The Changing Paradigm of Ethics in Uterus Transplantation: A Systematic Review
1Division of Plastic Surgery, University of Maryland Medical Center, Baltimore, MD, 2London North West University Healthcare Trust, London, United Kingdom, 3Department of Plastic & Reconstructive Surgery, Johns Hopkins Hospital / University of Maryland Medical Center, Baltimore, MD, 4Division of Plastic & Reconstructive Surgery, R Adams Cowley Shock Trauma Center, Baltimore, MD, 5Plastic Surgery Section, University of Michigan, Ann Arbor, MI
Meeting: 2019 American Transplant Congress
Abstract number: D194
Keywords: Economics, Ethics, Informed consent, Quality of life
Session Information
Session Name: Poster Session D: Non-Organ Specific: Economics & Ethics
Session Type: Poster Session
Date: Tuesday, June 4, 2019
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: The first uterus transplantation (UTx) was performed in 2000 and sparked ethical debate. As key milestones are reached (successful human UTx in 2011, and first human birth from UTx in 2014), the ethical debate around UTx grows and evolves. The aim of this review was to evaluate how ethical concerns have changed over time.
*Methods: We performed systematic review of the English language articles concerning ethics in uterus transplantation and conducted literature search in four databases (PubMed, Embase, Cochrane, and Scopus). A secondary search of the bibliographies of relevant papers identified additional studies for inclusion. Ethical themes were extracted using qualitative analysis software (NVivo) and categorised according to Beauchamp and Childress’ four principles: autonomy, beneficence, non-maleficence and justice. Papers were divided into time periods separated by landmark UTx events in UTx: 2002-11, 2012-14, and 2015-18.
*Results: We identified 284 citations. Following deduplication, 81 articles were eligible for inclusion. The most common bioethical principle discussed was non-maleficence. The number of ethical publications increased after each landmark event (p<0.0001), reaching a peak in the 2015-18 time period where the majority were published (65%, p<0.0001). Non-maleficence was discussed by a lower proportion of articles in the 2015-18 group when compared to the 2012-14 group (70% vs 100%, p=0.0073), as was beneficence (42% vs 72%, p=0.0309). The proportion of papers discussing justice increased significantly from 2002-11 to 2015-18 when it became the most discussed principle (40% vs 83%, p=0.0085). Notably, there was a reduction in concern for immunosuppressive risk to newborn (67% vs 22%, p=0.0152), and an increase in concern for risks to living donors (39% vs 70%, p=0.0399), after the first birth from UTx (2012-14 vs 2015-18).
*Conclusions: The ethical debate surrounding UTx has evolved around landmark events that signify scientific progress in the area. Currently, non-maleficence is the primary bioethical concern throughout UTx literature. As the safety and efficacy of this novel therapy becomes increasingly evident, bioethical concerns shift from benefit:risk ratio towards socioeconomic challenges and equitable access to UTx.
To cite this abstract in AMA style:
Ngaage LM, Ike S, Elegbede A, Gebran S, Vercler CJ, Liang F, Rada EM, Cooney C, Redett RJ, Rasko YM. The Changing Paradigm of Ethics in Uterus Transplantation: A Systematic Review [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/the-changing-paradigm-of-ethics-in-uterus-transplantation-a-systematic-review/. Accessed May 19, 2025.« Back to 2019 American Transplant Congress