It was recently announced that a New York hospital is making plans to perform the first uterus transplant. The press release announced that "the hospital's ethics board has conditionally approved the plans." The physicians involved in the project have shown "that wombs can be obtained from organ donors, and now are screening potential recipients." Can a uterus transplant be done?...Sure. Will it be done?...Probably. But, should it be done?...I don't believe so, especially in this day and age of sophisticated and efficient assisted reproductive technologies.
The ethical issues here are foremost. This procedure offers no direct benefit to ANY woman. Indeed, the risks involved far outweigh any purported psychological benefits to women who were born without, or have prematurely lost, their uteri. The practitioners who will do this procedure will "be the first" (and for that will obtain some degree of fame, or notoriety) but there is likely to be no major contribution to medical knowledge or technology that will come out of this procedure either.
If the ultimate goal of this procedure (other than the joys of menstruation and validation of 'womanhood', without the cramping that would be felt in the presence of neural connections, and the opportunity to develop uterine or, more likely, cervical cancer while on immunosuppressive drugs) is childbearing, then the physicians involved need to step back, take their egos out of the picture, and think about what they are doing more carefully. Can a woman who has a transplant of any kind carry a baby? Certainly, and over the years I have taken care of many women with kidney transplants, and even the occasional liver transplant, and though challenging, the outcomes have generally been good. However, there are risks to the woman of transplant rejection, diabetes as a consequence of the immunosuppressive therapy, preeclampsia, early delivery, and potential risks to the fetus from all of these factors. But, apart from these other risks of organ transplants, we have no idea whether the vascular changes that are required to support a normal pregnant uterus, and the baby inside, can occur with a transplanted uterus, what the risks of transplant rejection of a uterus might be during a pregnancy to the woman,or the consequences of these events on a developing baby. To be the first woman with a transplanted uterus to take this chance on a baby is, in my opinion,a selfish and foolish proposition.
Years ago, I worked with a specialist in reproductive endocrinology who was very good at what he did, but unbearably cocky. A patient of mine, with whom I was good friends, asked for my recommendations for an infertility specialist to help her conceive another (high risk) pregnancy. I told her about my colleague, I assured her of his capabilities, but knew they might have a bit of a personality clash. We joked about it for awhile, and then decided together that she would indeed see him, but would do so "on her terms." The plan was that she would tell him at the time of her initial visit that she was "interviewing REI specialists" and that her primary criteria for selection was their "previous success rates with uterus transplants." She did this, enjoyed the look of shock and submission on his face when she told him what she wanted, pretended to be miffed at his response of "never having done one," pretended to get up to leave, and then filled him in on the joke. They got along quite fine after that and I eventually delivered her next baby. Truth in fact, the technology to perform such a procedure was already available at that time, but the ethical and medical contraindications could not be surmounted then, and probably should not be now.
One of the first things we are taught in medical school when we enter, and one of the last admonitions that is given to us as we leave, is "primum non noncere" - loosely translated, "above all, do no harm..." I believe the physicians and the institution that would support this procedure, especially when there are so many other good options available today to provide the experience of 'motherhood' to a woman who cannot bear a child herself, need to repeat this mantra from the Hippocratic Oath repeatedly to themselves before they embark on this endeavor...
P.S. for other comments related to this issue, check out a recent post by Dr. Anonymous.