“A Womb of One’s Own?” Lesson Plan

Altruism 

Acting in the best interest of others, sometimes superseding one’s own interests. 

• Women who volunteer to undergo risky surgery to donate their uteruses to strangers are often motivated by altruism. 

Coercion 

When someone is compelled, pressured, or forced to act in a certain way or make a certain decision, sometimes against their own interests.  

• A mother or aunt may be coerced by other family members to donate her uterus to her daughter or niece.  

Gestational Carrier/Surrogate 

A gestational carrier or gestational surrogate is someone who carries a pregnancy for someone else and does not have a genetic connection to the resulting baby. 

Informed Consent 

Ethical and legal standards require informed consent in medical decision making and when agreeing to participate in research. In medicine, informed consent requires “a discussion of the nature of the procedure, the risks and benefits, the reasonable alternatives, and an assessment of the patient’s understanding of these items.”

• How did Jen Dingle get a uterus? 

• In Jen’s case, how did the doctors make sure that the person who donated their uterus wasn’t coerced?  

• What are some other ways to start a family besides uterus transplant?
  • Why didn’t they work for Jen? 

• What are some of the sources of donated uteruses mentioned in the Episode? Sample answers below.
  • Donation by a living family member (for example, in Sweden, people could only receive a uterus from a parent)
  • Donation by a living stranger (this is the donation source in Jen’s case)
  • Donation by a deceased organ donor 

• Who is facing risks when a uterus is transplanted? What risks are they facing? Sample answers below.
  • Living donors face surgery risks
  • Living donors who are related to the recipient may face pressure from family to donate their uterus in addition to risks of surgery
  • Recipients face surgery risks, as well risks associated with organ transplant (for example, organ rejection, complications from immunosuppressants)
  • Recipients might not successfully get pregnant or have a baby, even if the organ transplant is successful
  • Risks to the baby who is gestated in and delivered from a transplanted uterus 

• Currently, women of reproductive age who were born without a uterus due to a congenital condition are eligible to join the research study testing uterus transplants, and the purpose of the transplant is for these women to try to get pregnant. In the future, when this procedure becomes more widely available, who should be able to use it? Sample answers below.
  • People who were born with a uterus but lost it (for example, from cancer or an accident)
  • Transgender women who hope to get pregnant
  • Transgender women or others who do not intend to get pregnant 

• Think about other ways to become a parent. What ethical concerns are associated with these methods?
  • What is needed for informed consent? What are the risks of coercion?
  • What are the risks, and to whom? Do the risks outweigh the benefits?
  • Who has access to these methods? Who doesn’t? Is it fair?

Description: 

Students, in pairs and as a class, review the pros and cons of different uterus donation sources (living donor, known/related; living donor, anonymous; deceased donor). Students should take the time to consider concerns highlighted in the Episode, for example, financial cost, emotional labor, health risks, and any other aspects they can come up with. This helps them think about concepts like risks, benefits, informed consent, and how these concepts interact. 

Instructions: 

Before the Activity: 

• Students should listen to the Podcast Episode. They should be familiar with the terms provided in the Vocabulary. 

• Print the Lesson 5 Handout, one for each small group or pair.  

Pros and Cons: 

Students are divided into pairs. Each is given a copy of the Lesson 5 Handout with three different sources for uterus donation and a blank list to fill in pros and cons. Each pair is given around 10 minutes to think about the different sources and fill in their sheets based on ideas presented in the Episode as well as their own. While students are working on this, the teacher can use the chalkboard or whiteboard to make a larger blank list that looks something like this: 

After this, the class is brought back together to compile all the pros and cons they have come up with on the big list that the teacher has created. Repetitions and overlap are expected, and the teacher can guide the class in condensing their thoughts into a single list. Then, as a class, the students can select a single model that they believe is the best, through having a show-of-hands vote. 

1. ELA writing assignment: Over the years, there have been many innovations to help people have children. This includes IVF, gestational carriers, and now uterus transplants, among others. Each student can pick one of these techniques or technologies and briefly explore the ethical questions it poses and the questions that surrounded its earliest use.

Uterus Transplant Program, Baylor Scott & White Health. 

Uterus Transplantation: state of the art in 2021, Journal of Assisted Reproduction and Genetics, 2021. 

Uterine transplant raises hopes — and thorny ethical questions, STAT, 2016. 

First Baby Born To U.S. Uterus Transplant Patient Raises Ethics Questions, NPR, 2017. 

Uterus Transplantation: The Ethics of Using Deceased Versus Living Donors, The American Journal of Bioethics, 2018. 

Uterus Transplantation: ethical considerations, Current Opinion in Organ Transplantation, 2021.