Ethical Considerations in Expanding Eligibility Criteria for Uterus Transplant Recipients: A Scoping Review

Purpose: As uterine transplantation (UTx) shifts from an experimental fertility treatment toward standard of care, ethical considerations in expanding access to UTx beyond currently eligible recipients merit attention. We conducted a scoping review to map existing scholarship on the ethics of candidacy for UTx beyond cisgender female recipients.Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), five databases were searched (PubMed, PsycINFO, Embase, Scopus, and CINAHL) from database inception to June 24, 2022. Following title, abstract, and full-text screening, data were extracted and charted to identify thematic patterns and identify gaps in scholarship.Results: Thirty-two articles were included in the final sample. Issues of justice figured most prominently. Common themes included the right to gestate for transgender women and beyond, the possibility of increased surgical and medical risks for other recipient populations, and attendant moral obligation to expand access to UTx if additive risks are mitigated. Equity considerations were also frequently cited, along with the value of gestation in female identity and its role in defining womanhood.Conclusion: Discourse on the ethics of expanding eligibility for UTx is still emerging. Areas for further consideration include exploring the relation of gestation to identity and gender, clarifying the need for further research on safety and efficacy of UTx in other recipient populations, assessing desire for UTx among individuals other than cisgender women, and addressing sustainable funding. This scoping review can inform efforts to develop equitable eligibility criteria for access to UTx moving forward.