Womb Transplants

[JumpingPumpkin]

Just heard the news on R4 of a successful pregnancy from a womb transplant in this country. Paid for by a charity “womb transplant U.K.”. Finished the report with a question as to the ethics and “it gives women an alternative to surrogacy or adoption”.

This just seems unethical to me.

Yes. No doubt during the process of psychological assessment for this particular procedure this was examined. But it’s hard for medical professionals to completely uncover all of a family’s dynamics. That’s not to say this particular family has complex issues. But it has to be applied to all. What if there’s a guilt issue between sisters? What if an overbearing parent is putting pressure on a sister? Who knows. How confident are the assessors that they can truly get to the bottom of it all? If they don’t, does it matter?

And then the next issue, both with womb transplants and surrogacy, is how the dynamics are changed in the future. It could ruin a relationship between sisters. Does the recipient feel guilty for subjecting her donor sister to increased risk of a stroke? How long is she to feel beholden and grateful? What about effects on the baby?

I would be very surprised if there hasn’t been ethical consideration of some of these issues, but sometimes the issues get pushed aside, waylaid, or not fully, truly explored until it’s out there happening. Like surrogacy: it’s just gone ahead and become established despite many, many ethical concerns, so I have somewhat diminished confidence in the process of really actually and stopping to think about these issues before proceeding.

The BBC story on this includes the paragraph
"The surgical team told the BBC they have carried out three further womb transplants using deceased donors since Grace's transplant. They aim to carry out a total of 15 as part of a clinical trial."
https://www.bbc.co.uk/news/articles/c78jd517z87o

And that's why I took myself off the donor register. I'm very sorry about those who might need a donation of another organ for clinical reasons, but just no.

You will always find medics, particularly surgeons, who are keen to cut and to do new and exciting things, and to see if they can. That doesn't mean it's ethical, and it doesn't mean they should.

If as a society we are now taking away benefits and support from disabled people because society basically can't afford them, and we're about to start seeing massive cuts and reductions in provisions educationally for disabled children because there's too many and too much need and we can't afford them, is it really a good idea to create more potentially unwell, disabled children/adults in the long term? How does this all add up?

It's very exciting for the surgeon whose involvement finishes with the surgical record and a live baby, but that's the end of his involvement and interest. The child has to live with the outcomes of his exciting adventure.

I thought the woman who had the donated womb and pregnancy looked quite unwell? Yes, she might be in the exhausting ‘no sleep’ stage of the newborn months but she must have had such a heavily monitored and medicated pregnancy. She is still on all the anti-rejection drugs which must lower immunity and take its toll - all to try and get another viable pregnancy from the womb before it gets removed. It sounds so brutal to me and how is the baby affected in utero by these drugs?

I speak as part of a couple who came to motherhood in my late 30s/early 40s. My partner and I said we would never go through IVF because of the arduous process and heartbreak of potentially several miscarriages, injections etc. We were adamant on this but thankfully managed to have 2 children naturally. ‘Secondary infertility’ loomed at one point and we turned down the offer of an appointment at a fertility clinic. I know we were privileged in already having a child, and of being in a very long term, stable relationship but we were always of the mind that if it wasn’t meant to be, it wasn’t meant to be - not everyone can have children, maybe you could with another partner, or they could with another partner - it was something we discussed often.

I can’t begin to imagine the conversation where my sister would offer to donate her ‘redundant’ womb and have it transplanted into my body. I wonder if they were medics themselves and wanted to be part of pushing the frontiers of science? Were they approached by the company who carried out the procedure? I’m not sure if I was the partner of the mother, whether I could watch my wife go through that to have our own child. And what are the long term implications on her health, never mind the baby’s?

Of course I’m in awe of the phenomenally skilled Doctors and surgeons involved but am not certain that it’s a good use of that knowledge and skills.

It doesn’t sit well with me…

I Think it's great news for women that want children 😊

I don’t think I’m understanding your objection - you took yourself off the donor register because someone might benefit from your uterus after your death? Didn’t you have an objection beforehand to your lungs/heart etc being donated?

Didn’t you have an objection beforehand to your lungs/heart etc being donated?

No, nor various other organs and tissues one can donate. Because the need for those would be clinical.

Thanks. That’s an interesting perspective. I suppose I feel that if the history of medicine wasn’t full of experimental techniques and pushing the boundaries, we wouldn’t have half of the life saving techniques we do now. If this procedure allows a woman to have a child why wouldn’t we do it? I’ve more of a moral issue with a living donor than a dead one really as obviously a hysterectomy is a huge surgery.

I recently had private treatment abroad and one of the consultants commented on the UK and the NHS basically not treating anything that won’t kill you (chat was in relation to thyroid levels and how the NHS “safe” limits are so much higher than what is optimal) and I really worry with our lack of funding etc that that’s where we are headed. If the NHS is going to be life saving necessary treatment only then that’s fine but are we going to pay less tax in order to compensate for needing to go private for anything not 100% clinically necessary? My cousin got a boob job on the NHS 20 years ago. My SIL got one 15 years ago. I’ve got a bigger issue with that than giving a woman the ability to carry children.

If a procedure allows a woman to have a child it still needs to be an ethical procedure.

What are the longterm outcomes for the woman?
What are the long term outcomes for the child? Disability? Illness? Lifespan?
What about the heavy use of very serious drugs involved where normally even mild medication is considered a very serious risk to the child?
Are the child's needs and rights being equally considered to an adult's desire to have a child?
Is it ethical or right to experiment in this way on a child when no one knows what the outcome for the child might be?
What about the financial implications of a very expensive, complex procedure that is not medically necessary or lifesaving as with other transplant operations but is a desire and emotional need? Particularly in a country where currently children are waiting years for diagnosis or any support with many SEND needs, and people are waiting years for needed operations and lifesaving care due to there not being a magic money tree, in a failing health service not able to cope with the population as it stands?
What about the financial implications and ethics of a high risk pregnancy that may involve (no one knows yet) high risk of disability to the child in a country where SEND support and provision is struggling and about to be severely cut, and where disabled people's benefits are about to be cut as the current population's need is higher than can be afforded? Is this an ethical thing to do to a child and family?
What impact does this have on women's trust and willingness to donate when ethics begin to be involved as to what may happen to a child by medics using their body?

In all safeguarding decisions the question has to be asked: are adults' feelings and wants taking precedence rather than a focus on the child?

All the points made by @TheOtherRaven are important but the main one for me is this.

"What about the financial implications of a very expensive, complex procedure that is not medically necessary or lifesaving as with other transplant operations but is a desire and emotional need? Particularly in a country where currently children are waiting years for diagnosis or any support with many SEND needs, and people are waiting years for needed operations and lifesaving care due to there not being a magic money tree, in a failing health service not able to cope with the population as it stands?"

The other major consideration for me is - how far are medics going to push this?

I find this so odd - pregnant women are advised against certain foods and any amount of alcohol due to risk. Breastfeeding mothers have to avoid various medications and the infant can’t have certain meds (oral thrush gel etc) due to lack of regulation in the community when some are licensed in hospitals. Then we read about this trial with all the huge amount of drugs and hormones involved and no one seems to consider the impact on the baby. I just can’t rationalise all these incompatible ideas. Obviously the science was impressive with this transplant but looking into the future it gives me concerns about where this will end up. So many moral questions…

As long as your definition of women is adult human females.

I think it's a really dangerous path to be on. There are so many ethical concerns this raises and there will also be a raft of unknowns too.

I absolutely agree! Anti-rejection medication deliberately damps down your immune system. Yet the growing fetus needs that immunity to "seed" it's own immune system doesn't it?.(Correct me if I'm wrong)

Mind boggling that a child is subjeted to such a powerfully drugged maternal environment...just imagine how the mother will feel if the child suffers an impact from this 🙁

Obviously it’s early days but there are a few mothers on Instagram with young children born through uterine transplants in the USA and all are perfectly healthy. It’s a tiny sample size though and things may emerge in years to come. The biggest issue seems to be the risk to the recipient because of the anti-rejection meds, which is why they are only allowed to keep the uterus for two pregnancies max. Most only have the uterus for 1-3 years going by previous cases.

I don’t know much about this but I’m assuming if you’ve had any other organ transplanted you are on anti-rejection meds for life? So if that’s the ethical issue should we be sterilising anyone who has had a kidney transplant, in case they later get pregnant and subject baby to anti rejection meds? The main information websites dealing with liver and kidney transplants in the UK both say you can get pregnant safely and deliver a healthy baby.

There should be evidence regarding the effects of immunosuppressants on a growing foetus as there are women who have had a kidney transplant & gone on to have a child.

Well that's encouraging - yes a poont about ppl who have say a transplant ed kidney..

I do also wonder about the integrity of the blood supply - whether there is a full quantity going to the placenta.

Playing devils advocate, surely every medical procedure in existence, including the ones that save your life today, were once considered experimental and unethical and are a result of a medic trying to “push this?”

A craniotomy to reduce swelling on the brain that can kill you was pioneered in Greece by what everyone thought was a maniac with a drill.

I agree the health service is failing and the country is financially failing those who are already here, but do we stop all fertility services then? Or do we find a way to better manage our resources and support our population? I don't think childless women should be denied opportunities to become mothers because our Government can’t manage money and have been failing us for decades.

Just because you can doesn't mean you should.

What happens when they can gestate a foetus without a woman's body at all? Like those lambs in bags a few years ago. Would it be right? Good? What would that do to a child?

Science fiction now but more likely than transplanting uteruses into men I'd think. They find a way to supply the right mix of nutrients and hormones. Or they think it's right - like baby formula it will never be quite the same. Could it ever be ethical?

I think the medical arrogance that goes beyond "first do no harm" to this degree of playing god is highly highly risky. You only need to have got one small thing wrong to have perpetrated a horror.

Recently I was talking to a man who was employed by customs in a big international airport, dealing with leaving luggage.
I asked what was the being smuggled out ?
The answer, Organs.
Human organs. Daily.
He had reason to lie.

Infertility is an illness according to WHO

The baby in this case was born "several weeks early" by Caesarian section. weighing "just over two kilos (four and a half pounds".

Is it just me thinking she was delivered as soon as compatible with a reasonable outcome precisely to reduce her exposure to immunosuppressant drugs?

It must be a delicate balancing act.

Wow, I was really happy for her. The very informative doc who's been on radio 5 and 2 says the immuno suppressant drugs are safe for the baby; we also know it was not on the NHS; both her sisters offered her their womb, not a heavily pressured sole possible sister (and I understand there will always be pressure as we have had organ donation within our family, it's a massive consideration, just one that often only has one answer for those you love).

My only suprise was not that two different people online asked if it was suitable for men 🙄, but that Jeremy Vine thought it was an intriguing possibility. As if a womb and an exit out form the entirety of the complexity of female biology. Luckily I had already heard the doc clearly say no on a previous programme.

BBC news said she will have to take immune suppressants until the womb is removed after she has her second so I don’t think it impacted delivery

By 'her' in "to reduce her exposure to immunosuppressant drugs" I meant the baby girl, Amy.

Suitability for men "an intriguing possibility", eh?

One doctor may have said no on another programme, but does anyone wonder why I'm concerned about how far some medics are willing to take this?