The authors argue uterus transplants risk turning women in poorer countries into passive sources of reproductive tissue for wealthier patients.
In 2018, doctors in Brazil made history when they transplanted a uterus from a 45-year-old dead woman into a 32-year-old recipient who had been born without one. The woman went on to deliver a healthy baby, marking the world’s first live birth from a deceased-donor uterus.
This achievement sparked global excitement about uterus transplantation (UTx) as a treatment for absolute uterine factor infertility.
But Kenyan sociologist Dr Patricia Kingori and psychiatrist Dr David Bukusi say the growing interest in harvesting wombs from dead women raises troubling questions about consent, dignity, and global health inequality, questions the world is not yet ready to answer.
Kingori, Bukusi and seven other experts last week jointly authored a commentary in the
BMJ Global Health journal, challenging the ethical assumptions driving deceased-donor
UTx.
They argued that existing ethical discussions around uterus transplants focus almost exclusively on the living recipients, while largely ignoring the dead women whose organs are being taken.
“Most ethical assessments of uterus transplantation predominantly focus on the recipients, with less attention given to the deceased donors or their families,” they wrote. “Although UTx from deceased donors is often viewed as morally preferable since it does not harm a living donor, the unique role of the uterus in creating life introduces complexity to the consent process.”
The authors pointed out that while families of the deceased
may consent to organ donation for vital functions like saving a life, the
uterus has a unique and deeply personal meaning. Its use in reproduction raises
additional ethical burdens that general consent may not cover.
“There are concerns about whether obtaining consent from family members is appropriate, given the organ’s reproductive purpose and the importance of individual procreative liberty,” they stated.
They also noted that in many cultures – including Kenya’s –
public understanding of organ donation is limited, and asking bereaved families
to consent to removing a uterus could be seen as invasive, confusing, or even
offensive.
“The social and cultural implications of using a deceased person’s uterus for childbearing are not well understood,” they said, “highlighting the need for careful considerations of different cultural contexts and further research and discussion in that area.”
After the Brazil transplant in 2018, approximately 90 UTx procedures had been performed worldwide by 2023. This number includes both from deceased and living donors, with a growing number of using deceased donors, leading to over 45 successful births, according to the authors.
The commentary, “Life from death: ethical implications of uterus transplantation from deceased donors in global health,” is co-authored by Halina Suwalowska, Abhilasha Karkey, and Michael Parker of University of Oxford; Adamu Addissie of Addis Ababa University; Joseph Ali of Johns Hopkins University; Deborah Nyirenda of the Malawi-Liverpool-Wellcome Trust Clinical Research Programme; and Srdjan Saso of the Imperial College UK.
They said though uterus transplantation is still rare, there is a worrying trend: the global health community is importing Western medical practices into countries with vastly different social, economic, and ethical landscapes.
“Ethical recommendations like those from the American Society for Reproductive Medicine… primarily reflect Western perspectives,” they wrote. “These frameworks assume relatively high levels of gender equity, equality and robust healthcare systems, overlooking the unique ethical challenges that arise when UTx is performed in diverse socioeconomic contexts.”
This, they argued, risks turning women in poorer countries into passive sources of reproductive tissue for wealthier patients, especially if uterus transplants become part of international reproductive tourism.
Mid this year a similar trend was reported in Kenya where
patients from rich countries came to Kenya to receive kidneys harvested from
poor Kenyan youths, who were paid.
“Although parenthood is a deeply valued aspiration for many… the demand can produce unethical and exploitative practices, including child harvesting, baby factories and illegal surrogacy,” the authors wrote.
Although the article is global in scope, Kingori and Bukusi’s position as Kenyan scholars makes the critique especially relevant for their home country.
Kenya’s organ donation is guided by the 2017 Health Act.
The country has several kidney transplant centres, but they are bedevilled by low donations.
Dr Maurice Wakwabubi, former CEO of the Kenya Tissue and Transplant Authority, last year summed up the challenge:
“We have trained many doctors… but the problem is where do we get the organs?”
The Health Act also legalises organ donation from deceased persons. But low rates of body donation persist. Even donations to science are rare and families often overrule donors’ wishes.
Dr Wakwabubi last year said the KTTA was drafting frameworks that could introduce opt-out organ donation, inspired by successes in the UK and Spain.
The commentary authors noted that even if the law allows cadaver organ transplant, it must not proceed without a national conversation and culturally sensitive ethical guidelines.
Their most piercing question in the case of womb donations: Which women are being prioritised in the drive to expand reproductive technologies, and which are being forgotten?
“Which women count as important in the discussion of the solutions to Western infertility?” they asked. “Under what conditions is it acceptable to offer UTx from deceased donors? What safeguards are essential to protect the rights and interests of disadvantaged and marginalised women and their families?”
