Uterus transplantation: an ethical analysis

Uterus transplantation (UTx) represents an emerging therapeutic option for women with absolute uterine-factor infertility (AUFI) and raises complex ethical questions as a non-life-saving intervention. This study presents an ethical analysis based on the four principles of Beauchamp and Childress-autonomy, non-maleficence, beneficence, and social justice-and is grounded in a structured narrative literature review of current medical and ethical publications, drawing on the German legal context as an illustrative example. Uterus transplantation demonstrates potential benefits, particularly in terms of improving quality of life and enabling affected women to experience pregnancy and childbirth. However, significant ethical concerns arise, especially regarding the risks for donors, recipients, and offspring, as well as issues of equitable access and resource allocation. Living donation, in particular, presents ethical challenges due to the exposure of healthy individuals to surgical risks. Uterus transplantation may be considered conditionally justifiable, particularly when autonomy and beneficence are fulfilled, and provided that it is performed within controlled clinical trials and that deceased donation is preferred over living donation. Nevertheless, substantial concerns remain regarding non-maleficence and social justice. Therefore, UTx should not yet be regarded as a standard treatment; further research, especially long-term outcome studies, which are currently lacking, and a revision of the Montreal criteria are required before it can be established more broadly.