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Public funding of uterine transplantation
  1. Jacques Balayla
  1. Correspondence to Dr Jacques Balayla, Obstetrics and Gynecology, University of Montreal, Montreal, Quebec, Canada H4W1S8; jacques.balayla{at}

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The recent success of uterine transplantation (UTx) leading to a viable birth has provided the first evidence for the treatment and cure of absolute uterine factor infertility.1 Indeed, while its clinical and scientific merits have been recently established,1 a number of social, economic and ethical concerns remain.2–4 In particular, the question whether uterine transplants should be publicly funded remains a source of debate and controversy.5

In an insightful essay by Nicola Williams and Stephen Wilkinson, the authors address the question from the opposing premise: are there any compelling reasons for the state not to fund UTx?5 To achieve this goal, the authors counter three arguments commonly raised against the public funding of UTx. The first argument suggests that UTx funding would increase the carbon footprint, which is inconsistent with governments’ obligations to prevent climate change. The second claims that UTx does not treat a disorder and is therefore not medically necessary. Finally, the third asserts that funding for UTx should be denied because of the availability of alternatives such as adoption and surrogacy.

Before undertaking their analysis, two key premises are raised by the authors. First, their study is limited to countries with socialised healthcare systems paid through taxation and may not apply to countries where healthcare is privately funded. This argument is a key to the understanding of the ethical implications of UTx funding at the world's stage. Second, and perhaps more importantly, an emphasis is placed on the notion that before determining …

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