In the past, trans women they couldn’t do much more than dress according to the gender with which they identified. However, over time, medicine has helped them feel better about themselves in many ways. For starters, like trans men, they have gender-assigned hormone therapy. But they can also breast-feed or even have a vaginoplasty. It would only be necessary for them to undergo a uterus transplant, that even allowed them to be mothers. However, this has long been considered unfeasible based on principles of bioethics.
The truth is that the uterus transplant operation itself is in its infancy, even for cis women. Very few interventions have been carried out, but some have been successful. In fact, in 2014 a baby was born for the first time to a woman who had received a uterus transplant. In trans women it has not been done, although it has there was an attempt in 1931which ended with the death of the patient due to an infection.
Today, hygiene measures, as well as the techniques used, have evolved a lot. It could be time to include trans women in the list of possible recipients of a uterus transplant. Precisely for this reason, an Indian surgeon, Dr. Narendra Kaushika, has been in favor of taking that step once and for all. As explained in IFLSciencethe sanitary you are already planning how to carry out this intervention for the first time. However, the detractors around him there are still many.
Difference between trans and cis women
Before starting to talk about this topic, it is important to be clear who is a trans or cis woman.
Cis women are those whose gender corresponds to the one they were assigned at birth. That is, they were born anatomically as women. In contrast, trans women are those who were assigned the male gender at birth.
They are important concepts, because they will be present throughout this article repeatedly. With them clear, let’s see why there is so much reluctance towards the fact that trans women can receive a uterus transplant.
The Montreal Criteria and Uterus Transplantation
Absolute infertility due to uterine factor is one that refers to the inability to have children due to the anatomical or physiological incapacity of the uterus.
For a long time, the cis women with this problem they could only to adopt or, at most, resort to a surrogacy in countries where it is legal. Although the truth is that if we are going to talk about unethical activities, surrogacy would give us a good time to comment.
Leaving that aside, over time the possibility of uterus transplant. This can be from a living donor or someone who has died. The problem is that it is a complex procedure that involves certain risks. When the situation is life or death, as can happen with a heart transplant, the risk is worth it. But if it is only to be able to have children, there are options such as adoption, it comes into play. ethical dilemma. That’s why in 2012 what are known as the Montreal Criteria were enunciatedaimed at focusing principles of bioethics about the need or not to carry out a uterus transplant.
The main principles of bioethics are the one of beneficence, the one of maleficence, the one of autonomy and the one of justice. Based on the first, these criteria establish that a uterus transplant would be adequate, if the circumstances are good, because do good to those who need it. On the other hand, the concept of non-maleficence opposes this idea, since both the donor and the recipient can suffer physical and emotional damage. For that reason, it would be very important to talk to both parties, so that they take a informed decision. Here the principle of autonomy would be enhanced. And finally, the concept of justice is based on the fact that these interventions favor equality between people.
It should be noted that these principles were enunciated based on what it would be like to carry out a uterus transplant for cis women. Trans women were not thought of at first.
However, when this possibility began to be considered over time, many surgeons pointed out that these patients require a series of extra considerations that would conflict with the Montreal Criteria. For example, in 2018 Dr. amel alghraniProfessor of Law at the University of Liverpool School of Law and Social Justice, recalled in an article that it would be necessary to create a new vascularization and support the uterus transplant with a hormone treatment that helps both the maintenance of the organ and a possible subsequent pregnancy. On the other hand, the uterus would be placed in a non-gynecoid pelvis. This would imply that the hips, unlike those of most cis women, would not be prepared for pregnancy and, above all, for childbirth.
These would be additional risks that would conflict with the principles of bioethics, especially with that of non-maleficence. However, for Dr. Kaushik the problems would not be so many.
How could a uterus transplant be performed on trans women?
Dr. Kaushik is the director of the Olmec Transgender Surgery Institute, New Delhi. There she performs the usual interventions on trans women, but so far she has not been able to carry out a uterus transplant. Even so, she believes that it would be viable and that it would help these women, benefiting their health and making them happier. Clearly, this goes very much in favor of the beneficence principle.
As for the donor, although it could be a living trans man or cis womanif cadavers are used, that part of the risks would be eliminated.
Regarding the issue of vascularization and hormonal treatment, having enough information for the recipients should not be a problem. And neither is the fact that her hips are narrower. At the time of delivery it would be solved with a caesarean sectionas is the case with many cis women.
Still, all this is said working on the hypothetical. We must not forget that even for cis women very few uterus transplants have been carried out to date. Perhaps one day they will be a much more widespread reality and that already includes trans women. Meanwhile, they have many other rights to fight for. Because, unfortunately, they are still considered different from other women for much more than what a uterus transplant implies. We have evolved, yes, but not enough.