https://www.indystar.com/article/20121129/OPINION13/211300317/David-Orentlicher-Uterus-transplants-offer-women-hope?gcheck=1David Orentlicher: Uterus transplants offer women hope
Upon the death this week of Dr. Joseph Murray, the first surgeon to perform a successful organ transplant, news accounts reminded us that many people responded critically to his pioneering kidney transplant. He was compared to Dr. Frankenstein and attacked for doing the unnatural. He also was condemned because of the health risks to his patients.
Of course, transplants with kidneys, livers, lungs and hearts are commonly performed today and rarely elicit objection. Yet as surgeons contemplate new types of transplants, we hear criticisms similar to those that greeted Murray in 1954.
Several years ago, ethicists fretted about face or hand transplants. More recently, uterus transplants have come under fire. So far, only a few physicians have reported performing such transplants, and none of the patients has reported a subsequent pregnancy. But two women received uterus transplants in September, and improvements in technique may make the transplants available more widely.
Why transplant uteruses? Some women are born without a functioning uterus; others have hysterectomies for cancer or other reasons. Many of these women want to become mothers and carry their own pregnancies. They simply want to reproduce in the same way that other women have for millennia.
Why the controversy? If a woman can receive a new kidney, why not a new uterus? Critics have distinguished transplants that can extend life from transplants that only improve the quality of life. As long as transplant recipients have their new organs, they must take drugs to prevent their immune systems from rejecting the transplants. These drugs put people at a greater risk of cancer or other medical problems. Although it makes sense to assume serious health risks for the possibility of a longer life, can improvements in the quality of life justify the risks that transplant recipients face?
The answer is yes. Over time, researchers have developed better drugs for transplant recipients. The risks are not as serious as they used to be. In addition, because a transplanted uterus can be removed after childbirth, the women do not have to take the drugs for many years or even decades, as do other transplant recipients. The risks from uterus transplantation are well within the range of risks that patients are allowed to assume.
But what about the health of the children? Although no woman has given birth after a uterus transplant, we still can gauge the risks to fetuses from organ transplant drugs. Recipients of kidneys, livers and other organs have given birth to more than 15,000 children since the 1950's.
Although not definitive, the data are reassuring. Children exposed to organ transplant drugs during pregnancy are more likely to be born prematurely and with low birth weight, but they do not appear to be at elevated risk of physical malformations or other serious side effects. Overall, they do quite well.
Why put the children at any risk? A woman wanting a uterus transplant can have a child without exposing it to organ transplant drugs. She can adopt one of the many children who lack a permanent home. If she wants a biologically related child, she can use in vitro fertilization to create embryos and then have a surrogate carry her pregnancy.
Often, these alternatives will not be satisfactory. If the women become parents through adoption, they not only lack biological ties to their children. In addition, their offspring may suffer from developmental problems that were not detected before the adoption.
In vitro fertilization and surrogacy can ensure a genetic relationship with the child, but in some states, surrogacy is prohibited by law. In addition, surrogacy can come with significant drawbacks. The genetic mother is unable to create the ties with her child that develop during pregnancy -- ties that play a meaningful role in forming motherhood.
The surrogate also may suffer. She may not anticipate the extent to which she will develop maternal feelings during pregnancy. Hence, she may wish to raise the child as her own.
And with all alternatives to uterus transplantation, a woman must share her parenthood with another woman, who typically will be a stranger to the woman's family. People generally want to share their parenting only with their spouse or other partner.
Uterus transplantation may be an unusual kind of treatment, and its novelty can be unsettling. Nevertheless, as with other organ transplants, it offers the promise of important benefits at tolerable risks.
Orentlicher, a former Democratic state representative, is Samuel R. Rosen Professor at Indiana University Robert H. McKinney School of Law.
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