Should uterus transplants be publicly funded?

J Med Ethics. 2016 Sep;42(9):559-65. doi: 10.1136/medethics-2015-102999. Epub 2015 Dec 15.


Since 2000, 11 human uterine transplantation procedures (UTx) have been performed across Europe and Asia. Five of these have, to date, resulted in pregnancy and four live births have now been recorded. The most significant obstacles to the availability of UTx are presently scientific and technical, relating to the safety and efficacy of the procedure itself. However, if and when such obstacles are overcome, the most likely barriers to its availability will be social and financial in nature, relating in particular to the ability and willingness of patients, insurers or the state to pay. Thus, publicly funded healthcare systems such as the UK's National Health Service (NHS) will eventually have to decide whether UTx should be funded. With this in mind, we seek to provide an answer to the question of whether there exist any compelling reasons for the state not to fund UTx. The paper proceeds as follows. It assumes, at least for the sake of argument, that UTx will become sufficiently safe and cost-effective to be a candidate for funding and then asks, given that, what objections to funding there might be. Three main arguments are considered and ultimately rejected as providing insufficient reason to withhold funding for UTx. The first two are broad in their scope and offer an opportunity to reflect on wider issues about funding for infertility treatment in general. The third is narrower in scope and could, in certain forms, apply to UTx but not other assisted reproductive technologies (ARTs). The first argument suggests that UTx should not be publicly funded because doing so would be inconsistent with governments' obligations to prevent climate change and environmental pollution. The second claims that UTx does not treat a disorder and is not medically necessary. Finally, the third asserts that funding for UTx should be denied because of the availability of alternatives such as adoption and surrogacy.

Keywords: Allocation of Health Care Resources; Concept of Health; Distributive Justice; Reproductive Medicine; Transplantation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cost-Benefit Analysis
  • Delivery of Health Care / economics
  • Delivery of Health Care / ethics*
  • Female
  • Health Services Accessibility / economics
  • Health Services Accessibility / ethics*
  • Humans
  • Infertility, Female / classification
  • Infertility, Female / economics
  • Infertility, Female / surgery*
  • International Classification of Diseases / ethics*
  • Pregnancy
  • Public Sector
  • Reproductive Health Services* / economics
  • Reproductive Health Services* / ethics
  • Reproductive Techniques, Assisted
  • State Medicine / economics*
  • Tissue Donors / ethics*
  • United Kingdom
  • Uterus / transplantation*