The year 2018 could well see the UK’s first babies born to women who have received womb transplants because their own uteruses didn’t work properly or were missing at birth. While such transplants have successfully taken place elsewhere in the world, and have resulted in the birth of apparently healthy children, the UK births will differ in one important – and ethically interesting – respect.
Previous transplanted wombs have been donated by living women, and often to individuals to whom they are related. In the UK, they will be donated post-mortem. This means that no operations will be needed to remove the wombs of any living women, thus avoiding the risks that attend such procedures. However, it is debatable whether this is the morally preferable approach.
The main issue is consent. Will women be happy for their wombs to be taken and used for childbirth by someone else after they die? It might be logical to think that if a woman was willing to donate her vital organs, she would also be willing to donate her womb. But this might not necessarily be the case. Donating organs might save a life. Yet while the desire to become pregnant and carry a child is deeply felt, womb transplantation is not a life-saving procedure. Will all women be happy to donate their wombs for what some might consider a “lifestyle choice”?
Organ donor pool
In cases of live donation, the issue of consent is complicated but there is no question that it is given. This consent is called into question in the case of post-mortem donation. It appears the ten wombs intended for transplant will be taken from women who have signed the UK’s Organ Donor Register (ODR). However, no information about womb transplant is provided to those who sign the ODR. While this is not surprising – it is a very new procedure – it is not clear how individual women might feel about their wombs being made available for transplant.
The ODR does provide registrants with some degree of control over the specific organs they wish to donate. And if womb transplants become more common, we would expect them to be added to the list of potential organs. But for the purposes of these ten experimental procedures, it would seem that the wombs of all currently registered women will be considered for donation alongside their other organs, if the worst were to happen.
The NHS Blood and Transfusion service has confirmed it will be working with the womb transplant team and, no doubt, with others to consider how best to approach this issue. At present, the suggestion is that the transfusion service will seek consent from the families of those who are candidates for donation.
But Wales has just become the first part of the UK and the latest country to introduce a system of presumed consent where people have to opt out of becoming an organ donor rather than opt in. It’s reasonable to ask whether this will also apply to womb donation and, if so, whether this is legitimate.
Impact on other donations
As someone who does not have a womb, I am not sure if these questions are ones that I should seek to answer, at least not in the first instance. But how we respond to them will likely inform our subsequent accommodation of face and hand transplants if and when these procedures become more common occurrences.
Even if most women feel no differently about their wombs than they do about any of their other transplantable organs there is, as yet, no evidence for this. Furthermore, regardless of what the majority think it is almost certain that some women will not wish to donate their wombs whilst being happy to donate other organs.
If we want these individuals to remain on the ODR – and thereby continue to be among the pool of potential life-saving organ donors –- we should give serious consideration to including “womb” (and “face” and “hands”) on the list of organs people can choose not to offer.