Womb Transplant

Read the articles, review links, and search for new information when answering the following:1.  What are the ethical implications of uterine transplants?2.  What are the legal implications of uterine transplants?3.  How will insurance companies approach the cost of this procedure?4.  Could a womb be transplanted into a transgender woman – or even cisgender (non- transgender) men?5.  Could pregnancy soon be unisex?6.  What are the implications of this procedure and the large number of babies and children awaiting adoption?ArticlesAfter six successful live births following a womb transplant in Sweden, the idea of unisex pregnancy is no longer science fiction.Vincent, the first child born following a uterine transplant, was born in Sweden in 2014. This marked the end of a long and hard-fought global race to perform the first “successful” human uterine transplant. Swedish research trials recently reported there have now been six healthy live births via womb transplants. These are the only successful human attempts so far, but globally teams are seeking to emulate the success of Sweden. Clinical trials of uterine transplantation are underway in North America, Europe and Asia.The primary purpose of a human uterus transplant is to restore fertility in female patients. Prior to the success of these trials, for a woman lacking a functioning uterus, the only way genetic motherhood could be achieved was through surrogacy. And, as a path to parenthood, surrogacy is far from unproblematic. It can be an emotionally draining method of founding a family, and in the UK the practice is shrouded in legal uncertainty.Furthermore, research demonstrates that many women attach great importance to the experience of gestation and pregnancy. Womb transplantation allows women suffering from infertility due to womb abnormalities the unique experience of gestation, pregnancy and childbirth. But the technology also raises broader societal concerns as to whether publicly funded healthcare systems, such as the UK’s National Health Service (NHS), should fund such procedures. Just as the state helps fund IVF for women who cannot conceive, I have argued that there are strong grounds to allow for public funding for those who cannot gestate.But these developments also raise further questions. Unlike the transplantation of other vast organs, womb transplantation is not intended to save life, but to create it. If women can receive wombtransplantations, some have queried whether the procedure may also work in trans women and, even more controversially, in men. Mats Brannstrom, who led the Swedish trial, has said his inbox is now inundated: “I get emails from all over the world on this, sometimes from gay males with one partner that would like to carry a child”?While in theory a womb transplant in trans women and men may be possible, in practice there are anatomical barriers that would have to be overcome due to differing shapes of the pelvis, which in trans women is much narrower than those in cis women. But there is no reason to think such barriers might not be overcome.In the UK, the Gender Recognition Act 2004 gives trans women who have gender reassigned the same rights as their female counterparts. So if womb transplantation becomes clinical treatment in the UK for women who are unable to gestate, could a trans woman claim, under this legislation, that she too has a right to a womb transplant?While some have advocated the “reproductive needs” of trans women, who may have strong desires to experience gestational motherhood, it has also provoked opposition. Julie Bindel reportedly stated: “This is not about transgender rights – it’s about a twisted notion as to what constitutes a ‘real woman’.” A debate is now needed on whether it can be claimed that there is a right to gestate under the umbrella of procreative liberty or the right to a private family life. And if such a right to gestate does exist, does it apply only to those born female, or trans women and men also?A right to gestateIn light of womb transplant technology, we need to address whether or not there is a right to gestate, not whether or not the NHS should fund it – the question that has so far dominated media coverage. Finite public resources should not be invoked as a smokescreen to mask prejudices towards gender reassigned individuals to whom parliament has given clear rights. If it is decided that women should be allowed womb transplants on the NHS, it follows, given the legislation enacted by parliament, that trans women also have that right.In terms of the overblown hype over cisgender men becoming pregnant, even if womb transplantation in a male body becomes scientifically feasible, it would only be possible for men to carry a pregnancy if an IVF embryo was implanted into the womb. In the UK, assisting a male to become pregnant does not fall within the specified activities for which a licence can be granted to a fertility clinic when “bringing about the creation of embryos in vitro” under the Human Fertilisation and Embryology Act 2008. Therefore, implantation of an IVF embryo in order to assist a man to experience pregnancy, in the absence of a licence, would be liable to imprisonment or a fine upon conviction.Almost 40 years ago, the birth of Louise Brown, the world’s first “test-tube baby”, prompted ethical and legal discussions and debates. As womb transplants move from science fiction to science fact, it is clear that reproductive science continues to propel us into uncharted territories and tests the very essence of legal and ethical principles, such as the right to procreative liberty and the right to private and family life. Does this encompass a right to gestate? It is clear that not all would interpret such a right, if there is one, as encompassing unisex gestation.First Baby Born To U.S. Uterus Transplant Patient Raises Ethics QuestionsThe first baby born as a result of a womb transplant in the United States in the neonatal unit at Baylor University Medical Center in Dallas.Beautiful. Pure. Natural. Medicine at its pinnacle.Those were the words of Dr. Giuliano Testa (Links to an external site.) this week — the principal investigator of a clinical trial (Links to an external site.) with ten women underway at Baylor University Medical Center in Dallas.He was talking about the birth of a baby boy to a mother who underwent a uterus transplant last year. It’s a first in the U.S., but in Sweden, eight babies have been born to mothers with uterus transplants.Not everyone is celebrating though.Dr. Testa and his colleague, Dr. Liza Johannesson, who joined the Baylor team from Sweden earlier this year, spoke with All Things Considered host Kelly McEvers about this development. Excerpts of the interview follow, edited for length and clarity.Dr. Johannesson, you’ve delivered a lot of babies, can you describe what this one was like, watching this baby boy be born in Dallas?Dr. Johannesson: It doesn’t really matter how many babies you’ve delivered … This was a very special moment.Dr. Johannesson, you’ve been through this in Sweden, we mentioned that eight babies have been born there to mothers with transplants. How complicated a procedure is it? (Links to an external site.)A First: Uterus Transplant Gives Parents A Healthy Baby (Links to an external site.)Dr. Johannesson: Well it’s a transplant, and it’s a completely new transplant. …. I think we can compare it to a hysterectomy. When it comes to the donor surgery, probably a little bit more complicated than a simple hysterectomy. It takes about five hours. For the recipient, the transplant itself takes about five hours too. … Then after you have the transplant, you don’t have an immediate success. First you have to know the uterus is staying with the recipient, then you have the periods coming, showing it’s viable, then you have to implant the embryo, and then finally you have a pregnancy and then you have to wait the nine months before you have a baby. So the actual success is one and a half years down the line. That’s very rare in transplants.We should mention, Dr. Testa, some of the other women who have been involved in this trial have had transplants that were unsuccessful. What lessons did you learn from those?Dr. Testa: Well we learned a lot of emotional lessons. … They trusted us for doing something that for them was of extreme value. We were not able to deliver. So that was a big humbling lesson in itself. And then all the scientific information we got, we were able to apply to the woman who came afterwards, and now we are successful. So I really feel for the first ones.We mention that not everyone is celebrating this. It raises some ethical questions. Is it possible with a procedure that is so experimental, so risky, to get informed consent from women who desperately want to have a baby?Dr. Testa: I doubt it is possible for lay people to have informed consent about anything we do in medicine, if you ask me. This is even more complicated because we are going into uncharted waters. … I think that we go through years of studying to understand what we do, and to achieve mastering the things we do. And then we pretend that in ten minutes we can explain something to anybody. … I don’t think it’s really possible…. We try to use the simplest terms we can think about and then we leave it to the autonomy of the patients, in this case not even patients, these women, to make the decisions. I think we really refrain, and it was really important for us, from any pressure of any kind from our side but then of course, the inner pressure of this woman to have a child I think drove the entire process and their decision at the end.What about the risk for the baby? What possible complications do you have to consider?A Transplanted Uterus Offers Hope, But Procedure Stirs Debate (Links to an external site.)Dr. Johannesson: So in that sense, we know a lot. That’s maybe the only aspect of this that we actually have a good knowledge of because females have been giving birth after kidney and liver transplants for many many years on immunosuppressive drugs. So we know what the effect of immunosuppressive drugs has on pregnancies, on babies, on recipients. And we know which immunosuppressive drugs you should not take during pregnancy.Dr. Testa, women and families do have other options to have a baby — adoption, using a surrogate mother. I wonder how you think about that, about committing scarce medical resources to solving a problem that does have other solutions.Dr. Testa: True, I don’t have a very intelligent answer to this question. I just understood through this process that I myself had completely underestimated the wish of any woman that I’ve met thus far to have their own child. I don’t know whether there is a price for it. I have no philosophical discussion to add. I just have to say that it was a humbling discovery and I’m still profoundly touched by it.Dr. Johannesson: I think it’s important to say also that it doesn’t exclude surrogacy or adoption. We’re just offering this as a complement treatment.You’re adding this to a menu of options. Which raises the cost question: This is not a cheap procedure to go through. Right now as part of a clinical trial, this is being paid for with research funds, I gather. It is not clear that people’s insurers are going to pay for this going forward, which means you may perfect this technique and women may desperately want it and may not be able to afford it.Dr. Testa: That’s absolutely true. But this is true for infertility at large in this country. … Some woman will go to extremes to be able to have this experience. The cost of medical care is at any rate extremely high for anything we do. As I said, I don’t know whether this is really an important question, who’s going to pay and how. I doubt the insurers will ever pay for something like this.What is the cost?Dr. Testa: We are collecting all the data. … I assume it’s going to be a similar cost that we face today for a kidney transplant. … The ballpark is, I would say around $200,000 to $250,000.What’s next? You have another mother in the trial who is pregnant?Dr. Johannesson: We do, we have one that’s in an advanced stage of pregnancy. So next up is her delivery. Then we have a couple of other women in different stages of the procedure, so we’re hoping for a very happy 2018.Guidelines:Submit written papers that clearly and concisely answers the question(s) in the assignment.You should include:A cover pageA purpose statementIntroductionSection headersConclusionA minimum of four external referencesInclude a Works Cited/References PageYour work should:Be written professionally, be grammatically correct, and cited appropriately.Reflect a logical process, flow, transitions, structure, and appropriate content.Cohesively, clearly, and comprehensively explain ethical issues relating to healthcare today.Have proper paragraph development, transitions, and academic tone.General Guidelines:Avoid use of I, you, we12-point Times New Roman1-in marginsLeft alignedDouble spacedSpell words out first time used, then abbreviations are acceptableUse complete sentences in the active voiceDo not use contractionsCite appropriately

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