Evolving ethical challenges after a decade of uterus transplantation: recommendations from the International Society of Uterus Transplantation Ethics Committee

Uterus transplantation (UTx) became a clinical reality with the birth of the first baby in 2014. Following increased success, the procedure has now transitioned to clinical practice in many institutions throughout the world. With a rising number of donors, recipients, and babies born from this procedure, and with more institutions offering UTx, ethical challenges have evolved while novel aspects gained prominence. Here, the Ethics Committees of the International Uterus Transplantation Society, a section of The Transplantation Society, summarize current and future ethical challenges in UTx and provide recommendations for addressing these challenges. Ethical considerations covered here span (i) donor and recipient selection, (ii) living versus deceased donation, (iii) use of assisted reproductive technologies, (iv) informed consent, (v) clinical provision of UTx, and (vi) research protocols for further studies of UTx. For each topic considered, ethical analysis and recommendations are offered to ensure the practice of UTx remains within an acceptable foundational ethical framework that balances respect for autonomy, beneficence, and justice.