News of a proposal to give up to ten women new wombs, donated by deceased women, filled the airways and news channels with excitement this week.
This could give some women, who do not have viable wombs, hope for the first time of carrying their own babies, in their own wombs. The women most likely to receive these transplants would be those who have tragically lost use of, or have never been born with, a viable womb. The medical research and treatment facilities in the UK are some of the best in the world, and some of our finest consultants have invested huge amounts of time (17 years!), money and effort into making this possible. Sweden has done it, apparently successfully, so there is a precedent to follow.
It is exciting to see the UK at the forefront of such ground-breaking research and treatment.
Moreover, there seem to be few obvious ethical concerns with this. These women will carry their own biological child, in their own bodies. The donation of an organ by a deceased person is an incredibly generous gift to give someone. This is a treatment, a ground-breaking therapy, which will restore the bodies of these women. The only other options open to these women are surrogacy or adoption.
But there is still a ‘but’ to this new (potential) treatment on offer. As so often, there are two sides to the coin.
First, it is an eye-wateringly expensive potential treatment. Each operation will cost £50,000, which does not include the use of immunosuppressant drugs for twelve months, nor any follow up and care for each of the women.
Second, it is only going to be on offer for up to ten women only. That’s wonderful news for those ten, but there are estimated to be another 50,000 women of childbearing age in the UK who have no viable womb. Will they get such an offer too? What about the millions of other patients needing expensive life-saving treatment for cancers or other diseases, or life-saving operations? Is this the best prioritising of research and resources for a cash-strapped NHS facing ever-increasing demands? Clearly, just because something is expensive we cannot deny it to patients for that reason alone, but nevertheless questions about resource priorities and patients needs have to be asked, particularly when this is not a life-saving treatment.
And should these badly needed resources be directed to operations on healthy women (albeit without viable wombs), which may actually lead to health problems? These women will need to take strong immunosuppressant drugs to avoid possible rejection of the ‘foreign’ organs for months after the operation before there would be any chance of implanting some embryos, and continue to do so after the implant. They will experience side effects fromthree years on drugs, plus face medical risks from three major operations.
A healthy womb will be needed for the transplant. These will be taken from ‘ventilated donors who have no brain function’ to ensure they are ‘fresh’ and thus useable. So they will be taken taken from donors who are classed as brain dead but whose hearts have been kept beating. This raises questions about whether they are truly dead in the fullest sense of the word. Moreover, healthy, fresh wombs are not easy to obtain. They are only donated in the most tragic and rare of circumstances. So clearly womb transplants can never become a routine operation unless healthy wombs can be grown from scratch (still a pipe dream).
Embryos will be created using the woman’s egg and her partner’s sperm, then frozen, then one or two implanted. Any spare embryos will have be discarded, or used for research, both of which create significant ethical concerns for many people.
And finally, it is almost never said, but what about adoption? Why is this always dismissed as the last – or even worst – possible option? Of course it is not going to be the first choice for most infertilecouples who naturally desire to have their own biological child, yet adoption as a second option is surely the most altruistic, generous, life-affirming,positive alternative for potential parents. Adoption provides a much neededfamily and home for children who have neither (and there are around 60,000!) and it provides for couples who long for children.
Of course adoption is not a ground-breaking idea or option that is worthy of media attention nor the attention of the world’s top consultants, as it offers no kudos or funds, but to me, it makes a lot more sense.