Morally unjustified conditions on access to scarce transplantable Uteruses

Ryan Tonkens1

1 Centre for Human Bioethics, Monash University, Wellington Rd., Clayton VIC, 3800, 

Uterine transplants are now a real medical possibility (Brännström et al. 2015). Like other types of transplantable human organs, wombs are expected to be in very high demand, and the supply is likely to be small. Given this, difficult decisions need to be made about (justifiable) eligibility criteria for access to the scarce transplantable uteruses available.

There have been some recent arguments in the literature that suggest that the expected parenting ability of the woman to receive the transplant ought to play a role in allocation decisions. For example, the Revised Montreal Criteria for the Ethical Feasibility of Uterine Transplantation (Lefkowitz, Edwards and Balayla 2013) includes as one of its assessment criteria that the woman “does not exhibit frank unsuitability for motherhood” (p.924). Moreover, Bayevsky & Berkman (2016) suggest that “child-rearing capacity” ought to be considered when making allocation decisions regarding available wombs. [The most recent NHMRC (2016) and TSANZ (2016) guidelines on eligibility for transplantable organs do not mention uterine transplantation at all].

The purpose of this paper is to challenge the inclusion of such non-medical eligibility criteria, regarding anticipated parenting ability: (1) As there is nothing about fertility status that says anything about parenting ability, and not all kinds of family builders are being screened prior to pursuing their family building goals, the inclusion of this information is an example of “infertilitism”, i.e. undue discrimination based on fertility status; (2) appealing to the best interests of the (potential, future) child is medically and morally irrelevant in this context, and it is not clear that uterine transplants ought to be made available exclusively for the purpose of gestating new life; and (3) parenting ability is very difficult to predict ahead of time, and medical professionals cannot be expected to have the necessary ‘expertise’ to make such assessments.


Dr Tonkens received his PhD in Philosophy in 2012. His main research areas are in applied ethics and bioethics, especially reproductive ethics, transplantation ethics, and the ethical issues accompanying recent developments in artificial intelligence and robotics research.