107, 71%) and most were not aware the uterus could be donated after death (n = 130, 92%). 43% of the cohort were willing to donate their uterus after death (n = 57). 8% stated they wished to donate their organs but not their uterus (n = 10). 30% of women (n = 42) believed the child born following UTx would have genetic links to the donor. Over half of the respondents (n = 65, 51%) strongly agreed or agreed they would feel joy in the knowledge that donation would lead to bringing a new life into the world. A quarter of respondents strongly agreed or agreed (n = 45, 25%) that the use of their uterus by another woman would feel like an extension of life.ConclusionThe findings indicate a favorable opinion toward UTx and a positive attitude toward donation of the uterus after death among the general public in the United Kingdom. The findings also highlight the need for education around UTx now this therapeutic option is available.

show abstract

Uterine transplantation: legal and regulatory implications in England

Cited by 6 publications

References 49 publications

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

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

For Women Only? Reconsidering Gender Requirements for Uterine Transplantation Recipients

Attitudes, knowledge, and perceptions among women toward uterus transplantation and donation in the United Kingdom

Contact Info

Product

Resources

About