ETHICAL CRITERIA FOR UTERINE TRANSPLANT RECIPIENTS & DONORS IN CLINICAL PRACTICE BY MARGARET ELIZABETH HORVAT A Thesis Submitted to the Graduate Faculty of WAKE FOREST UNIVERSITY GRADUATE SCHOOL OF ARTS AND SCIENCES in Partial Fulfillment of the Requirements for the Degree of MASTER OF ARTS Bioethics December 2018 Winston-Salem, North Carolina Approved By: Ana Iltis, Ph.D., Advisor Nancy M.P. King, JD, Chair Rich Robeson DEDICATION AND ACKNOWLEDGEMENTS This feat would not have been possible without the persistence and help of my advisor, Dr. Ana Iltis. She patiently pushed me to think deeper and challenge my initial conclusion. Ana, your teaching has not only influenced my work, but the way I think through questions in life in general. To my sweet husband, Jake Horvat, thank you for bearing with me as I pursued this degree. I would not be here if not for your love and encouragement. I am unbelievably lucky and grateful to have you by my side and pushing me to try new things and pursue scary dreams. Lastly, this work is dedicated to my parents Robert and Lisa Weiss. Stories of your struggles with infertility are what initially spurred me on to study Bioethics many years ago. Thank you for taking on the burdens, risks, and immense joys of In vitro fertilization and adoption to make the Weisses a family of four. You made this journey of graduate school a reality and allowed me to learn more about something I love, I truly could not have done this without you. ii TABLE OF CONTENTS LIST OF ABBREVIATIONS ................................................................................................. v ABSTRACT .......................................................................................................................... vii INTRODUCTION ................................................................................................................ viii CHAPTER ONE: UTx as a Organ Tx and an ART ............................................................... 1 ORGAN DONATIONS ................................................................................................................................................... 4 HISTORY OF ORGAN TRANSPLANTS .......................................................................................................... 4 EXPANSION OF ORGAN DONATION ............................................................................................................ 6 CATEGORIES OF ORGAN DONATIONS ....................................................................................................... 8 RISKS OF ORGAN TRANSPLANTS .............................................................................................................. 11 COSTS AND PAYMENTS .................................................................................................................................. 13 ASSISTED REPRODUCTIVE TECHNOLOGIES ............................................................................................... 15 TYPES OF ARTS.................................................................................................................................................... 15 LEGAL SITUATION ............................................................................................................................................. 17 BURDENS OF REPRODUCTION ................................................................................................................... 20 COSTS AND PAYMENTS .................................................................................................................................. 22 REPRODUCTION AND THE UNDERSTANDING OF WOMANHOOD .......................................... 24 UTERINE TRANSPLANTATION BACKGROUND ........................................................................................... 27 ASSESSING ETHICAL CRITERIA.......................................................................................................................... 30 CHAPTER TWO: Ethical Criteria for UTx Recipients .......................................................31 INTRODUCTION ......................................................................................................................................................... 31 CURRENT CRITERIA STANDARDS ............................................................................................................ 32 RELEVANT ETHICAL CONCEPTS................................................................................................................ 34 RECIPIENT’S EXPERIENCE ............................................................................................................................ 36 ETHICAL ASSESSMENT OF CRITERIA FOR UTX RECIPIENTS .............................................................. 37 REASON FOR PURSUING................................................................................................................................. 37 MOTHERHOOD STATUS .................................................................................................................................. 46 AGE ............................................................................................................................................................................. 48 SUITABILITY FOR MOTHERHOOD ............................................................................................................ 51 ADHERENCE .......................................................................................................................................................... 56 CONCLUSION ............................................................................................................................................................... 58 CHAPTER THREE: Ethical Criteria for UTx Donors ........................................................60 INTRODUCTION ......................................................................................................................................................... 60 CURRENT CRITERIA STANDARDS ............................................................................................................ 60 RELEVANT ETHICAL CONCEPTS................................................................................................................ 61 DONOR’S EXPERIENCE .................................................................................................................................... 62 ETHICAL CRITERIA TO EXAMINE ..................................................................................................................... 66 LIVING VS. DECEASED ..................................................................................................................................... 66 AGE & MOTHERHOOD STATUS ................................................................................................................... 78 RELATIONSHIP TO PATIENT ....................................................................................................................... 84 iii COMPENSATION ................................................................................................................................................. 92 CONCLUSION ............................................................................................................................................................... 98 CHAPTER FOUR: Remaining Questions & Research Considerations .......................... 100 INTRODUCTION ....................................................................................................................................................... 100 ALLOCATION ............................................................................................................................................................. 101 PAYMENT .................................................................................................................................................................... 105 FURTHER RESEARCH ............................................................................................................................................ 108 QUANTITATIVE ................................................................................................................................................ 109 QUALITATIVE .................................................................................................................................................... 113 FURTHER ETHICAL DISCUSSIONS .................................................................................................................. 114 PRONATALISM .................................................................................................................................................. 115 CLAIMS TO PARENTHOOD ......................................................................................................................... 116 MATERNAL FETAL CONFLICT .................................................................................................................. 118 EXPANDING UTX RECIPIENTS ................................................................................................................. 119 CONCLUSION ............................................................................................................................................................. 122 REFERENCES .................................................................................................................... 123 CURRICULUM VITAE