- 一般社団法人 日本移植学会
- 移植 (ISSN:05787947)
- vol.57, no.1, pp.37-43, 2022 (Released:2022-05-19)
Uterus transplantation (UTx) has become a new potential option for women with absolute uterine factor infertility (UFI), who desire to give birth to their own children. In UTx, organ transplantation from living or deceased donors is used under the goal of assisted reproductive technology. In July of 2021, the commission for ethical issues on UTx under the Japanese Association of Medical Sciences published the report, and allowed the conducting of clinical research on UTx with a limited number of patients. This article discusses bioethical considerations of UTx. Transplantation from a living donor is an exceptional procedure which does not fulfill ethical principles of non-maleficence nor justice. Autonomy is also affected because the national guideline requires that a donor should primarily be a family member of the recipient and it raises a concern whether both a donor and a recipient feel pressure. Transplantation from a living donor is accepted because beneficence (saving a patient’s life) surpasses the other principles. This formula cannot be applied to UTx from living donors because the uterus is not a vital organ, and it is difficult to ethically justify such a transplantation. The interest of children is another important ethical issue. From a research ethics perspective, UTx is an unproven intervention to achieve the clinical goal for UFI women. Implementing UTx not as treatment but as clinical research first is supported by the standard of research ethics today. However, allowing clinical research embraces the practice of UTx itself, while unresolved ethical considerations are left behind. Continuous discussion open to public, review of institutional systems including legislation reform, and wholistic care and support for UFI women are needed.