Friday, April 29, 2016
Is uterus transplantation ethical?
I am not a woman. I cannot contemplate the physical and emotional experience of carrying a pregnancy and birthing a child. I imagine that it is a singular experience that is as deep and awesome today as it has always been. We have all seen the explosion in reproductive technology with in vitro fertilization, surrogate mothers, fertility agents and other emerging techniques. This process, beyond the high costs, can create anguish for those who are on this journey.
I have felt in many instances that the ethical ramifications of some of these techniques are minimized or dismissed. Sadly, we often do stuff because we can, not because we should. Do we really think we can stop human cloning?
Recently, a woman in Cleveland had a cadaver uterus placed during an extremely demanding 9 hour operation on February 24, 2016. This was the first time this was performed in the United States. Only a handful of these operations have been performed worldwide. This woman, who has adopted children, was born without a uterus and yearned to carry a pregnancy. As this operation was part of a clinical trial, I assume that it was paid for out of grant funds. Shortly after surgery, a complication developed and the uterus was urgently removed.
Uterine transplants are not a 1-day affair. To prepare, the recipient's eggs are harvested and then embryos are created and frozen. Then, the complex process of finding a donor is triggered. The donor organ is harvested and must be transported to the recipient. Then, the all-day transplant surgery occurs. The patient is then kept on anti-rejection drugs. A year later, the embryos are implanted. Deliveries are performed by Caesarean sections. After the desired number of pregnancies, the uterus is removed so that the anti-rejection drugs can be withdrawn.
The cost of all this is unfathomable, assuming that no complications occur that would require additional care. It is certainly possible that a woman could go through the entire process and not carry a baby to term. Indeed, very few successful pregnancies have occurred worldwide.
I request that readers contemplate the following concerns regarding uterine transplant.
• Can society justify this massive cost for a procedure that is not necessary to save a life or cure a disease?
• Is it ethical to risk a healthy patient's life with highly complex surgery even if she consents to it?
• Is it ethical to maintain anti-rejection drugs, which have risks of severe complications, for years to preserve the transplanted uterus?
• Is there a right to pregnancy that the medical profession is obligated to satisfy regardless of the financial, emotional, and ethical costs?
If this technique gets perfected, then it might become possible to implant a uterus in a man. Then, perhaps, I will have the opportunity to experience the profound wonder that has eluded my gender since the beginning of time.
This post by Michael Kirsch, MD, FACP, appeared at MD Whistleblower. Dr. Kirsch is a full time practicing physician and writer who addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.
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Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.
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Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.
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Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.
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One of the most popular anonymous blogs written by an emergency room physician.