Gifting the Womb: A Legal and Ethical Analysis of Uterine Transplantation

Abstract

This PhD thesis considers legal and ethical questions raised by the prospect of uterine transplantation (UTx). Over the course of recent years various scientific advances in the realm of reproduction have changed the reproductive landscape, enhancing the reproductive freedoms of those diagnosed with infertility, and increasing the choices available to them. Uterus transplants are the latest of such medical innovations aimed at providing an additional, and experientially unique, option in the management of absolute uterine factor infertility (AUFI). Unlike other options for family building such as surrogacy and adoption, UTx offers those diagnosed with AUFI the chance to not only have their own child, but to have this as a result of their own pregnancy. Since proof-of-concept was established in Sweden in 2014 when the world's first baby was born following UTx, research has progressed rapidly. UTx is now being conducted at centres across Africa, North and South America, Asia, Australia, Europe, and the Middle East. As a technology at the intersection of two distinct medical specialties: reproductive and transplantation medicine, UTx raises distinct legal, ethical and social challenges. This thesis identifies and addresses a number of conceptual and practical concerns posed by the introduction of UTx in a series of four papers that form the main body of this work. Paper One provides an overview of some of the key areas of controversy arising in the debates about UTx, focussing in particular on three main ethical and policy issues. These concern: the purported value of gestation, the choice between living and deceased donors, and access to UTx. In Paper Two, I consider the extent to which we should respect the reproductive autonomy of patients who choose to pursue UTx and uterus donation in the light of considerable medical risk posed by the treatment. I argue that for as long as the benefits of UTx continue to outweigh the harms associated with donation and transplantation, we ought to respect the reproductive autonomy of recipients and donors who choose to pursue it. In Paper Three, I examine the question of the public funding of UTx in the context of the NHS. I contend that the dual commissioning system for medical treatment means that NHS- commissioned UTx could give rise to the creation of inequalities of access to treatment between different groups of infertile patients, and that UTx has the potential to raise an important political perspective regarding treatment access and the wider funding landscape for assisted reproduction. Paper Four asks what role child welfare considerations should have in our ethical and legal reasoning about UTx. I argue that proposals to use pre-conception welfare considerations as a threshold tool to determine patient access to transplant waiting lists and/or as a tool to optimise the allocation of deceased donor uteri should be categorically rejected on the grounds that this would constitute an unjust burden on prospective patients, that it would unjustifiably infringe their reproductive autonomy and may result in unjust discrimination.

Date of Award	1 Aug 2022
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Iain Brassington (Supervisor) & Alexandra Mullock (Supervisor)