243
Views
1
CrossRef citations to date
0
Altmetric
Reproductive Medicine

Uterine transplant: an ethical framework analysis from a Middle Eastern perspective

ORCID Icon
Pages 1049-1060 | Received 28 Sep 2020, Accepted 09 Mar 2021, Published online: 31 Mar 2021

References

  • Brännström M, Dahm Kähler P, Greite R, et al. Uterus transplantation: a rapidly expanding field. Transplantation. 2018;102(4):569–577.
  • Grynberg M, Ayoubi JM, Bulletti C, et al. Uterine transplantation: a promising surrogate to surrogacy? Ann N Y Acad Sci. 2011;1221(1):47–53.
  • Ber R. Ethical issues in gestational surrogacy. Theor Med Bioeth. 2000;21(2):153–169.
  • Arvidsson A, Johnsdotter S, Emmelin M, et al. Being questioned as parents: an interview study with Swedish commissioning parents using transnational surrogacy. Reprod Biomed Soc Online. 2019;8:23–31.
  • Courduries J. At the nation’s doorstep: the fate of children in France born via surrogacy. Reprod Biomed Soc Online. 2018;7:47–54.
  • Goli M, Farajzadegan Z, Heidari Z, et al. Reproductive and sexual health of surrogate mothers, developing a care program: a protocol for mixed methods study. Reprod Health. 2019;16(1):23.
  • Kisu I, Banno K, Mihara M, et al. Current status of surrogacy in Japan and uterine transplantation research. Eur J Obstet Gynecol Reprod Biol. 2011;158(2):135–140.
  • Castellón LA, Amador MI, González RE, et al. The history behind successful uterine transplantation in humans. JBRA Assist Reprod. 2017;21(2):126–134.
  • Puntambekar S, Puntambekar S, Telang M, et al. Novel anastomotic technique for uterine transplant using utero-ovarian veins for venous drainage and internal iliac arteries for perfusion in two laparoscopically harvested uteri. J Minim Invasive Gynecol. 2019;26(4):628–635.
  • Wei L, Xue T, Tao KS, et al. Modified human uterus transplantation using ovarian veins for venous drainage: the first report of surgically successful robotic-assisted uterus procurement and follow-up for 12 months. Fertil Steril. 2017;108(2):346–356.
  • Fageeh W, Raffa H, Jabbad H, et al. Transplantation of the human uterus. Int J Gynecol. 2002;76(3):245–251.
  • Altchek A. Uterus transplantation. Mt Sinai J Med. 2003;70(3):154–162.
  • Eraslan S, Hamernik RJ, Hardy JD. Replantation of uterus and ovaries in dogs, with successful pregnancy. Arch Surg. 1966;92(1):9–12.
  • El-Akouri RR, Kurlberg G, Dindelegan G, et al. Heterotopic uterine transplantation by vascular anastomosis in the mouse. J Endocrinol. 2002;174(2):157–166.
  • Groth K, Akouri R, Wranning CA, et al. Rejection of allogenic uterus transplant in the mouse: time-dependent and site-specific infiltration of leukocyte subtypes. Hum Reprod. 2009;24(11):2746–2754.
  • Saso S, Hurst S, Chatterjee J, et al. Test of long-term uterine survival after allogeneic transplantation in rabbits . J Obstet Gynaecol Res. 2014;40(3):754–762.
  • Kisu I, Banno K, Mihara M, et al. A surgical technique using the ovarian vein in non-human primate models of potential living-donor surgery of uterus transplantation. Acta Obstet Gynecol Scand. 2015;94(9):942–948.
  • Andraus W, Ejzenberg D, Santos RMND, et al. Sheep model for uterine transplantation: the best option before starting a human program. Clinics (Sao Paulo). 2017;72(3):178–182.
  • Arvin J, Ashrafi M, Lotfi S, et al. Experimental uterus transplant in various models: review of surgical techniques. Exp Clin Transplant. 2018;16(2):119–126.
  • Fageeh W. Apology to Dr Wafa Mohammed Khalil Fageeh, Obstetrician and Gynaecologist and Assistant Professor at King Abdulaziz University, and her medical team. Lancet. 2001;358(9287):1076.
  • Ozkan O, Akar ME, Erdogan O, et al. Uterus transplantation from a deceased donor. Fertil Steril. 2013;100(6):e41.
  • Brännström M, Johannesson L, Dahm-Kähler P, et al. First clinical uterus transplantation trial: a six-month report. Fertil Steril. 2014;101(5):1228–1236.
  • Brännström M, Johannesson L, Bokström H, et al. Live birth after uterus transplantation. Obstet Gynecol Surv. 2015;70(6):394–395.
  • Ejzenberg D, Andraus W, Mendes LR, et al. Live birth after uterus transplantation from a deceased donor in a recipient with uterine infertility. Lancet. 2018;392(10165):2697–2704.
  • Burke M. First baby in the U.S. born from transplanted womb of dead donor. New York: NBC News; 2019. [cited 2020 Jan 25]. Available from: https://www.nbcnews.com/health/health-news/first-baby-u-s-born-transplanted-womb-dead-donor-n1027946
  • Bucker S. Two healthy children after first uterine transplantations in Germany have been born. Tuebingen (Germany): Tuebingen University Hospital; 2019. [cited 2020 Jan 25]. Available from: https://www.medizin.uni-tuebingen.de/en-de/das-klinikum/pressemeldungen/168
  • Arora M. Mom donates womb to daughter in India’s first uterus transplant. Atlanta (GA): CNN; 2017. [cited 2020 Jan 25]. Available from: https://edition.cnn.com/2017/05/19/health/india-uterus-womb-transplant/index.html
  • Yinan Z. China’s first baby born from transplanted womb [Internet]. China: Xinhua; 2019. [cited 2020 Jan 25]. Available from: http://www.xinhuanet.com/english/2019-01/23/c_137768925_2.htm.
  • Practice Committee of the American Society for Reproductive Medicine. American Society for Reproductive Medicine position statement on uterus transplantation: a committee opinion. Am Soc Reprod Med Pages. 2018;110(4):605–610.
  • Ozkan O, Dogan NU, Ozkan O, et al. Uterus transplantation: from animal models through the first heart beating pregnancy to the first human live birth. Womens Health (Lond). 2016;12(4):442–449.
  • Mabiala E, Kaminska O, Szczepanowska M, et al. Uterus transplantation as a new method in uterine-factor infertility (UFI). MEDtube Sci. 2017;2:8–14.
  • Johannesson L, Jarvholm S. Uterus transplantation: current progress and future prospects. Int J Womens Health. 2016;8:43–51.
  • Zaami S, Marinelli E, di Luca NM, et al. Ethical and medico-legal remarks on uterus transplantation: may it solve uterine factor infertility? Eur Rev Med Pharmacol Sci. 2017;21(22):5290–5296.
  • Catsanos R, Rogers W, Lotz M. The ethics of uterus transplantation. Bioethics. 2013;27(2):65–73.
  • Daar J, Klipstein S. Refocusing the ethical choices in womb transplant. J Law and the Biosci. 2016;3(2):383–388.
  • Jones BP, Saso S, Yazbek J, et al. Uterine transplantation: past, present and future. BJOG. 2016;123(9):1434–1438.
  • Harris WJ. Early complications of abdominal and vaginal hysterectomy. Obstet Gynecol Surv. 1995;50(11):795–805.
  • Kisu I, Mihara M, Banno K, et al. Risks for donors in uterus transplantation. Reprod Sci. 2013;20(12):1406–1415.
  • Lanciego C, Diaz-Plaza I, Ciampi JJ, et al. Utero-ovarian anastomoses and their influence on uterine fibroid embolization. J Vasc Interv Radiol. 2012;23(5):595–601.
  • Kvarnström N, Järvholm S, Johannesson L, et al. Live donors of the initial observational study of uterus transplantation-psychological and medical follow-up until 1 year after surgery in the 9 cases. Transplantation. 2017;101(3):664–670.
  • Emanuel EJ, Wendler D, Killen J, et al. What makes clinical research in developing countries ethical? The benchmarks of ethical research. J Infect Dis. 2004;189(5):930–937.
  • Emanuel EJ, Wendler D, Grady C. What makes clinical research ethical? JAMA. 2000;283(20):2701–2711.
  • Tsoka-Gwegweni J, Wassenaar DR. Using the Emanuel et al. framework to assess ethical issues raised by a biomedical research ethics committee in South Africa. J Empir Res Hum Res Ethics. 2014;9(5):36–45.
  • Miller FG. Clinical research with healthy volunteers: an ethical framework. J Investig Med. 2003;51:S2–S5.
  • Williams N. Should deceased donation be morally preferred in uterine transplantation trials? Bioethics. 2016;30(6):415–424.
  • Giordano S. The freedom of scientific research: Bridging the gap between science and society. Oxford: Oxford University Press; 2018.
  • Ejzenberg D, Soares JM, Jr, Baracat EC. Uterus transplant: are we close to this reality? Rev Assoc Med Bras (1992). 2016;62(4):295–296.
  • Brosens I, Gordts S, Valkenburg M, et al. Investigation of the infertile couple: when is the appropriate time to explore female infertility? Hum Reprod. 2004;19(8):1689–1692.
  • Brannstrom M, Racho El-Akouri R, Wranning CA. Uterine transplantation. Eur J Obstet Gynecol Reprod Biol. 2003;109(2):121–123.
  • Brännström M, Wranning CA, Racho El-Akouri R. Transplantation of the uterus. Mol Cell Endocrinol. 2003;202(1–2):177–184.
  • Confino E, Vermesh M, Thomas W, Jr, et al. Nonvascular transplantation of the rabbit uterus. Int J Gynaecol Obstet. 1986;24(4):321–325.
  • Jiga LP, Lupu CM, Zoica BS, et al. Experimental model of heterotopic uterus transplantation in the laboratory rat. Microsurgery. 2003;23(3):246–250.
  • Sieunarine K, Hakim NS, Corless DJ, et al. Is it feasible to use a large vessel patch with a uterine allograft en bloc for uterine transplantation? Int Surg. 2005;90(5):257–261.
  • McKay DB, Josephson MA. Pregnancy in recipients of solid organs-effects on mother and child. N Engl J Med. 2006;354(12):1281–1293.
  • Alston PK, Kuller JA, McMahon MJ. Pregnancy in transplant recipients. Obstet Gynecol Surv. 2001;56(5):289–295.
  • Armenti VT, Moritz MJ, Cardonick EH, et al. Immunosuppression in pregnancy: choices for infant and maternal health. Drugs. 2002;62(16):2361–2375.
  • Hathaway D, Winsett R, Prendergast M, et al. The First Report from the Patient Outcomes Registry for Transplant Effects on Life (PORTEL): differences in side-effects and quality of life by organ type, time since transplant and immunosuppressive regimens. Clin Transplant. 2003;17(3):183–194.
  • Jain AB, Reyes J, Marcos A, et al. Pregnancy after liver transplantation with tacrolimus immunosuppression: a single center’s experience update at 13 years. Transplantation. 2003;76(5):827–832.
  • Agich GJ. Extension of organ transplantation: some ethical considerations. Mt Sinai J Med. 2003;70(3):141–147.
  • Genden EM, Urken ML. Laryngeal and tracheal transplantation: ethical limitations. Mt Sinai J Med. 2003;70(3):163–165.
  • Abouna GM. Ethical issues in organ and tissue transplantation. Exp Clin Transplant. 2003;1(2):125–138.
  • Abouna GM. Ethical issues in organ transplantation. Med Princ Pract. 2003;12(1):54–69.
  • Abouna GM. Negative impact of trading in human organs on the development of transplantation in the Middle East. Transplant Proc. 1993;25(3):2310–2313.
  • Daar AS. Organ donation—world experience: The Middle East. Transplant Proc. 1991;23(5):2505–2507.
  • Shaheen FA, Souqiyyeh MZ. How to improve organ donation in the MESOT countries. Ann Transplant. 2004;9(1):19–21.
  • Serour GI, Dickens BM. Assisted reproduction developments in the Islamic world. Int J Gynaecol Obstet. 2001;74(2):187–193.
  • Emanuel EJ, Wendler D, Grady C. An ethical framework for biomedical research. In: The Oxford textbook of clinical research ethics. Oxford: Oxford University Press; 2008. p. 123–135.
  • Tan HK, Tan BK, Tan LK, et al. Starting a uterus transplantation service: notes from a small island. BJOG. 2018;125(4):404–406.
  • Everett G. Lebanon becomes tenth country to perform uterus transplant. London (UK): BioNews; 2018. [cited 2020 Jan 25]. Available from: https://www.bionews.org.uk/page_137447
  • Albar M. Organ transplantation: a Sunni Islamic perspective. Saudi J Kidney Dis Transpl. 2012;23(4):817–822.
  • Akouri R, Maalouf G, Abboud J, et al. Uterus transplantation: an update and the Middle East perspective. Middle East Fertil Soc J. 2017;22(3):163–169.
  • Erman Akar M, Ozekinci M, Alper O, et al. Assessment of women who applied for the uterine transplant project as potential candidates for uterus transplantation. J Obstet Gynaecol Res. 2015;41(1):12–16.
  • Hammond-Browning N. UK criteria for uterus transplantation: a review. Int J Obstet Gynaecol. 2019;126(11):1320–1326.
  • Altawil Z, Arawi T. Uterine transplantation: ethical considerations within Middle Eastern perspectives. Dev World Bioeth. 2016;16(2):91–97.
  • Islam S, Nordin RB, Ab Rani Bin Shamsuddin HB, et al. Ethics of surrogacy: a comparative study of Western secular and Islamic bioethics. J Islamic Med Assoc. 2012;44(1):1–5.
  • Black N. Evidence based policy: proceed with care. BMJ. 2001;323(7307):275–258.
  • Macklin R. After Helsinki: Unresolved issues in international research. Kennedy Inst Ethics J. 2001;11(1):17–35.
  • Grady C. Science in the service of healing. Hastings Cent Rep. 1998;28(6):34–38.
  • Taneja A, Das S, Hussain SA, et al. Uterine transplant: a risk to life or a chance for life? Sci Eng Ethics. 2019;25(2):635–642.
  • Flyckt RL, Farrell RM, Perni UC, et al. Deceased donor uterine transplantation: innovation and adaptation. Obstet Gynecol. 2016;128(4):837–842.
  • Johannesson L, Wall A, Putman JM, et al. Rethinking the time interval to embryo transfer after uterus transplantation - DUETS (Dallas UtErus Transplant Study). BJOG. 2019;126(11):1305–1309.
  • Järvholm S, Warren AM, Jalmbrant M, et al. Preoperative psychological evaluation of uterus transplant recipients, partners, and living donors: suggested framework. Am J Transplant. 2018;18(11):2641–2646.
  • Guzik-Makaruk EM, Olesiuk-Okomska M, Matuszkiewicz-Rowińska J, et al. Selected legal aspects of donation after circulatory death in Poland. Ann Transplant. 2019;24:93–99.
  • Bruno B, Arora KS. Uterus transplantation: the ethics of using deceased versus living donors. Am J Bioeth. 2018;18(7):6–15.
  • Guntram L, Williams NJ. Positioning uterus transplantation as a “‘more ethical’ alternative to surrogacy: exploring symmetries between uterus transplantation and surrogacy through analysis of a Swedish government white paper”. Bioethics. 2018;32(8):509–518.
  • Kipnis K. Vulnerability in research subjects: a bioethical taxonomy. In: National bioethics advisory commission ethical and policy issues in research involving human participants. Rockville (MD): National Bioethics Advisory Commission. 2001. p. G1–G13.
  • United Kingdom. Human fertilization and embryology act, 1990. London (UK): Government of the UK; 1990. [cited 2020 Jan 25]. Available from: http://www.legislation.gov.uk/ukpga/1990/37/contents
  • O’Donovan L, Williams NJ, Wilkinson S. Ethical and policy issues raised by uterus transplants. Br Med Bull. 2019;131(1):19–28.
  • Taran F-A, Schöller D, Rall K, et al. Screening and evaluation of potential recipients and donors for living donor uterus transplantation: results from a single-center observational study. Fertil Steril. 2019;111(1):186–193.
  • Lefkowitz A, Edwards M, Balayla J. The Montreal criteria for the ethical feasibility of uterine transplantation. Transpl Int. 2012;25(4):439–447.
  • Weijer C. The ethical analysis of risk. J Law Med Ethics. 2000;28(4):344–361.
  • Freedman B, Fuks A, Weijer C. Demarcating research and treatment: a systematic approach for the analysis of the ethics of clinical research. Clin Res. 1992;40:525–526.
  • Richards EG, Agatisa PK, Davis AC, et al. Framing the diagnosis and treatment of absolute uterine factor infertility: insights from in-depth interviews with uterus transplant trial participants. AJOB Empir Bioeth. 2019;10(1):23–35.
  • Saso S, Clarke A, Bracewell-Milnes T, et al. Survey of perceptions of health care professionals in the United Kingdom toward uterine transplant. Prog Transplant. 2015;25(1):56–63.
  • Arora KS, Blake V. Uterus transplantation: the ethics of moving the womb. Obstet Gynecol. 2015;125(4):971–974.
  • Hsu DC, Katelaris CH. Long-term management of patients taking immunosuppressive drugs. Aust Prescr. 2009;32(3):68–71.
  • Ostensen M. Disease specific problems related to drug therapy in pregnancy. Lupus. 2004;12:746–750.
  • Woessner J, Blacke V, Arora K. Ethical considerations in uterus transplant. Medicoleg Bioeth. 2015;5:81–88.
  • Barbieri RL. Uterus transplantation: medical breakthrough or surgical folly? OBG Management. 2015;27(4):8–12.
  • Robertson JA. Impact of uterus transplant on fetuses and resulting children: a response to Daar and Klipstein. J Law Biosci. 2016;3(3):710–717.
  • Akar ME, Ozkan O, Aydinuraz B, et al. Clinical pregnancy after uterus transplantation. Fertil Steril. 2013;100(5):1358–1363.
  • Silva AF, Carvalho LF. A meta-analysis on uterine transplantation: redefining the limits of reproductive surgery. Rev Assoc Med Bras (1992). 2016;62(5):474–477.
  • Testa G, Koon EC, Johannesson L. Living donor uterus transplant and surrogacy: ethical analysis according to the principle of equipoise. Am J Transplant. 2017;17(4):912–916.
  • Wendler D, Rackoff J. Informed consent and respecting individual autonomy: what’s a signature got to do with it? IRB. 2001;23(3):1–4.
  • Council for International Organizations of Medical Sciences. International ethical guidelines for biomedical research involving human subjects. Geneva (Switzerland); CIOMS; 1993. [cited 2020 Jan 25]. Available from: https://cioms.ch/wp-content/uploads/2017/01/WEB-CIOMS-EthicalGuidelines.pdf
  • Suganuma N, Hayashi A, Kisu I, et al. Uterus transplantation: toward clinical application in Japan. Reprod Med Biol. 2017;16(4):305–313.
  • Srinivasan S. Uterus transplants in India: yawning regulatory gaps. Indian J Med Ethics. 2017;2(3):135–137.
  • White MT. Guidelines for IRB review of international collaborative medical research: a proposal. J Law Med Ethics. 1999;27(1):87–94.
  • Petrini C, Gainotti S, Morresi A, et al. Ethical issues in uterine transplantation: psychological implications and informed consent. Transplant Proc. 2017;49(4):707–710.
  • Weijer C, Emanuel EJ. Ethics. Protecting communities in biomedical research. Science. 2000;289(5482):1142–1144.
  • Alahmad G, Al-Jumah M, Dierickx K. Review of national research ethics regulations and guidelines in Middle Eastern Arab Countries. BMC Med Ethics. 2012;13(34):34–10.
  • Puntambekar S, Telang M, Kulkarni P, et al. Laparoscopic-assisted uterus retrieval from live organ donors for uterine transplant: our experience of two patients. J Minim Invasive Gynecol. 2018;25(4):622–631.
  • Hegde CV. Uterus transplant: does it have legs? J Obstet Gynaecol India. 2017;67(5):309–312.
  • Alghrani A. Uterus transplantation: does procreative liberty encompass a right to gestate? J Law Biosci. 2016;3(3):636–641.
  • Jones BP, Williams NJ, Saso S, et al. Uterine transplantation in transgender women. BJOG. 2019;126(2):152–156.
  • Canadian Institutes of Health Research. Tri-council policy statement: ethical conduct for research involving humans. Ottawa (ON): CIHR; 2005. [cited 2020 Jan 25]. Available from: http://www.pre.ethics.gc.ca/eng/policy-politique/initiatives/tcps2-eptc2/Default/
  • Racho El-Akouri R, Wranning CA, Molne J, et al. Pregnancy in transplanted mouse uterus after long-term cold ischaemic preservation. Hum Reprod. 2003;18(10):2024–2030.
  • Racho El-Akouri R, Kurlberg G, Brännström M. Successful uterine transplantation in the mouse: pregnancy and post-natal development of offspring. Hum Reprod. 2003;18(10):2018–2023.
  • Brännström M. Uterus transplantation and beyond. J Mater Sci Mater Med. 2017;28(70):1–9.

Reprints and Corporate Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

To request a reprint or corporate permissions for this article, please click on the relevant link below:

Academic Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

Obtain permissions instantly via Rightslink by clicking on the button below:

If you are unable to obtain permissions via Rightslink, please complete and submit this Permissions form. For more information, please visit our Permissions help page.