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Thread: Uterine Transplants: Ethical or not?

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    #21
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    As someone who was recently diagnosed as "semi fertile" I am so happy to see this, I shared it on Facebook. If I end up not being able to have kids I will be devastated. And this is another option for me. Yes I could do surrogacy and I'm not totally sure I would 100% do a uterus transplant but it's a great option because I've always wanted to be pregnant and have kids. If it comes down to surrogacy fine but I will be so so sad to not ever be able to carry my own child.
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    #22
    If it only affected the mother, definitely ethical. My only qualm is the need for the mother to be on some serious medications to prevent rejection of the uterus that I know, personally, I would never feel comfortable exposing a growing fetus to. Now, my personal comfort level is obviously different than other peoples, but we have no idea the long term effects of these drugs on kids really. I mean, there are kids that have been exposed, but fairly few and far between, and there could be physical or mental/behavioral deformities/changed/delays that could become more apparent as a bigger risk should more people do this and then we have a larger sample size. However, this also goes into my own personal discomfort with using meds while pregnant. For example, I would never use anti-depressants while pregnant or most meds. Even being on antibiotics would make me nervous (although obviously if needed, its needed). I think its ok that it exists, but I would hope that doctors would strongly urge people away from it just for the sake of the unknown to a fetus. Its one thing to enhance/surgically alter/fix your own body and deal with the repercussions and meds life-long, but to put another life at risk seems a bit icky to me.
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    #23
    Quote Originally Posted by Dr.VinoVet View Post
    If it only affected the mother, definitely ethical. My only qualm is the need for the mother to be on some serious medications to prevent rejection of the uterus that I know, personally, I would never feel comfortable exposing a growing fetus to. Now, my personal comfort level is obviously different than other peoples, but we have no idea the long term effects of these drugs on kids really. I mean, there are kids that have been exposed, but fairly few and far between, and there could be physical or mental/behavioral deformities/changed/delays that could become more apparent as a bigger risk should more people do this and then we have a larger sample size. However, this also goes into my own personal discomfort with using meds while pregnant. For example, I would never use anti-depressants while pregnant or most meds. Even being on antibiotics would make me nervous (although obviously if needed, its needed). I think its ok that it exists, but I would hope that doctors would strongly urge people away from it just for the sake of the unknown to a fetus. Its one thing to enhance/surgically alter/fix your own body and deal with the repercussions and meds life-long, but to put another life at risk seems a bit icky to me.
    This is actually completely untrue. The first reported pregnancy in a woman after solid organ transplant was in 1963. That is over 50 years ago!!! The children of the children of transplant patients are now having babies! We have also maintained registries of transplant patients since 1987 so we have data on hundreds of thousands of transplant patients. Of these patients there have been tens of thousands of solid organ transplant patients who have gone on to become pregnant while on anti-rejection drugs both here in the United States and across Europe. So to say that the kids exposed are "few and far between" is completely incorrect.

    The data registries are not without their flaws and it would always be nice to have more information but the registries do a very good job at giving us an idea of what the risks are. the biggest problem that solid organ transplant patients encounter is preterm birth. This of course leads to the complications associated with prematurity...increased morbidity and mortality. But again, there are lots of risk factors for prematurity. Women who smoke put themselves at increased risk for preterm birth. So should we say that women who smoke should not have children? Women who have a history of preterm birth are at an increased risk. So should we say that if a woman has had a preterm child that she should not get pregnant again?

    As far as antidepressants and other medicines go...well that is your opinion and you are entitled to it. If I have a patient who is pregnant and so depressed that she is not taking care of herself and is even potentially suicidal you best bet I am going to recommend an antidepressant. Depression has serious risks if left untreated the worst of which is suicide. I would much rather a woman who is pregnant and depressed be on an antidepressant which helps to stabilize her mood than end up dead because someone told her that the medicine was dangerous in pregnancy. We have several antidepressants that have not shown any dangerous side effects in pregnancy.

    Same goes for other medicines in pregnancy. We have lots of medicines that have proven safety records in pregnancy. If my patient is miserable and suffering I am not going to "strongly urge people away from it". That is just fear mongering.
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    #24
    Quote Originally Posted by villanelle View Post
    Are breast implants unethical? Or liposuction? Were the early lipo and implant procedures unethical, simply because they were still experimental, and they weren't necessary for life and limb? All procedures were experimental once, so that argument seems like a non-starter. And we don't question any number of elective procedures on ethical grounds, yet this one is somehow different? Why?
    This one is different IMHO because of the populations involved, i.e. Pregnant women and their fetuses. Two pretty vulnerable groups, medically. But also I do think we should consider there ethics of all those other things. They've just been around so long that the ethics there have been long since decided where as this is new.
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    #25
    Quote Originally Posted by Andie View Post
    They've just been around so long that the ethics there have been long since decided where as this is new.
    They were new once...
    ~Becca~


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    #26
    Quote Originally Posted by RetepDoc View Post
    This is actually completely untrue. The first reported pregnancy in a woman after solid organ transplant was in 1963. That is over 50 years ago!!! The children of the children of transplant patients are now having babies! We have also maintained registries of transplant patients since 1987 so we have data on hundreds of thousands of transplant patients. Of these patients there have been tens of thousands of solid organ transplant patients who have gone on to become pregnant while on anti-rejection drugs both here in the United States and across Europe. So to say that the kids exposed are "few and far between" is completely incorrect.

    The data registries are not without their flaws and it would always be nice to have more information but the registries do a very good job at giving us an idea of what the risks are. the biggest problem that solid organ transplant patients encounter is preterm birth. This of course leads to the complications associated with prematurity...increased morbidity and mortality. But again, there are lots of risk factors for prematurity. Women who smoke put themselves at increased risk for preterm birth. So should we say that women who smoke should not have children? Women who have a history of preterm birth are at an increased risk. So should we say that if a woman has had a preterm child that she should not get pregnant again?

    As far as antidepressants and other medicines go...well that is your opinion and you are entitled to it. If I have a patient who is pregnant and so depressed that she is not taking care of herself and is even potentially suicidal you best bet I am going to recommend an antidepressant. Depression has serious risks if left untreated the worst of which is suicide. I would much rather a woman who is pregnant and depressed be on an antidepressant which helps to stabilize her mood than end up dead because someone told her that the medicine was dangerous in pregnancy. We have several antidepressants that have not shown any dangerous side effects in pregnancy.

    Same goes for other medicines in pregnancy. We have lots of medicines that have proven safety records in pregnancy. If my patient is miserable and suffering I am not going to "strongly urge people away from it". That is just fear mongering.
    I get where you are coming from, which is why I said 'I would never feel comfortable'. I wouldnt feel comfortable potentially harming a fetus when we don't fully know the ramifications.

    And yes, transplant patients have absolutely had kids since they started transplants. I would feel as another doctor you wouldn't try to talk down to me and say it is untrue that we don't know the ramifications. I also have been fully educated on medications and, like you, know that while we know the extent of many medications, we would be foolish to say that we know these medications are ok. Medications for transplants have changed from 1960-2016 and there are quite a few meds that we dont have as much research for as we would like just due to time the drugs have been on the market. Not a bad thing, but still something to consider when you are considering not just your own life, but another one.We have a lot of proof that often these medications are ok, but just like anti-depressants, or NSAIDS or any medication, there can be effects, both know and unknown, common or uncommon, on a developing fetus that I, personally, don't think I would risk, and I would seriously urge others to consider as well, especially when it is avoidable with things such as adoption or surrogacy. If they consider the reward greater than the risk, more power to them, but does that mean a doctor or therapist counseling them on the risk vs reward is bad or fear-mongering? Not at all. I would consider that practicing good medicine.

    I don't think saying a doctor should talk to a patient about the use of medications while pregnant if fear mongering at all, and for you to suggest I am doing that is beyond rude. Do I think it is wise for someone with crippling depression/anxiety to get pregnant while on meds? No. I think the wisest decision is to go into therapy and try to get off/lowest effective dose/safest meds before trying to get pregnant. Do I think we should deny paxil to pregnant women who want to kill themselves? Of course not. But again there is ongoing research as to the long term effects that MANY (including, but not limited to, anti-depressants, immunosuppresants, antibiotics etc..) meds have on a developing fetus, and those effects can be not just physical but also behavioral, and the behavioral research has come a lot further in the past 15 years than what was occurring in the 60's and 70's.
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    #27
    Quote Originally Posted by RetepDoc View Post
    Surrogacy is fraught with its own ethical and legal concerns so I would not exactly say its a "safer" alternative. By having someone be a surrogate you are putting the gestational mother's life at risk to have the biological mother's baby. Pregnancy is not without it's risks. And then on top of that is the question of compensation. Surrogacy is being outsourced overseas to places like Nepal and other Southeast Asia countries. Women who are in dire need of money to support their families are being exploited as surrogates for the cheapest price so that surrogacy companies can profit. The whole surrogacy system has some serious issues.

    I don't see any problem with uterine transplants. Not having a uterus can cause serious mental problems for a woman. Especially if she lost her uterus (or was born without one) before she was able to conceive a child. So yes, a uterus is not a lifesaving operation but the vast majority of operations we perform do not save lives, they improve quality of life.

    You mentioned the risk of anti rejection drugs. So should all women who have had a transplant of any kind not be allowed to have a child due to the "risk"? Yes, there are a few antirejection drugs we don't want women on when they are pregnant but there are several we are able to use in pregnancy. There are higher rates of miscarriages and prematurity but this is also true for women who smoke. So maybe we should say it's also unethical for women who smoke to get pregnant. overall thousands of women who have had organ transplants have had successful pregnancies.

    Yes, a doctor's job is to first "do no harm" but I disagree with you that attempting uterine transplants is harmful. There are of course risks involved (as there are with everything) but that doesn't mean we are causing harm. What about patient's with gallstones that just have symptoms when they eat and want their gallbladder out? We do that surgery all of the time. The gallstones are not going to kill them but the surgery can. Should we not be taking people's gallbladder out? Instead should we let them live a miserable life everytime they eat? As long as the patient has informed consent then I am ok with it.
    I would still say surrogacy is the safer option, certainly, but I wasn't aware of the exploitations taking place there so safer, but perhaps not the more ethical.

    I actually don't know much about anti-rejection drugs effects on pregnancy but I was under the impression these were some pretty heavy drugs & that the effects during pregnancy aren't well known as I had imagined most transplant patients aren't exactly encouraged to go out and have babies. BTW, I think plenty of women cast some pretty severe judgements on women who smoke & get pregnant. No we don't stop women who smoke from getting pregnant but it's hardly encouraged or enabled, KWIM? Also I really wonder if the risks to the women/fetus are comparable as to the risks of uterine transplantation & the subsequent pregnancy. All I have heard is about the first baby needing to be born at 31-32 weeks due to pre-eclampsia which seems pretty severe a risk, but I have no idea how the other pregnancies am have gone and if they have all ended up needing to be born quite that early for that same reason. Guess that's why we're doing these experiments in the first place. Just wish there was a way to check the efficacy without endangering healthy women and innocent babies/fetuses.

    ETA: I don't think the experience of being pregnant is comparable to having to live every day with pain as a reason to undergo surgery, but I do agree that it is question an individual in collaboration with their doctors have to make. As, ultimately, all of this.
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    #28
    Quote Originally Posted by brahette View Post
    They were new once...
    I know? And if they were the new cutting edge procedure maybe we'd be talking about them & not uterine transplants.
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    #29
    Quote Originally Posted by RetepDoc View Post
    This is actually completely untrue. The first reported pregnancy in a woman after solid organ transplant was in 1963. That is over 50 years ago!!! The children of the children of transplant patients are now having babies! We have also maintained registries of transplant patients since 1987 so we have data on hundreds of thousands of transplant patients. Of these patients there have been tens of thousands of solid organ transplant patients who have gone on to become pregnant while on anti-rejection drugs both here in the United States and across Europe. So to say that the kids exposed are "few and far between" is completely incorrect.

    The data registries are not without their flaws and it would always be nice to have more information but the registries do a very good job at giving us an idea of what the risks are. the biggest problem that solid organ transplant patients encounter is preterm birth. This of course leads to the complications associated with prematurity...increased morbidity and mortality. But again, there are lots of risk factors for prematurity. Women who smoke put themselves at increased risk for preterm birth. So should we say that women who smoke should not have children? Women who have a history of preterm birth are at an increased risk. So should we say that if a woman has had a preterm child that she should not get pregnant again?

    As far as antidepressants and other medicines go...well that is your opinion and you are entitled to it. If I have a patient who is pregnant and so depressed that she is not taking care of herself and is even potentially suicidal you best bet I am going to recommend an antidepressant. Depression has serious risks if left untreated the worst of which is suicide. I would much rather a woman who is pregnant and depressed be on an antidepressant which helps to stabilize her mood than end up dead because someone told her that the medicine was dangerous in pregnancy. We have several antidepressants that have not shown any dangerous side effects in pregnancy.

    Same goes for other medicines in pregnancy. We have lots of medicines that have proven safety records in pregnancy. If my patient is miserable and suffering I am not going to "strongly urge people away from it". That is just fear mongering.
    There is a difference between someone unintentionally becoming pregnant when they are on medications that could be harmful to a fetus or becoming pregnant and then finding out they need to be on meds or risk life & limb vs the medical profession enabling/supporting dangerous pregnancies. Now, I don't have the power nor do I want to decide for each person what an acceptable amount of risk is, but that doesn't mean I don't think we (as a society) shouldn't have that dialogue at all.
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    #30
    Quote Originally Posted by Andie View Post
    I would still say surrogacy is the safer option, certainly, but I wasn't aware of the exploitations taking place there so safer, but perhaps not the more ethical.

    I actually don't know much about anti-rejection drugs effects on pregnancy but I was under the impression these were some pretty heavy drugs & that the effects during pregnancy aren't well known as I had imagined most transplant patients aren't exactly encouraged to go out and have babies. BTW, I think plenty of women cast some pretty severe judgements on women who smoke & get pregnant. No we don't stop women who smoke from getting pregnant but it's hardly encouraged or enabled, KWIM? Also I really wonder if the risks to the women/fetus are comparable as to the risks of uterine transplantation & the subsequent pregnancy. All I have heard is about the first baby needing to be born at 31-32 weeks due to pre-eclampsia which seems pretty severe a risk, but I have no idea how the other pregnancies am have gone and if they have all ended up needing to be born quite that early for that same reason. Guess that's why we're doing these experiments in the first place. Just wish there was a way to check the efficacy without endangering healthy women and innocent babies/fetuses.

    ETA: I don't think the experience of being pregnant is comparable to having to live every day with pain as a reason to undergo surgery, but I do agree that it is question an individual in collaboration with their doctors have to make. As, ultimately, all of this.
    All of this seems like reasons for a person to decide not to have the procedure. I can definitely see why someone, when looking at the full picture, would decide it isn't right for them. That's why *informed* consent is so important. But I don't see how any of this comes close to reaching a level of making the entire procedure unethical, especially if we are talking about an official declaration that it is unethical and thus doctors would be unable to even offer it as an option or consider performing the procedure.

    There are lots of choices I wouldn't be comfortable making. I won't get too specific because someone here might have made them, but getting pregnant with certain genetic diseases or markers in me or DH might be one example. But that's far different from a blanket statement that is is unethical, and the strong implication that goes with that that no one should be doing this, or should be allowed to do this.
    Science always wins over bullshit. ~Dick Rutkowski
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