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.

You’re right. Suicidal people should shut up about it. That’s known to help mental health outcomes.

I don't think that is what @RedToothBrush is saying at all, @adviceneeded1990. I think she is saying we need to be aware that women could feel pressured into offering to donate their uterus, if they know their relative is suicidal due to their infertility, and to ensure that donors are carefully chosen and assessed to ensure they understand the risks and are not feeling manipulated (albeit unintentionally, by the recipient) into donating.

No one is suggesting that suicidal people should shut up about it. People are rightly questioning whether live womb donation can ever be truly altruistic if the donor is told that their daughter/sister friend will likely attempt suicide if they don't go through with it. It's a coercive act that places their needs above all others. But it's also unlikely that someone who has expressed suicidal ideation would be eligible for the program.

I would hope (and this is as someone who has suffered from suicidal ideation due to infertility) that no one who is actively suicidal would be accepted as obviously the program failing could make them worse and they wouldn’t be ok to take part. I wasn’t ok to do IVF when I felt that way, we waited until I’d had counselling. I 100% agree that this element of it would need to be very carefully managed.

However referring to suicidal people as manipulative and coercive is taking mental health education back about 100 years and people who think like that need to be stopped because they are literally risking lives when they open their mouth. The language of “manipulative” and “coercive” around suicidal thoughts and feelings is outdated, dangerous and can’t be allowed. It’s just a different way of saying that mentally ill and suicidal people are attention seeking.

I don't think that someone has to be deliberatively manipulative for their behaviour to be coercive.

Coercion in organ donation stems from family or emotional bonds anyway and the threat that a loved will die by suicide completely compromises the free and voluntary decision to donate an organ.

In a wider sense suicide threats ARE used to coerce and control within domestic abuse situations and shouldn't be downplayed.

So whilst I understand your point about being careful around the language used when discussing suicide and suicidal ideation, I disagree that it can NEVER be described as coercive.

RedToothBrush didn’t say suicidal people are coercive, but that the line of argument is coercive.

Which it is.

The problem isn't feeling suicidal.

The problem is saying, 'if you don't allow it, lots of people will kill themselves'.

Its the demand lead expectation of a particular desired outcome, thats the problem.

Its the 'if you don't met my demand, then you are to blame and therefore we MUST have this or else' that absoluetely is problematic, because of where that ethically also leads. Anyone can make any demand using the threat of suicide then.

Its not ok.

You can be suicidal WITHOUT making demands. If you are making demands whilst suicidal, you are actually showing quite the opposite in your intentions...

I agree with you in general here. I just think there’s a difference between saying “donate your womb to me or I’ll jump off a bridge” and “infertility makes lots of people suicidal”. One is blackmail, of course it is, but one is just a fact, hard as it may be to hear. I’m in an IVF support group of 6 women - 5/6 have confessed to suicidal feelings.

Does that mean we should do this? Maybe not. But an automatic “that can’t be considered,” can’t apply either - medical advancement is meant to improve quality of life and a child or the chance to have a child would improve quality of life for many in this situation. But it’s a balance.

For what it’s worth I’m not sold on live donation either. I just want all perspectives considered, including the perspectives of those going through infertility and having to read that their treatment shouldn’t be available on the NHS.

Its the point isnt it?

Surgeons are justifying their work because its improves lives.

So the donors will be pressured because without their wombs, the life improving surgery cannot happen.

The recipient becomes the priority, the need for the womb is the most important thing in their lives. The donor is told that they do not need their womb as much as the potential recipient does.

It's manipulation.

I don't mean to downplay anyone's feelings, but people can be brought to suicidal feelings for reasons/problems (including health problems) other than infertility that could be resolved, but which would require a significant money to do so. I don't understand why infertility should get special treatment.

So use dead donors like all other organ donation?

I remember that the last time this was discussed in detail that several women said that they opted out of being a donor due to the discussion.

I look forward too to the studies that keep getting mentioned about the life quality long term of children born from pregnancies where the mother needs drugs to not reject body parts. Because from what I have read the recent reviews state more studies need to be done before a well supported conclusions can be drawn.

Plus it is known already that one of the negative side effects is the higher likelihood of premature births and the complications that come with this.

Between the influence, intended or not, of mental health on the decisions made by the donors for living donations and the outcomes for the children there really does need to be discussion around this issue. If there is a way to resolve the issues, why shouldn’t that become a major focus?

But that's too big a gamble to take with someone already on the edge. At the moment it looks like there's roughly a 50/50 chance of the procedure improving quality of life or making a suicidal women even more unwell.

I completely agree with you about healthy debate being important in society and I am very much a proponent for free speech, whatever the message. But surely there is a way of debating things in a sensitive and compassionate manner? This thread hasn't been too bad but I see numerous threads on MN discussing similar women's reproductive issues and the comments are judgey and downright rude bordering on cruel to the person they are directed towards. It's obvious that they're being said to hurt. I can't imagine many of the comments being said to the face of the person that they are talking to online. Even if the message was the same (and any genuinely held opinion is fine), they wouldn't say it in such a rude judgemental tone using the words that they do in a face to face environment.

Might it be that fertility treatments and surgeries are funded in the UK because there is a falling birth rate in this country and so the government sees publicly funded IVF and other fertility enhancing interventions as a future investment? I don't know, just an idea.

If that were the most feasible solution, then the women in the article wouldnt have needed her sister to donate.

While the procedure is still experimental, wouldnt the most ethical solution be donations from the dead?

I suspect tax breaks would be cheaper and more effective.

Women aren't having fewer children because of infertility.

There have been live healthy births from dead donors in the USA. I think it’s possibly the most ethical solution.

No you're right, women aren't having less children during to infertility. But it's one of many fixes to produce more children in society.

At the moment it seems like a very precarious and expensive "fix". Over the last decade, from the R&D phase to live births tens(maybe even hundreds) of millions of dollars has been spent on trying to perfect a procedure that has to date produced around 50 babies. If we wanted to increase birth rates, this money would absolutely have been better spent elsewhere.

There have been live healthy births from dead donors in the USA. I think it’s possibly the most ethical solution.

I agree, it probably is the most ethical solution.

If the outcomes from dead donors is just as good as from living ones, we need to ask why the medical profession isnt taking the most ethical path. And why, then are we trusting the whole process to be ethical?

This.

We don't know what the health implications from an at risk group are from having this surgery.

If we are talking about an already depressed group, then we have additional risks from PND (women with pre-existing mental health issues are at significantly greater risk) and if someone has major surgery like this, with the prospect of another inevitable operation a couple of years down the line hanging over them, we need to take that into consideration too and what that may mean in terms of both mental and physical health.

The child being the magic bullet, is a very heavy thing to pin on a child and it may well not be the solution that every woman in this group needs. Is this a fair thing? It's actually worse than the women who 'take having a child for granted' because it's been built up and put on a pedestal in a way that's different.

Indeed, a desire for a child may be just as much about the ideal of a child and fitting in with society's expectations than the reality of a child. Especially if that child doesn't live up to that dream for whatever reason (potentially behaviour/disability/not being the mini me wanted).

I do think we need to be careful around these ideas of 'The Solution' being only one possible desirable outcome especially if it's an idealised vision. Because in some cases that's going to be far removed from the reality of daily life.

In fairness, @adviceneeded1990, there are some other occasions where organ donation involves a live donor - you can donate a kidney or a lobe of your liver. But in those cases, the donor isn’t left without - they have one healthy kidney or a liver which can (if I’ve recalled correctly) regenerate.