• Transplantation

Our paper ‘Should the State Fund Uterus Transplants?’ was recently published as a feature article alongside commentaries by Alghrani, Balayla and Lotz. We would like to thank all three for their insightful and careful analyses and JME for providing us with the opportunity to publish in this format. The commentaries were generally favourable and we have little to add regarding the pieces by Alghrani and Balayla. We would however like to take this opportunity to respond to some challenges and questions raised by Lotz.

Our approach has much in common with hers. In particular, we agree that:

1. the most important components of parenthood are social in nature, with the desire to gestate or have genetically related children being secondary;

2. many harms linked to infertility are caused or exacerbated by social and cultural attitudes which overestimate the importance of gestational and genetic ties;

3. prospective medical treatments should not automatically be disqualified from public funding because the harms they treat have primarily social causes.

Nonetheless, Lotz is sceptical about our proposal that uterus transplants (UTx) should be publicly funded if and when it meets the usual standards of safety, efficacy and cost-effectiveness. There appear to be three main reasons for this:

1. Reforming law and practice could render adoption a ‘sufficiently good’ alternative to UTx.

2. Our paper underestimates the extent to which the harms of infertility are caused by the sociocultural context in which reproduction takes place, and the likelihood of changing this context.

3. State provision of UTx might itself undermine efforts to secure positive attitudinal change.

In what follows, we focus mainly on (ii) and (iii) since (i) is heavily dependent on those more fundamental issues. We note from the outset however that we would of course welcome any reforms of adoption law and practice that serve to make it a more …