Are womb transplants immoral?

A recent story from The New York Times described how uterine transplants may soon be performed in Cleveland to help some infertile women in the United States become pregnant.

The first successful instance of this kind of surgery took place in Sweden at the University of Gothenburg and involved a 29-year-old woman born without a uterus who, in an unusual twist, received a transplanted womb from her post-menopausal mother, the same womb that had brought her into the world a generation earlier. The woman then became pregnant through in vitro fertilization (IVF) and delivered a healthy baby boy via a cesarean section.

Various medical anomalies can cause a woman to be missing a uterus. A congenital disease called Rokitansky syndrome can cause the uterus to develop anomalously or not form at all. Uterine cancer or other serious gynecological issues may necessitate that a woman undergo a hysterectomy, resulting in permanent infertility.

The womb is a unique organ with a highly specific function, and the transplantation of a healthy womb into a woman who lacks one due to a birth defect or disease is loosely parallel, some would say, to a situation where a patient’s kidney fails, and another person donates a healthy replacement organ.

Yet others would stress that the womb is not a vital organ like a kidney, and while the transplantation of a womb is directed toward improving a patient’s quality of life, it clearly does not constitute life-saving surgery like a kidney transplant.

In fact, significant ethical concerns exist regarding womb transplants. Any time we reflect on the ethics of new medical treatments and technologies, it can be helpful to recall the general principle, mentioned in the Catechism of the Catholic Church, that the morality of a human act depends on three factors: the object, the end and the circumstances involved. An act is morally good only if all three of these factors are morally good. If any one of them is bad, we recognize that the overall act itself becomes morally bad. For example, a diva using her voice to sing a passage from a famous opera has the morally good object of performing a beautiful and artistic musical composition. The end for which the diva might sing would be to perfect her singing skills — also morally good. But if she decides to do it at 3 a.m. in her dormitory so that it disturbs the sleep of her neighbors, then the circumstances would not be good, and we would conclude that the action of singing in that concrete situation is, in fact, morally bad.

The specific circumstances involved in uterine transplantation are likewise critical to determining whether this novel type of surgery is ethical. The object of the act could certainly be good: namely, to restore a woman’s bodily wholeness by transplanting a healthy womb in situations where she lacks one. The end for which the womb transplant would be carried out would also be good: namely, to achieve a pregnancy.

But the specific circumstances of the action would render the womb transplant immoral if the transplant were done for the purposes of pursuing a pregnancy through in vitro fertilization, because IVF represents a morally disordered means of engendering new human life.

Authentic human dignity is invariably violated by the decision to create young humans as manipulable quantities in laboratory glassware, so they can be manhandled, frozen or discarded, in satisfaction of parental desires and infertility industry profitability.

All reported instances thus far of womb transplants followed by successful pregnancies have arisen because of the use of IVF. The Cleveland Clinic, as they embark on the experiment of womb transplants, is requiring all candidates to donate multiple eggs so that a minimum of 10 human embryos can be engendered and frozen for later implantation attempts after the womb transplant has occurred. Hence, all currently reported instances of uterine transplantation are being done for the purposes of carrying out IVF and raise grave moral objections.

It should be noted that current protocols, including the one used by the Cleveland Clinic, do not involve attempts to reconnect the transplanted uterus to the recipient’s fallopian tubes or ovaries so that a normally functioning reproductive system might be re-established. Under what conditions might a womb transplant become morally acceptable? If a uterus were transplanted from either a deceased or a freely consenting, post-menopausal woman to another woman whose ovaries, fallopian tubes and other reproductive tissues were then able to function normally so she could conceive a child within the marital embrace rather than through IVF (and assuming very minimal medical risks to both donor and recipient), the womb transplant could probably represent an ethical means of resolving her infertility.

In conclusion, the specific circumstances involved will be crucial to discerning the ethical appropriateness of this unusual procedure.

Father Tadeusz Pacholczyk, Ph.D, is the director of education at The National Catholic Bioethics Center in Philadelphia.