Can Trans Women Get A Womb Transplant? Groundbreaking Surgery Sparks Debate On Ethics And Eligibility

Following the birth of the first baby conceived in a transplanted womb in the UK, the potential for uterine transplants to aid infertile women—and even transgender women—has once more sparked significant debate within the medical community and beyond. This pioneering surgical procedure raises profound ethical questions, challenges traditional notions of motherhood, and forces us to reconsider who should be eligible for such a life-changing treatment.

In 2024, a young boy in Sweden celebrated his tenth birthday, a milestone that attracted attention from reproductive experts and physicians worldwide. What made his arrival truly extraordinary was the groundbreaking fact that he was the first child to be born following a uterine transplant—a remarkable event that took place in 2014.

The First Uterus Transplant Success

His mother, a 35-year-old who was born without a womb, had received a donated uterus from a 61-year-old, a close friend of the family. She was among a small group of just eleven women globally who had experienced this trial surgery.

By 2024, the number of uterus transplants performed worldwide had surpassed 135, leading to the joy of over 50 healthy babies being born, according to a report by MIT Technology Review. This surgical advancement has deeply impacted these families, offering a chance at pregnancy that would have otherwise been impossible.

Who Should Receive A Uterus?

However, significant legal and ethical considerations persist around this procedure, which remains in the trial phase. The question of who should be eligible for a uterus transplant is still being debated. Could this surgery ever become an option for transgender women? Furthermore, the matter of funding for these operations remains an open question.

These points were raised during a recent online event organised by the Progress Educational Trust (PET), a UK charity dedicated to informing the public about genomics and infertility. Mats Brännström, the leader of the University of Gothenburg team that achieved the first successful uterus transplant, was among the speakers.

Where It Began: A Patient's Vision

For Brännström, the journey of uterus transplantation started in 1998. He recounted meeting a 27-year-old woman named Angela during a trip to Australia. Angela sincerely wished to carry a child but did not have a functional womb. It was her suggestion to Brännström that her mother could potentially donate her uterus. 'I was amazed I hadn't thought of it before,' he said.

In Brännström's view, approximately one in every 500 women faces infertility because of a condition called absolute uterine factor infertility, or AUFI, which means they lack a working uterus. He believes that uterus transplants could provide a path for them to experience pregnancy.

In that initial study, Brännström's group performed uterus transplants on nine women, all of whom underwent IVF to create and freeze embryos beforehand. The first woman to successfully give birth had IVF treatment for a year, finishing six months before her operation.

Removing the donor's uterus took slightly over 10 hours while attaching it to the recipient took just under five hours. Following the transplant, the recipient's menstrual cycle began after 43 days. Doctors then transferred one of her embryos into the new uterus a year after the operation. Just three weeks later, a pregnancy test confirmed a successful pregnancy.

Not A Flawless Procedure

At 31 weeks into the pregnancy, she was hospitalised due to preeclampsia, a serious condition that can arise during pregnancy. Her baby was delivered via C-section 16 hours later. The mother was able to leave the hospital after three days, though the baby remained in the neonatal unit for 16 days.

Despite those challenges, her experience is viewed as a triumph. Other individuals who have received uterus transplants have also faced pregnancy-related issues, and some have encountered surgical complications. Furthermore, all transplant recipients must follow a strict course of immunosuppressing medications, which can have unwanted effects.

These transplanted wombs are not meant to be permanent. Surgeons typically remove them once the recipients have finished having children, often after one or two births. This removal procedure is also a major surgery.

Considering all these factors, uterus transplants are a significant undertaking. Moreover, there are alternative ways to become parents. Natasha Hammond-Browning, a legal expert at Cardiff University in Wales, mentioned at the event that some ethicists worry that focusing on uterus transplantation as a fertility solution could strengthen the notion that a woman's worth is tied to her ability to have children.

Transgender Women And Womb Transplants

Hammond-Browning also raised whether a 'right to gestate' exists, and if so, who possesses this right? She emphasised that these concerns must be weighed against the significance of reproductive autonomy—the principle that individuals have the right to make decisions about and control their own reproductive lives.

Additional questions linger about whether uterus transplants could ever be a possibility for transgender women, who are born without a uterus and also have a different structure in their pelvic region. 'I asked the speakers if the surgery might ever be feasible. They weren't hugely optimistic that it would, at least in the near future.'

J. Richard Smith from Imperial College London, who co-led the first uterus transplant in the UK, responded by saying, 'I personally think that the transgender community have been given ... false hope for responsible transplantation in the near future.'

Smith explained that even cisgender women who have undergone surgery to create 'neovaginas' are not eligible for the uterus transplants his team is offering in their research study. He noted that these individuals have a changed vaginal environment that seems to elevate the chances of pregnancy loss.

Navigating The Future Of Womb Transplantation

Smith says, 'There is a huge amount of work to be done before this work can be translated to the transgender community.' Brännström concurred, adding his belief that the surgery would eventually become an option, but only after extensive further investigation.

Hammond-Browning highlighted that medical teams would first need to establish the purpose of such a surgery. For instance, is the aim reproduction or gender affirmation? She questioned how this objective might shape decisions regarding who should receive a donated uterus and the reasoning behind it.

While the ethical and practical considerations surrounding broader applications of womb transplantation continue to be explored, the UK recently celebrated a significant milestone in the field with its first successful birth following this innovative procedure.

UK's First Womb Transplant Baby

Doctors are celebrating an 'astonishing' medical achievement after a woman became the first in the UK to deliver a baby following a uterus transplant.

Grace Davidson, 36, who learned as a teenager that she had a rare condition meaning she lacked a womb, expressed that she and her husband, Angus, 37, had received 'the greatest gift we could ever have asked for.'

As reported by The Guardian, they named their five-week-old daughter Amy Isabel. 'Amy' honours Grace's sister, Amy Purdie, who donated her uterus in an eight-hour surgery in 2023, while 'Isabel' recognises Isabel Quiroga, a surgeon instrumental in refining the transplant method.

In conclusion, while uterus transplantation offers a beacon of hope for individuals facing uterine factor infertility, its application, particularly to transgender women, remains a complex landscape of ethical, surgical, and societal considerations. The groundbreaking success stories, like the first UK birth, highlight the immense potential of this evolving field.