Uterine Transplants and Surrogacy in Islam

Infertility is, unfortunately, a common occurrence in modern society. 15% of the population at the reproductive age are infertile and 3-5% of them are infertile due to uterine dysfunction. Whether the dysfunction is caused by past hysterectomies due to illnesses like uterine cancer, being born without a uterus, or uterine hyperplasia, the uterus is either non-existent or not viable for pregnancy. Although there are other ways to have children such as surrogacy or adoption, these options do not work for some women. Many women wish to have a child that is biologically theirs, but in countries such as Sweden, Japan, and Italy, surrogacy is either illegal or restricted, therefore eliminating it as an option. In 2003, however, another option became a reality when a woman in Sweden gave birth to the first live child after receiving a uterine transplant from a live donor (Zaami et al).

The process of transplanting a uterus is not unlike the transplantation of other organs. Surgeons must first determine whether the organ is viable for transplant or not. In the case of a uterine transplant, the donor must have had a child to ensure that the uterus is capable of carrying a baby to term. The organ must also be clear of any diseases like endometriosis, infections, or abnormal cells. Once the surgeons determine that the uterus will work, they make an incision from the donor’s pubic bone to belly-button to reach the uterus. The cut the ligaments and also remove tissue from near the bladder that will help the uterus graft into the recipient’s body. The surgeon's clamp off the arteries and veins to keep blood and oxygen in the uterus. It is then flushed with an anticoagulant solution that removes the donor’s blood and preserves her uterine cells. Surgeons put the uterus in a saline solution to protect it and then put it on ice. At this point, the uterus is lacking blood supply. It will remain on ice for about half an hour until it is ready to be transplanted into the recipient (Maldarelli).

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Organs can’t remain viable without blood supply for long, so while the donor is undergoing the hysterectomy, the recipient is being prepped in a separate operating room. If she was born with a uterus, it would have been removed prior to this operation. Doctors use an MRI and CT scan to map out her arteries and veins which helps them locate the internal end of her vagina where the uterus attaches. The donor uterus is brought in and an artery of the uterus is connected to a vessel that runs down the recipient's leg. The uterus is then attached to the woman’s vagina (Maldarelli). The uterus is not connected to the fallopian tubes because attempts at conception through the fallopian tubes all failed in past attempts. Therefore, in vitro fertilization is required as the fallopian tubes are the sight of traditional fertilization (Taylor).

To prevent the body from rejecting the organ, the recipient must take immunosuppressive anti-rejection drugs. Assuming the surgery was a success and the body did not reject the uterus, the woman will begin to have regular menstrual cycles, and after three to six months of consistent menstruation, an embryo fertilized through in vitro fertilization is implanted into the uterus. Nerve endings are not connected during this process, so to combat the unpredictability of how a nerveless uterus will act during labour, the baby is delivered by cesarean section. The uterus is removed at this stage as well because the uterus has done its job, and doctors want to take the patients off the immunosuppressive drugs as soon as possible (Maldarelli).

Although uterine transplants seem like a wonderful option for women with uterine infertility, there are controversies regarding the procedure. Women who are candidates for uterine transplants desire a baby strongly enough that they are willing to go through three major surgeries in order to make that dream a reality; one operation to remove the uterus if one is present but not viable, one to remove the baby via cesarean section, and one to remove the uterus after the child is born. The procedure is also still experimental and often the uterus is rejected upon transplantation, causing the recipient emotional and physical harm (Kelly). Those who argue against uterine transplants are unsure whether or not a woman who is that desperate for a baby is able to give informed consent.

Another argument against uterine transplants is that two woman must undergo invasive, expensive, and risky procedures when there other options available such as adoption and, in some countries, surrogacy. The harm of keeping a patient on anti-rejection drugs for an elective surgery is another aspect those against uterine transplant focus on. Others argue that there are other elective procedures such as hand, face, and arm transplants that are equally risky and also non-life saving, but those are not questioned because they improve the quality of life. The same could be said for those who wish to undergo a uterine transplant; it will not save their life, but it will improve it (Zaami et al).

Live donors for organ transplants are generally preferred as the amount of cadaveric organs are limited, but using live donors in the case of uterine transplants is a controversial topic. Donors would have to undergo a hysterectomy which in itself is a risky surgery. The mortality rate of hysterectomies is higher than pregnancy itself and many believe that since there are other options for those who wish to be mothers, it is not right to allow such a procedure to occur (Zaami et al). On the same note, it is thought that because hysterectomies are final and dangerous, there would not be many donors willing to donate. When the experiments first started in Sweden, however, ninety women volunteered to donate their uteruses without any connection to the recipients (Kelly). It is also possible that family members such a recipient’s mother can donate their uteruses as they are likely finished having children and even after menopause, their uterus is often still viable.

Despite the controversy, I believe that an individual has the right to self-governance. If a woman wishes to carry a child and the option to do is medically possible, it is her right to do so whether the procedure is risky or not. While some may argue that informed consent is hard to get considering the desperation of these women, I disagree. The desperation they feel is no different than those who receive hand transplants or, more recently, penis transplants. The risk is not any higher for women who want a uterine transplant than those who wish to receive other non-life saving transplants. Dr. Liza Johannesson, one of the Swedish doctors who delivered babies grown in transplanted uteruses, counteracted the claim that the usage of immunosuppressive anti-rejection drugs are harmful by noting that because women have undergone other organ transplants and continued to use anti-rejection drugs throughout their pregnancies, there is plenty of information to decide which drugs are safe to use (Kelly).

The topic of women’s bodily autonomy is undoubtedly a reason behind these negative claims, as it often is when it comes to women and their reproductive rights. A woman has a right to chose; she should be able to choose if she does not wish to be pregnant and she should be able to choose if she does. If it is medically feasible and has been proven to be arguably successful, it is not the right of the government to forbid it, especially when there are no other options for certain women to have children that are biologically their own. The women in countries that outlaw surrogacy, for instance, do not have another option, nor do women of certain religions. The Muslim religion forbids surrogacy, but not uterine transplants (Zaami et al).

Uterine transplants can change the lives of many women. That change should be encouraged, not forbidden. Modern medicine is no longer solely about saving lives; it is about improving them, advancing them, and continuing to create solutions for problems that science can solve.

Works Cited

1. Maldarelli, Claire. “How to Relocate a Uterus.” Popular Science, vol. 290, no. 3, Summer 2018, p. 40. EBSCOhost, santarosa.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=v1h&AN=129261689&site=eds-live&scope=site.
2. Mary Louise Kelly. “First Baby Born To U.S. Uterus Transplant Patient Raises Ethics Questions.” All Things Considered (NPR), Dec. 2017. EBSCOhost, santarosa.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=n5h&AN=6XN201712052112&site=eds-live&scope=site.
3. Taylor, English. “What Is a Uterine Transplant.” Modern Fertility Blog, Modern Fertility Blog, 17 July 2018, http://www.modernfertility.com/blog/uterine-transplant/.
4. Zaami, S., et al. “Advancements in Uterus Transplant: New Scenarios and Future Implications.” European Review for Medical & Pharmacological Sciences, vol. 23, no. 2, Jan. 2019, p. 892. EBSCOhost, santarosa.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=edo&AN=134474005&site=eds-live&scope=site.