پیوند رحم از منظر اصول اخلاق زیستی: یک مطالعه مروری

نوع مقاله : مروری

نویسنده

استادیار گروه مامایی، دانشکده پزشکی، دانشگاه علوم پزشکی اراک، اراک، ایران.

چکیده

مقدمه: پیوند رحم به‌عنوان یک روش درمانی برای نازایی رحمی مطلق، هنوز در مرحله آزمایشی قرار دارد. لازم است قبل از اینکه به‌‌عنوان درمان استاندارد نازایی رحمی مطلق به‌کار رود، چگونگی انجام اخلاقی آن مشخص شود، لذا مطالعه حاضر با هدف مروری بر پیوند رحم از منظر اصول اخلاق زیستی انجام شد.
روش‌کار: در این مطالعه مروری جهت یافتن مقالات مرتبط پایگاه‌های اطلاعاتی SID، MagIran، Irandoc و PubMed و بانک مقالات پزشکی ایران جستجو شدند. جستجو بدون هیچ محدودیتی در پایگاه‌های اطلاعاتی فارسی تا 20 جون 2020 و در بانک اطلاعاتی PubMed تا 20 مارس 2020 انجام شد. پس از دستیابی به مقالات مرتبط، موضوعات اخلاقی ذکر شده در آنها پیرامون پیوند رحم، شناسایی و در غالب اصول چهارگانه اخلاق زیستی طبقه‌بندی شد.
یافته‌ها: از 92 مقاله شناسایی شده، 48 مقاله جهت بررسی کیفی وارد مطالعه شدند. بر اساس نتایج، از منظر اصل خودمختاری، پیوند رحم گامی جهت رسیدن به استقلال باروری می‌باشد. از منظر اصل سودرسانی، علاوه بر امکان زایمان یک بچه سالم توسط گیرنده، درمان نازایی از طریق پیوند، محاسن زیادی برای گیرنده و اهداکننده دارد. از منظر اصل عدم ضرررسانی، تلاش‌های گسترده‌ای جهت شناسایی، کاهش و حذف خطرات پیوند صورت گرفته است با این حال تعادل مناسب سود و زیان برای انجام پیوند ضروری است. از منظر اصل عدالت معیارهایی جهت تخصیص عادلانه رحم پیوندی در نظر گرفته شده است، اما چگونگی تأمین مخارج پیوند، همچنان مورد بحث و اختلاف نظر می باشد.
نتیجه‌گیری: از منظر اصول خودمختاری، سودرسانی و عدم ضرررسانی، انجام اخلاقی پیوند رحم امکان پذیر است. در حال حاضر بیشترین بحث اخلاقی در زمینه پیوند رحم، مربوط به اصل عدالت می‌باشد.

کلیدواژه‌ها


عنوان مقاله [English]

Uterus transplantation from the perspective of bioethical principles: A review study

نویسنده [English]

  • Sakineh Taherkhani
Assistant professor, Department of Midwifery, Faculty of Medicine, Arak University of Medical Sciences, Arak, Iran.
چکیده [English]

Introduction: Uterus transplantation, as a treatment method for absolute uterine infertility, is still in the experimental stage. It is necessary to determine the ethical feasibility of uterus transplantation before using it as a standard treatment for absolute uterine infertility. Therefore, this study was conducted with aim to review uterus transplantation from the perspective of bioethical principles.
Methods: In this review study, to find the related articles, the databases of SID, MagIran, Irandoc, PubMed and Iran Medical Articles Bank were searched. The search was conducted without any limitation in Persian databases until June 20, 2020 and in English databases until March 20, 2020. After acquiring the relevant articles, the ethical issues mentioned in them regarding uterus transplantation were identified and classified in principles of bioethics.
Results: From 92 identified articles, 48 papers were entered the study for qualitative review. Based on the results, from the perspective of the principle of autonomy, uterus transplantation is a step towards achieving the reproductive autonomy. From the perspective of the principle of beneficence, in addition to the possibility of giving birth to a healthy baby by the recipient, treating infertility through transplantation has many benefits for the recipient and donor.
From the perspective of the principle of non-maleficence, extensive efforts have been made to identify, reduce and eliminate transplantation risks; however, a proper balance of benefit and loss is essential to perform the transplantation. From the perspective of the principle of justice, some criteria have been considered for the fair allocation of transplant uterus, but funding of the transplant is still debated.
Conclusion: From the perspective of the principles of autonomy, beneficence and non-maleficence, ethically performing of uterine transplantation is possible. Currently, the most ethical discussion in the field of uterus transplantation is related to the principle of justice.

کلیدواژه‌ها [English]

  • Bioethical principles
  • Bioethics
  • Ethics
  • Review Study
  • Uterus transplantation
  1. Lefkowitz A, Edwards M, Balayla J. The Montreal criteria for the ethical feasibility of uterine transplantation. Transplant international 2012; 25(4):439-47.
  2. Lavoué V, Vigneau C, Duros S, Boudjema K, Levêque J, Piver P, et al. Which donor for uterus transplants: brain-dead donor or living donor? A systematic review. Transplantation 2017; 101(2):267-73.
  3. Williams N. Should deceased donation be morally preferred in uterine transplantation trials?. Bioethics 2016; 30(6):415-24.
  4. Bruno B, Arora KS. Uterus transplantation: the ethics of using deceased versus living donors. The American Journal of Bioethics 2018; 18(7):6-15.
  5. O’Donovan L. Pushing the boundaries: Uterine transplantation and the limits of reproductive autonomy. Bioethics 2018; 32(8):489-98.
  6. Behdani F, Mosavifar N, Hebrani P, Soltanifar A, Mohamadnejad M. Anxiety and mood disorders in infertile women referred to Montaserie infertility clinic in Mashhad, North-East Iran. Iran J Obstet Gynecol Infertil 2008; 11(3):15-23.
  7. Haririan HR, Mohammadpour Y, Aghajanloo A. Prevalence of depression and contributing factors of depression in the infertile women referred to Kosar infertility center, 2009. Iran J Obstet Gynecol Infertil 2010; 13(2):45-9.
  8. Altawil Z, Arawi T. Uterine Transplantation: Ethical Considerations within M iddle E astern Perspectives. Developing World Bioethics 2016; 16(2):91-7.
  9. Favre-Inhofer A, Rafii A, Carbonnel M, Revaux A, Ayoubi JM. Uterine transplantation: review in human research. Journal of Gynecology Obstetrics and Human Reproduction 2018; 47(6):213-21.
  10. Peters HE, Juffermans LJ, Lambalk CB, Dekker JJ, Fernhout T, Groenman FA, et al. Feasibility study for performing uterus transplantation in the Netherlands. Human Reproduction Open 2020; 2020(2):hoz032.
  11. Liu Y, Zhang Y, Ding Y, Chen G, Zhang X, Wang Y, et al. Clinical applications of uterus transplantation in China: Issues to take into consideration. Journal of Obstetrics and Gynaecology Research 2020; 46(3):357-68.
  12. Catsanos R, Rogers W, Lotz M. The ethics of uterus transplantation. Bioethics 2013; 27(2):65-73.
  13. Richards EG, Agatisa PK, Davis AC, Flyckt R, Mabel H, Falcone T, et al. Framing the diagnosis and treatment of absolute uterine factor infertility: insights from in-depth interviews with uterus transplant trial participants. AJOB empirical bioethics 2019; 10(1):23-35.
  14. Fageeh W, Raffa H, Jabbad H, Marzouki A. Transplantation of the human uterus. International Journal of Gynecology & Obstetrics 2002; 76(3):245-51.
  15. Ngaage LM, Ike S, Elegbede A, Vercler CJ, Gebran S, Liang F, et al. The changing paradigm of ethics in uterus transplantation: a systematic review. Transplant International 2020; 33(3):260-9.
  16. Akar ME, Ozkan O, Aydinuraz B, Dirican K, Cincik M, Mendilcioglu I, et al. Clinical pregnancy after uterus transplantation. Fertility and sterility 2013; 100(5):1358-63.
  17. Brännström M, Kähler PD, Greite R, Mölne J, Díaz-García C, Tullius SG. Uterus transplantation: a rapidly expanding field. Transplantation 2018; 102(4):569-77.
  18. Brännström M, Johannesson L, Bokström H, Kvarnström N, Mölne J, Dahm-Kähler P, et al. Livebirth after uterus transplantation. The Lancet 2015; 385(9968):607-16.
  19. Farrell RM, Johannesson L, Flyckt R, Richards EG, Testa G, Tzakis A, et al. Evolving ethical issues with advances in uterus transplantation. American Journal of Obstetrics and Gynecology 2020.
  20. Flyckt R, Davis A, Farrell R, Zimberg S, Tzakis A, Falcone T. Uterine transplantation: surgical innovation in the treatment of uterine factor infertility. Journal of Obstetrics and Gynaecology Canada 2018; 40(1):86-93.
  21. Del Priore G, Saso S, Meslin EM, Tzakis A, Brännström M, Clarke A, et al. Uterine transplantation—a real possibility? The Indianapolis consensus. Human Reproduction 2013; 28(2):288-91.
  22. Allyse M, Amer H, Coutifaris C, Falcone T, Famuyide A, Flyckt R, et al. American Society for Reproductive Medicine position statement on uterus transplantation: a committee opinion. Fertility and sterility 2018; 110(4):605-10.
  23. Farrell RM, Falcone T. Uterine transplantation. Fertility and Sterility 2014; 101(5):1244-5.
  24. Taherkhani S. Ethical considerations in domestic violence related researches. Medical Ethics Journal 2016; 10(35):141-75.
  25. Testa G, Koon EC, Johannesson L. Living donor uterus transplant and surrogacy: ethical analysis according to the principle of equipoise. American Journal of Transplantation 2017; 17(4):912-6.
  26. Nair A, Stega J, Smith JR, Del Priore G. Uterus transplant: evidence and ethics. Annals of the New York Academy of Sciences 2008; 1127(1):83-91.
  27. Del Priore G, Gudipudi DK. Promise of uterine transplant–Myth or a reality?. Maturitas 2014; 77(1):20-3.
  28. Brännström M, Wranning CA, Altchek A. Experimental uterus transplantation. Human reproduction update 2010; 16(3):329-45.
  29. Benagiano G, Landeweerd L, Brosens I. Medical and ethical considerations in uterus transplantation. International Journal of Gynecology & Obstetrics 2013; 123(2):173-7.
  30. Lefkowitz A, Edwards M, Balayla J. Ethical considerations in the era of the uterine transplant: an update of the Montreal Criteria for the Ethical Feasibility of Uterine Transplantation. Fertility and sterility 2013; 100(4):924-6.
  31. Petrini C, Gainotti S, Morresi A, Costa AN. Ethical issues in uterine transplantation: psychological implications and informed consent. InTransplantation proceedings 2017; 49(4):707-710.
  32. Rahbarpoor MR. The concept of bioethics and its scope. Bioethics Journal 2011; 1(1): 13-48. (persian)
  33. Tatari F, Abbasi M. The study Ethical aspects of embryo and gamete donation from the four principles of medical ethics point of view. Medical Ethics Journal 2017; 8(27):153-82.
  34. O’Donovan L, Williams NJ, Wilkinson S. Ethical and policy issues raised by uterus transplants. British medical bulletin 2019; 131(1):19-28.
  35. Testa G, Koon EC, Johannesson L, McKenna GJ, Anthony T, Klintmalm GB, et al. Living donor uterus transplantation: a single center's observations and lessons learned from early setbacks to technical success. American Journal of Transplantation 2017; 17(11):2901-10.
  36. Testa G, Anthony T, McKenna GJ, Koon EC, Wallis K, Klintmalm GB, et al. Deceased donor uterus retrieval: a novel technique and workflow. American Journal of Transplantation 2018; 18(3):679-83.
  37. Taneja A, Das S, Hussain SA, Madadin M, Lobo SW, Fatima H, et al. Uterine Transplant: A Risk to Life or a Chance for Life?. Science and engineering ethics 2019; 25(2):635-42.
  38. Horsburgh CC. A call for empirical research on uterine transplantation and reproductive autonomy. Hastings Center Report 2017; 47:S46-9.
  39. Testa G, Johannesson L. The ethical challenges of uterus transplantation. Current Opinion in Organ Transplantation 2017; 22(6):593-7.
  40. Johannesson L, Dahm-Kähler P, Eklind S, Brännström M. The future of human uterus transplantation. Women’s Health 2014; 10(4):455-67.
  41. Chmel R, Nováčková M, Pastor Z, Matěcha J, Čekal M, Froněk J. Ethical aspects of uterus transplantation. Casopis lekaru ceskych 2017; 156(1):36-42.
  42. Arora KS, Blake V. Uterus transplantation: ethical and regulatory challenges. Journal of Medical Ethics 2014; 40(6):396-400.
  43. Arora KS, Blake V. Uterus transplantation: the ethics of moving the womb. Obstetrics & Gynecology 2015; 125(4):971-4.
  44. Dickens BM. Legal and ethical issues of uterus transplantation. International Journal of Gynecology & Obstetrics 2016; 133(1):125-8.
  45. Zaami S, Marinelli E, di Luca NM, Montanari Vergallo G. Ethical and medico-legal remarks on uterus transplantation: may it solve uterine factor infertility. Eur Rev Med Pharmacol Sci 2017; 21(22):5290-6.
  46. Olausson M, Johannesson L, Brattgård D, Diaz-Garcia C, Lundmark C, Groth K, et al. Ethics of uterus transplantation with live donors. Fertility and sterility 2014; 102(1):40-3.
  47. Kisu I, Banno K, Mihara M, Suganuma N, Aoki D. Current status of uterus transplantation in primates and issues for clinical application. Fertility and sterility. 2013; 100(1):280-94.
  48. Farrell RM, Falcone T. Uterine transplant: new medical and ethical considerations. Lancet (London, England) 2014; 385(9968):581-2.
  49. Kisu I, Mihara M, Banno K, Umene K, Araki J, Hara H, et al. Risks for donors in uterus transplantation. Reproductive sciences 2013; 20(12):1406-15.
  50. Guntram L, Williams NJ. Positioning uterus transplantation as a ‘more ethical’alternative to surrogacy: Exploring symmetries between uterus transplantation and surrogacy through analysis of a Swedish government white paper. Bioethics 2018; 32(8):509-18.
  51. Kumnig M, Jowsey-Gregoire SG. Key psychosocial challenges in vascularized composite allotransplantation. World J Transplant 2016; 6:91-102.
  52. Hammond‐Browning N. UK criteria for uterus transplantation: a review. BJOG: An International Journal of Obstetrics & Gynaecology 2019; 126(11):1320-6.
  53. Gomel V. Uterine transplantation. Climacteric 2019; 22(2):117-21.
  54. Jones BP, Saso S, Quiroga I, Yazbek J, Smith JR. Re: UK criteria for uterus transplantation: a review. BJOG: An International Journal of Obstetrics & Gynaecology 2019; 126(12):1507-8.
  55. Williams NJ. Deceased donation in uterus transplantation trials: novelty, consent, and surrogate decision making. The American Journal of Bioethics 2018; 18(7):18-20.
  56. Ejzenberg D, Andraus W, Mendes LR, Ducatti L, Song A, Tanigawa R, et al. Livebirth after uterus transplantation from a deceased donor in a recipient with uterine infertility. The Lancet 2018; 392(10165):2697-704.
  57. Sampson A, Kimberly LL, Goldman KN, Keefe DL, Quinn GP. Uterus transplantation in women who are genetically XY. Journal of medical ethics 2019; 45(10):687-9.
  58. Bruno B, Arora KS. Uterus transplantation: the ethics of using deceased versus living donors. The American Journal of Bioethics 2018; 18(7):6-15.
  59. Horvat M, Iltis A. What Are Good Guidelines for Evaluating Uterus Transplantation?. AMA journal of ethics 2019; 21(11):988-95.
  60. Mirkes SR. The Ethics of Uterus Transplantation. The Linacre Quarterly 2008; 75(2):112-31.
  61. Surman OS, Saidi R, Burke TF. Regulating the sale of human organs: a discussion in context with the global market. Current Opinion in Organ Transplantation 2008; 13(2):196-201.
  62. Bayefsky MJ, Berkman BE. The ethics of allocating uterine transplants. Cambridge Q. Healthcare Ethics 2016; 25(3): 350-65.
  63. Balayla J. Uterine transplants in the Canadian setting: a theoretical framework. Journal of Obstetrics and Gynaecology Canada 2016; 38(10):955-60.
  64. Wilkinson S, Williams NJ. Should uterus transplants be publicly funded?. Journal of Medical Ethics 2016; 42(9):559-65.
  65. Balayla J. Public funding of uterine transplantation. Journal of medical ethics 2016; 42(9):568-9.
  66. McTernan E. Uterus transplants and the insufficient value of gestation. Bioethics 2018; 32(8):481-8.
  67. Lotz M. Uterus transplantation as radical reproduction: Taking the adoption alternative more seriously. Bioethics 2018; 32(8):499-508.
  68. Blake VK. Financing uterus transplants: the United States context. Bioethics 2018; 32(8):527-33.
  69. Balayla J, Dahdouh EM. Uterine transplantation is not a good use of limited resources: FOR: Uterine transplantation is not a good use of limited resources-a case of distributive justice and burden of disease. BJOG 2016; 123(9):1439.