How ethical are womb transplants: do we need this?
Sanchita Sharma : Is India’s first womb (uterus) transplantation a reason for celebration or concern? With only a handful of countries doing it, a successful transplantation will showcase the microsurgical expertise of surgeons at Pune’s Galaxy Care Laparoscopy Institute to the world.
But the question is: why do it?
All major transplantations – kidneys, liver, heart and lungs, to name a few – save lives or dramatically improve the health of the recipients.
Womb transplantations do neither. Women don’t need a womb to survive. These are risky and expensive elective surgeries done to help women born without a uterus or with irreversible uterine damage to have their own child using in-vitro fertilisation (IVF).
Why should donors and recipients go through all the physical stress when there is an easier way to have genetically-related children, such as surrogacy, which is legal and widely-accepted. Adoption is another great option, where you can give a child a loving home.
Instead, women who undergo womb recipients go through the surgical stress of getting a uterus transplanted into their abdomen, getting pregnant using one or more IVF cycles, delivering the baby through a caesarean-section, and then having the womb removed so that they can stop having immunosuppressant medicines after they have had children.
Since the nerves are not transplanted with the uterus, the mother-to-be does not feel the baby kicking in her womb. She also does not feel contractions associated with birth, so the pregnancy has to be tracked very closely.
Another risk is that women need to take immunosuppressant drugs so that their body does not reject the organ, which lowers immunity and increases the risk of infections, which can harm the baby in the womb.
There’s more bad news. Not all transplantations result in the women conceiving. Medical literature shows many implanted wombs – four womb transplantations failed in the US before their first success – were rejected and less than a third of the recipients have delivered a baby.
What’s equally worrying are the red flags raised about the Pune surgery by Dr Mats Brännström, who pioneered womb transplantation in Sweden in 2012 and delivered the first baby from a transplanted womb in 2014. Calling the Pune attempt “a dangerous escapade of surgical cowboys wanting to be the first in their country and to get publicity and fame”, he warns that the donor and recipient are at very high risk of complications, such as bleeding, infection, and rejection of the transplanted womb.
Supporters of uterus transplantation argue that no major surgery comes without side-effects, but they must keep in mind that womb transplantation is not about saving lives over potential complications and irreparable health damage.
Saying that the donor, recipients and their families wanted the transplantation is not ethical. It’s for the doctors to underline the many potential complications of this experimental surgery for both the donor and recipient and determine the pressures that are driving women to take such risks.
Since womb transplantation is not lifesaving, the onus is on the surgeons to ensure the benefits to the women’s mental health outweigh the physical risks. If they don’t, they will have to bear the albatross of surgical complications and failure for life.