The Ethics and Potentials of Womb Transplants

I think it's pretty obvious that we're fans of The Daily Show and The Colbert Report around here (the AJOB blog folks are equally guilty). That said, I will note I've been working on this post for a few days, and the fact that Colbert mentioned artificial wombs on the show this evening is just him being a thief. Honest.

That disclaimer out of the way, a news story crossed my desk over the weekend, but didn't appear to get picked up by anyone. Several outlets, including the New York Post and Australia's Herald Sun reported that American doctors at New York Downtown Hospital had won approval from their in-house ethics committee to perform a womb transplant when an appropriate candidate is found. They apparently have a lot of potential donors lined up (hmm).

Dr. Del Priore (of the New York Downtown Hospital) doesn't appear to be too concerned about the fact that there's only been a single rhesus monkey transplant done, and the womb was removed after 20 hours. The human womb transplant done in 2000, in Saudi Arabia, ended with the womb being removed after two artificially generated menstrual cycles due to a blood clot. Although there are these very limited results, Del Priore thinks that it would not be essential to do further research before offering the procedure to women, saying that face transplant surgeries went ahead in without being tested in non-human primates first.

This seems really problematic to me, though. The only reason you would transplant a womb into someone would be for the potential to carry a pregnancy to term - shouldn't we make sure that a transplanted womb can stay within a body for longer than 20 hours, or three months, without complications? Shouldn't we verify that a transplanted womb can actually carry a pregnancy to term with no complications, before cautiously and optimistically offering this procedure to women?

Furthermore, anyone undergoing a transplant has to take immunosuppressant drugs for life. The several stories reporting on this have said that the idea is for the womb to be transplanted, the woman to carry a pregnancy to term, and then have the womb removed so that she can stop taking the immunosuppressant drugs.

The little bit of digging I did on immunosuppressant drugs and pregnancy suggests that you'd need to be taking the drugs for about two years before they were at a low enough level where pregnancy is feasible, so long as you avoid certain known teratogenic medications and under close medical supervision. Still, the long term effects of immunosuppressant drugs on pregnancies and on the resulting children is unknown - and it seems more than irresponsible to advertise hope and willingness to do the transplant with intent to allow pregnancy without knowing all of the possible risks and costs.

What effect will the pregnancy have on the transplanted womb? Will the graft "stick", or will the growth of the uterus over the course of the pregnancy run the risk of the graft separating? What about rejection potential? Will it go up, requiring more medication? And of course, what about the entire concept of a non-vital transplant? Is this really a quality of life issue, and does it matter if it is? Should everyone have the option of carrying their own child to term, or if something causes the necessity of removal of womb, should we encourage those women/couples to look towards adoption or surrogacy? And if we start allowing non-vital transplants, what'll be next?

Any which way, it seems like way too contentious a surgery to advertise in the media and suggest will happen within the next year or two, when a willing volunteer is found. A lot more research, and a lot more dialogue about the ethics of it, should be had before we move forward to make it a medical reality.