Our demonstration of a live birth after uterus transplantation in a woman born with no uterus has eradicated the diagnosis of absolute uterine factor infertility.
Professor Mats Brannstrom, Sweden
God knows what any female bears. He knows well to what extent the uterus may decrease and to what extent they may increase. To him everything is well measured and balanced (Quran 13:8)
Reproduction and the ability to have children is a fundamental aspect of many people’s lives. This great desire to be able to fulfil the basic human need to procreate has fuelled the global technological revolution over the last half century in the context of artificial reproductive technologies designed to alleviate the effects of infertility. The latest reproductive breakthrough to dominate global headlines is the recent success in Sweden, where the world’s first ever baby has been born following a uterus transplant. This technology offers hope to women across the world who until now may have been unable to experience motherhood through pregnancy. The technology could hold distinctive advantages to Muslim couples, for it will enable them to have a genetically related child, even if the woman was born without a uterus, or suffers from some form of uterine factor infertility. Prior to this breakthrough, the only other option for such women to achieve genetic motherhood was through surrogacy, which is forbidden in Islam. This paper explores how this advance may be received in the Islamic faith.
- Reproduction, Islam and Uterus Transplant Technology
- Historical Overview
The main function of the uterus is to accept a fertilized ovum which becomes implanted into the lining of the uterine cavity, and to provide it with nourishment derived from blood vessels which develop exclusively for this purpose (Saladin 2007, 1052-1053). Should pregnancy occur, the uterus serves as an incubator for the developing embryo where it can safely develop until birth (Soloman and Philips 1987, 334). Transplantation of this vast organ is technically difficult given the complex blood vessels that supply the uterus which are smaller than those in other organ transplants (Grady 2002). Recipients of a transplanted uterus would need to take immunosuppressant drugs to prevent the body rejecting the uterus. Despite initial fears surrounding adverse effects such drugs may have on the foetus, Brannstrom et al contend that there is now a long experience of outcome from pregnancies in human organ transplant patients that have been under immuno suppression drugs (Brannstrom et al 2007, 92). They refer to the results from the three large registries of pregnancy data of transplanted patients (UK Pregnancy Registry, European Dialyses and Transplantation Association, National Transplantation Pregnancy Registry in the USA) which evidence no increased risk of congenital malformations in those patients.
Human Research into Uterine Transplantation - ‘The race is over’
The first attempt at transplanting a human uterus transplant occurred in Saudi Arabia in 2000. The uterus was donated to a 26-year old patient, who some years earlier had undergone a hysterectomy because of life-threatening bleeding. She received the uterus from a 46-year-old unrelated woman, who had been advised to have a hysterectomy after being diagnosed with benign ovarian disease. Post-transplant, the uterus produced two menstrual periods which was considered to reflect good blood perfusion and viability of the transplanted uterus. However, on the 99th day, an ultra sound confirmed cessation of the blood flow as a result of blood clots which had formed in the arteries. A hysterectomy became necessary and the transplanted uterus was removed. Notwithstanding this, Fageeh, regarded the surgery as “a good start” and asserted “our clinical results with the first human uterine transplantation confirm the surgical technical feasibility and safety of this procedure in gynaecological, surgical, and vascular terms”. Internationally the surgery was hailed as a breakthrough.
The second human uterus transplant was performed in Turkey in 2011, with the uterus coming from a deceased donor. The recipient, was a 21 year old married Muslim lady with Rokitansky syndrome, where the upper 2/3 of the vagina and uterine body were absent from birth. She had undergone vaginal reconstruction two years previously. After her sex life had normalised, she contacted the infertility clinic with her husband to discuss their options for having a child. Unlike the Saudi attempt, where a live donor was used, in this case the uterus taken from a deceased donor 22-year-old, brain dead woman who had incurred cerebral trauma in a traffic accident. Informed consent for organ donation was signed by the donor’s family. In the 2013 article published by the clinicians who performed the surgery, they reported that since the transplant operation, the patient has had 12 menstrual cycles and has been sexually active with her husband since the third month of the transplant procedure. It is thought that this attempt has been more successful that the 2000 attempt in Saudi Arabia due to the use of a cadaver donor (enabling removal of a wider section of tissue surrounding the uterus along with longer vessels to support the organ) in conjunction with improvement in immunosuppressive drugs. IVF was performed prior to the transplant and the clinical team will in due course implant those in a bid to achieve a successful pregnancy in the transplanted uterus. The team prudently stated they will not declare the surgery a success until the recipient successfully gestates a healthy baby in the transplanted uterus.
The third and most successful research attempt into uterus transplantation has just occurred in Sweden under Professor Mats Brannstrom and his team. As part of a clinical trial of uterus transplantation in nine women with absolute uterine factor infertility, one of the women has successfully given birth to a baby boy, named Vincent. The details, published in The Lancet medical journal inform us that the mother is a 36-year-old woman who was born with Rotkitansky syndrome. The donor was a close family friend of the recipient who had completed her family. and at the date of the surgery was 61 year of age. IVF was done prior to transplantation of the uterus. The patient became pregnant at her first transfer of a frozen –thawed embryo. The pregnancy proceeded normally for the first 31 weeks, but then the recipient developed pre-eclampsia and was admitted to hospital. A caesarean section was performed 16 hours after admission. The birth weight of baby Vincent was 3.9 pounds (1.8kg) and he was released from the neonatal unit 10 days after birth. The mother was in good condition the day after delivery and her blood pressure normalised spontaneously with no further treatment. She was discharged form hospital three days after the caesarean section and has been followed up in regular outpatient visits. Brannstrom has stated “In the future it is not going to be a problem to get a donor, not like a kidney, heart or liver. It is a sisterhood thing. Women are saying that they have had their children and why shouldn't they help another women to have the same joy?” He and his team in the Lancet claim “our demonstration of the first live birth after uterus transplantation opens up the possibility to treat the many young women with uterine factor infertility worldwide”.
There are other teams working towards uterus transplants in the United Kingdom, China, France, Belgium, Spain and America. As the recent success in Sweden has shown, it is clear the surgical technique is possible. Jeanette Foley has argued the next step should be analysis and exploration into the ethical issues that surround uterus transplantation rather than the continued focus on “Is it Possible?” Without this, she states “we will have gone too far down the slippery slope to be able to stop”.
- (Bio) ethical deliberations
In the UK alone, it is estimated that approximately 15,000 women per year who seek the help of fertility specialists are found to be incapable of becoming pregnant because of uterine factor infertility (Bosley 2002). Brannstrom notes that women who suffer are from absolute uterine infertility are those that are (a) born with no uterus, a condition called Maayer-Rokitansky-Kutser_hauser (MKRH) syndrome (b) women that have the lost the uterus through a hysterectomy, for reasons such as emergency obstetric complications, malignancy, or benign uterine disease; or (c) or women that have a deficient uterus in regards to implantation or pregnancy (Brannstrom et al 2007, 86). Both the recipients in Sweden and Turkey fell under the first category and were born without a womb. The purpose of uterus transplantation is to restore fertility to these women. For women who have functioning ovaries, the lack of a functioning uterus means they have no permissible way of gestating their own child to term or attaining motherhood. For other women, surrogacy may theoretically provide an alternative but as outlined below this is far from an adequate alternative.
(a) Uterus transplants at this experimental stage are unsafe
With little data on potential outcomes some, such as Caplan, contend that it is unethical to transfer embryos into a transplanted uterus since “it is very likely that the first uterus transplant will fail” (Caplan 2007). Unsatisfied with Del Priore’s comments that the uterus can be removed if things go wrong, Caplan states:
But what if that uterus contains a fetus? What if the mother says she is willing to die to give birth to that fetus? What if the father or the mother say they want the uterus removed even if there is a fetus present if things are not going as planned? The doctors have not said as much as they need to about what their "exit" strategy will be if, sadly, the surgery does not go as planned.
At its experimental stages, a uterus transplant will raise concerns regarding the safety of the procedure. All novel methods of reproduction raise concerns, not least because potential harms to both mother and foetus may be unknown. Until a foetus is gestated in and born from a transplanted uterus, the success of the procedure will not be known. Yet the unpredictability of the procedure in its experimental stage should not of itself provide a sufficient reason to prohibit the technology. Coital conception can also pose risks. As Elsner comments “we accept a woman has the right to bear a child by the traditional method of procreation knowing that it will have suboptimal health (e.g. as the result of a parent’s genetically transmissible condition or the mother’s health status)”(Elser 2006, 598) An analogy can also be drawn with IVF when it was in its experimental stages. When Edwards and Steptoe embarked on IVF they:
could not be sure that developmental malformations would not occur. Indeed, noted ethicists had argued that IVF was unethical because of the risk that resulting children might be born damaged. (Kass 1971, 18-56) They condemned the selfishness of couples who were so bent on having children that they were willing to risk the birth of handicapped children (Robertson 1986, 939 – 1041).
Elsewhere it has been noted how:
Several years of failed attempts – including one attempt that resulted in an ectopic pregnancy in 1976 – preceded the first successful replacement of an IVF embryo into a recipient’s uterus. Furthermore, intracyto-plasmic sperm injection, which currently “accounts for nearly half of all assisted reproductive treatments in the United States”, was introduced without an experimental phase “partly because animal models were thought to be unsuitable” (Elser 2006, 598).
Determining whether an experimental reproductive technology is acceptable will be dependent on the level of risk posed to offspring as compared to the benefit, and thus will necessitate a risk/benefit ratio calculation. As with many new medical treatments in the initial stages there will be some risk involved. This necessitates setting a base for safety; for instance what if the procedure has a 20% risk of failure and 40% risk of serious harm to the foetus, would this be regarded as too high to justify proceeding? Whether the risks to offspring being gestated in this fashion is justified will be a question policy makers and governments in the relevant country must decide, taking account of the risks posed to the offspring, the “liberty interests of individuals needing assistance and to the moral responsibility of providers who decide whether or not to offer their services” (Robertson, 2004, 9). In the context of uterus transplantation, those working within the field have already undertaken such an assessment and proceeded, as evidenced by the recent success in Sweden.
Precautions can also be taken, such as prenatal diagnosis, to monitor the development of the pregnancy and healthy growth of the foetus. Measurements of heartbeat and foetal scanning by ultra-sonics can detect abnormalities of the head, limbs, and other organs, and three-dimensional ultra-sonic images enable clinicians to view images of the foetus.[i] Safety concerns of themselves do not justify prohibiting a future procedure, providing the risk of harm is minimal when compared to the potential benefits. Thus safety concerns per se do not provide sufficient reason to bar this procedure. Dr Brannstrom has stated that the babies born following the first successful womb transplants in Sweden will all be followed up carefully for many years.
(b) Uterus transplant surgery offers a better alternative to surrogacy
For a woman lacking a functioning uterus the only way genetic motherhood can be achieved is through surrogacy. At present, the practice of Surrogacy continues to generate controversy and pose an international regulatory nightmare. The story of baby Gammy, hit media headlines in July, when the 21-year-old Thai surrogate mother -of-two Pattaramon Chanbua was offered AU$16,000 to carry a pregnancy for a West Australian couple and subsequently became pregnant with twins. But when one fetus was diagnosed with Down's syndrome, Chanbua was asked (evidence is conflicting as to by whom) to undergo a partial abortion. She refused. The commissioning couple eventually left Thailand with Gammy's twin sister Pipah and he was left behind. Whilst the international surrogacy industry has been booming, particularly in countries like India and Thailand, some children have been left marooned stateless and parentless. Even in England, were non-commercial surrogacy is permitted, the practice remains problematic. Surrogacy can be an emotionally draining method of founding a family and is shrouded in legal uncertainty. In England, surrogacy agreements are not legally enforceable and it is the woman who gives birth to the baby who is regarded as the legal “mother” (The Human Fertilisation and Embryology Act 2008, s33(1)). Thus, there is always the risk that the surrogate could renege on the agreement; she may decide to keep or abort the child. Highlighting the difficulties surrounding surrogacy, Rosenfel explains why a surrogate may change her mind:
The consent that the birth mother gives prior to conception is not the consent of…a woman who has gone through the chemical, biological, endocrinological changes that have taken place during pregnancy and birth, and no matter how well prepared or well intentioned she is in her decision prior to conception, it is impossible for her to predict how she will feel after she gives birth (Andrews 1998, 162).
As a method of founding a family, the practice of surrogacy continues to generate legal and ethical debate. For Muslims, surrogacy provides little alternative, since it regarded as forbidden. Suffice it is to say that uterus transplant surgery holds major advantages over surrogacy; Brannstorm cogently sums these up as follows:
The advantages of a model for a successful uterine transplantation compared to gestational surrogacy are obvious for the infertile couple - apart from the joy of experiencing a pregnancy, they would not be dependent on a third party during gestation and would have full control over maternal lifestyle-influences on their offspring. Furthermore, the genetic mother, instead of the surrogate, would take the physiological risks involved with any pregnancy. Issues such as maternal bonding during gestation, the definition of motherhood and the risk of economic pressure being a factor in recruitment of the surrogate carrier, would be abolished. Also, the prospected child would not have to deal with the possible conflict of having two mothers (Brannstrom et al 2003 177- 184).
A uterus transplant would allow women the opportunity to gestate and experience pregnancy. Just as endeavours to assist women overcome other forms of infertility such as IVF, surgical sperm retrieval and embryo transfer have become widely acceptable; women lacking a functioning uterus are suffering from a form of infertility. Thus there is a persuasive case to be made that uterus transplantation should be regarded no differently to other forms of fertility treatment. Just as IVF assists couples having difficulty in conceiving, uterus transplantation will assist women having difficulty gestating.
Research demonstrates that many women do attach importance to the experience of gestation and pregnancy.. Altchek explains why gestation is deemed to be of such importance to women:
For many women, the ability to become pregnant can be very important. For them, childbearing fills a deep emotional and social need, and they may feel a corresponding sense of loss if they are unable to conceive and give birth. It is likely that for many women the intense desire to become pregnant is, at least in part, an innate feature of evolutionary biology. But there may be a stronger social component to this desire. Historically, in many cultures, to be barren was to be cursed. Having a child, on the other hand, meant that one was blessed and honoured, perpetuating a family and a name.
In light of the importance of gestation to many women and the shortfalls of surrogacy as alternative, there are strong grounds to allow uterus transplant technology as clinical treatment to enable women to overcome uterine factor infertility. Surrogacy, adoption and foster care offer no better alternative. They do not compensate for the inability to gestate one’s own child.
Limited resources might have thus far belated success in achieving a breakthrough in uterus transplant technology. The success of the IVF technologies may have negatively affected investments in this more recent endeavour, and now that it has become apparent that the IVF technologies do not present a solution for some infertility cases, uterus transplants appear to have resurfaced on the bioethical agenda. Arguments that uterus transplantation should not be publicly funded or invested in because it is not medical treatment needed to preserve life, can be rejected by reference to the fact that treatments are often permitted and invested in which are not life-saving. Consider kidney transplantation which will significantly improve a patient’s quality of life, and yet dialysis is a life-preserving alternative. Cornea transplants to restore the sight of people with clouded vision is also now a well-accepted therapy and it is performed only to improve a patient’s quality of life, not to preserve it.
In Sweden the ground-breaking research was funded by the Jane and Dan Olsson Foundation for Science, a Swedish charity. Research into womb transplants in England will also be funded through charitable donations to Womb Transplant UK. For now it seems that such research will either be funded privately or through charitable organisations.
There may well be a case for arguing that this treatment should be publicly funded in those countries, such as England which fund other forms of fertility treatment. Should uterus transplantation, now proven to be a successful method of reproduction, be made available for women suffering from uterus factor infertility, just as other forms of medical treatment to treat infertility are made available? As the Warnock Committee stated:
There are many other treatments not designed to satisfy absolute needs (in the sense the patient would die without them) which are readily available on the NHS. Medicine is no longer exclusively concerned with the preservation of life but with remedying the malfunctions of the human body. On this analysis, an inability to have children is a malfunction and should be considered in exactly the same way as any other….In summary, we conclude that infertility is a condition meriting treatment.
These arguments apply equally to uterus transplantation, which will help to create life and treat uterus factor infertility. At present, the costs of uterus transplantation are unknown and it may be the case that it will be more expensive than IVF. While allocation of state funding is beyond the scope of this paper, costs of this procedure could be limited by stating it is to only be available as an option of last resort in the face of a woman’s clinical inability to bear a child. Access to this procedure could be limited by the implementation of eligibility criteria; for instance that uterus transplants are only to be funded where the woman/couple have no children and the woman is unable to reproduce because she lacks a functioning uterus which could be remedied by a uterus transplant. Just as it is widely accepted that it is legitimate to invest state funds into both organ transplantation (which in the case of kidney transplants is not life preserving) and fertility treatment; it is argued that NHS funding should also extend to helping women overcome uterus factor infertility.
- Religious Deliberations In the Islamic Tradition: Finally a reproductive advance that Muslims can utilise in their reproductive endeavours?
- Infertility and Islamic Law (Shariah)
Within Islam, marriage is a fundamental institution and is recommended for those who can afford it. It is considered a duty and a form of Ibada (worship):
Marry those among you who are single and (marry) your slaves, male and female, that are righteous (Quran 24:32).
Sachedine states that in Islam marriage is said to have two functions; the first is to unite humanity:
And of His signs is that He created for you from yourselves mates that you may find tranquillity in them; and He placed between you affection and mercy. Indeed in that are signs for a people who reflect (Quran 30:21).
The second purpose is the procreative function:
And Allah hath given you wives of your own kind, and hath given you, from your wives, sons and grandsons, and hath made provision of good things for you. Is it then in vanity that they believe and in the grace of Allah that they disbelieve? (Quran 16:72).
The issue of infertility is also mentioned in the Quran:
to God belongs the dominion of the heavens and the earth; He creates what He wills; He bestows male or female, according to his will; or He bestows both males and females and He leaves barren whom He will; for He is full of knowledge and power (Quran 2: 49-50).
Since there was no mention of assisted reproduction in the primary sources, the opinion of Islamic Scholars are taken into account after due consideration (Abduljabbar 2009, 461). The application of assisted reproductive technology (ARTs) to overcome infertility in Islamic World was according to Gamal Serour “delayed for many years, based on the misconception that Islamic teachings do not approve assisted reproduction”. It is now widely accepted that Islam permits the use of assisted reproductive technologies within the frame of marriage. However genetic lineage is imperative in the Islamic faith and endeavours must be made to ensure an unadulterated inheritance of genes and heredity is preserved. This is made clear in the Quran in the context of adoption, whereby an adopted child must retain the name of his gamete progenitors:
Nor has [God] made your adopted sons your sons. That is but a saying of your mouths. And God says The Truth and He guides to the way. Call to them by the names of their fathers. That is more equitable to God. But if you know not their fathers, they are your brothers in the way of life and your defenders. And there is no blame on you in what mistake you make in it but what your hearts premeditate. And God has been Forgiving, Compassionate (Quran 33:4-5).
Whilst the Quran repeatedly emphasises the importance of taking care of orphans and those in need (2:67; 2:147; 4:36)[ii], it is clear that parenthood is defined by genetic origins. It is important to also note when considering marriage and the family, The Quran and hadith condemn as zina (fornication) any intercourse between a man and a woman who is not his wife or slave:
Nor come nigh to adultery: for it is a shameful (deed) and an evil, opening the road (to other evils (Quran 17:32).
Children born out of wedlock/ as a result of zina, as Atighetchi explains “cannot belong to the paternal family, there is no recognition for them; they have no connection with the father, no right to inheritance; the illegitimate child (walad az zina) has no connections other than with the mother and the maternal family”. These fundamental values placed on the importance of marriage, procreation and preserving the genetic lineage of children are reflected in the attitude of Islam towards ARTs. Thus in vitro fertilisation (IVF) to overcome fertility is permitted only if it is the gametes of the married couple that are used. Using donor sperm, donor oocyte, or embryo or surrogacy is considered haram (forbidden) and is assimilated to acts of zina.
Applying this to women who are unable to gestate due to uterus favour infertility as discussed above, the only recourse currently available to them which would allow her and her husband to have a genetically related child using their gametes would be to use a surrogate. Yet in Islam surrogacy is widely regarded as haram or forbidden and there have been fatwas issued to this effect. In March 2001 M.S Tantawi, sheikh of Al Azhar, issued a fatwa in which he condemned as illicit the practice of “renting out a uterus”(Atighetchi 2007, 146). In April of the same year, the Islamic Research Council condemned recourse to surrogate maternity which would have enabled a woman without a uterus, due to a tumour, to have a child using her and her husband’s gametes. Although, it should be noted that this was not voted unanimously (Serour; Atighetchi2007, 146). Notwithstanding the fact that surrogacy is regarded as prohibited in Islam, Morgan Clarke in research conducted in Lebanon for his book Islam and New Kinship noted how in Lebanon it was “clear that such procedures have occasionally been carried out, albeit in utmost secrecy” (Clarke 2009, 175) . Whilst it may be the reality that this practice is performed in exceptional circumstances in some Muslim states, the rulings on this practice declare it is as forbidden in the Islamic faith.
Thus surrogacy does not provide an alternative recourse for Muslim women suffering from uterus factor infertility. As uterus transplantation may provide the only permissible method in which such women can procreate, the discussion will now consider how uterus transplantation might be received in Islam.
- Islamic Jurisprudence (Fiqh)
At the outset the author notes how in the absence of an organised single theological body that speaks for the entire Muslim community and given the lack of unanimity among Muslims Jurists of different schools of Islamic law, it is difficult to write about how certain biomedical technologies may be received in the Islamic faith.[iii] As Mohammed Ghaly notes “it is generally acknowledged that bioethics in Islam is mainly a branch of Islamic law and ethics, and thus contrary to the case in the Western world, not (yet) and independent field of study” (Ghaly 2012, 175). Thus answers to ethical dilemmas often come from religious scholars. Ghaly further explains that where a biomedical advance is not mentioned in the Quran or Sunnah the main task of Islamic Scholars is to provide “an independent reasoning or interpretation known in the Islamic tradition as Ijtihad of what these sources would imply about the bioethical matter under consideration. Uterus transplant technology is one biomedical advance which is not mentioned in the Quran or Sunnah.
Much before the first ever human uterus transplant was attempted in 2000, the issue of transplantation of reproductive glands was considered in two different events. The first was at the Islamic Organisation for Medical Sciences (IOMS) sixth Juristic-medical seminar in Kuwait during October 1989. The IOMS seminars are attended by distinguished jurists, shariah experts, medical practitioners, scientists and specialists in other human sciences. The second was at the sixth session of the International Islamic Fiqh Academy (IIFA) held in Saudi Arabia in March 1990. It is to be noted that (b) quoted and also almost identically agreed with (a) although (a) was presented as an IOMS recommendation and (b) as an IIFA resolution.
In the IOMS in Kuwait in October 1989, the conclusive recommendation reached was wholly taken up the following year in 1990 by the IIFA in Resolution 6/8/59 of the Academy of Muslim law of Jeddah.[iv] The documents were divided into two parts:
- The transplant of genital glands (ovaries and testicles) which is prohibited as the glands continue to produce gametes which then transmit the genetic heritage of the donor, even after their transfer to another person.
- The transplant of the external genital parts, except awrat mugallaza [which means the male and female sexual organs, i.e., penis and vagina] is permissible in the case of a legitimate necessity and in accordance with the Sharʻi norms and criteria outlined in the IIFA resolution no.1 of the fourth session.
Atighetchi comments that the expression ‘awrat mugallaza’ in the text of the fatwa does not appear to include the uterus (Atighetchi 2007, 181) and both the IOMS Recommendation 1989 and IIFA Resolution 1990 do not appear to expressly prohibit uterine transplantation.
The comments of one Sheikh indicate a lack of consensus on this matter: in 2004 the Egyptian sheikh Abdel Rahman Al – Adawey, head of the Councils Jurisprudence Research Committee pronounced himself as against uterus transplants on the basis of a previous fatwa of the Islamic research council forbidding the donation and transplant of sexual organs as well as donation of individual organs ( e.g. hear, liver, pancreas) (Atighetchi 2007, 181). In the Sheikhs opinion, the uterus is not only a shelter for the child but has its own genealogical characteristics and as a consequence “as the infant takes the characteristics from the mothers uterus, if it grows in a uterus, donated by a stranger, he/she will carry some of the strangers genealogical characteristics. Then the question will have to be raised as to who the child’s mother is” (Kamal; Aitghetchi 2007, 181).
It could be asked why uterus transplantation was not mentioned in the specific. Furthermore, whether uterus transplantation could be included in the second category of external genital parts by addressing the question: does uterus transplantation transmit any genetic characteristics or affect the physical make-up of the fetus /baby in any sense?
It seems a consensus is emerging that the organ does not transfer the donors’ genetic codes and thus uterus transplantation is allowed like most organs.
Dr. Hatem Al-Hajj, Dean of Shari`ah Academy of America, states: Since the uterus does not carry the genetic code, it is permissible to be transplanted. This is the decision of the Fiqh Assembly of the Organization of Islamic Conference in its sixth conference in 1990.
Dr. Mohammad Qatanani, Professor in the Islamic American University and Imam of the Islamic Centre of Passaic County in New Jersey, states: “Uterus transplant is permitted according to most scholars and Fiqh councils in many places. This opinion is built on the notion that the uterus is only a container for the baby. The uterus does not transfer any genetic materials to the fetus”.
Replying to the same question as to whether uterus transplantation is permissible, Sheikh Kifah Mustapha, the Imam and Associate Director at the Mosque Foundation, one of the largest Islamic Centers in Chicago, states “To the best of my knowledge the main function of the uterus is holding a developing fetus to maturity; when it is ready to be born. To that, we can say the uterus is not something that relates directly to the carrying of the inherited genes of the infant and for that it should be halal.”[v]
Scientific advances attained in the West in the context of uterus transplantation surgery must not be disconnected from Islam and specifically Islamic Bioethics. Whereas Muslims have been excluded from utilising other advances in assisted reproductive technologies due to the importance on preserving the genetic code, uterus transplantation is one advance which Muslims’ may be able to utilise to help them achieve their desires of parenthood. What is now needed is for Islamic Scholars to revisit and clarify the matter. The interplay of Islam and the West is important, not merely to inform religious scholars of the technical and ethical aspects that such biomedical advances may raise and facilitate such discourse between the two; but also because we must not forget that ‘The West’ and Islam’ are not always two distinct separate identities. This is rhetoric which has come to characterise the dominate discourse surrounding the globalised ‘War on Terror’ and the imperialist military intervention which lay at its core (Gilmore, 2012). Rather in the context of uterus transplantation ‘Islam’ and the ‘West’ need not be mutually exclusive and rather are intertwined: the first attempt at human uterus transplant occurred in Saudi Arabia, a Muslim country and it was this that provided the impetus for the later advances in the West. The second attempt in Turkey was also designed to assist a young Muslim couple overcome their infertility. Whilst the third attempt, and only successful one to date to have resulted in a live birth took place in Sweden, it is imperative that Islam keeps up the momentum and deliberates on whether this breakthrough is one Muslim couples can utilise in their endeavours to found a family.
Furthermore one can be Western and Muslim and it is important that Islamic Scholars reach out and open channels of communication with individuals who may be living as religious minorities in the West. Islamic scholars must not go ‘quiet’ on the issue of uterus transplantation especially now that the first successful uterus transplant has occurred and it is quite possible that it is only matter of time before it is offered as clinical treatment in the West. Only when Muslims are informed can they a) utilise such advances and b) ‘speak up’ when consulted by the their governments about prospective legislation governing such novel advances, thereby ensuring the Muslim voice is heard and thus represented.
[i] Similar concerns were also raised with regards to IVF – Edwards raised similar defence in regards to objections based on the future well being of the foetus: Robert.G. Edwards “Fertilization of Human Eggs in Vitro: A Defense” in Kenneth. D. Alpern (Ed) The Ethics of Reproductive Technology (Oxford University Press: Oxford, 1992) p73.
[ii] For more on adoption in Islam see “Adoption and the Care of Orphan Children: Islam and the Best Interests of the Child”, August 2011, Muslim Women’s Shura Council, American Society for Muslim Advancement 2011.
[iii] Although the author notes that Muhammed Khalifa advocated for such a body in his paper “ Human Health in World religions and the Need to Establish an International Religious Organziation for Bioethics” as presented in International Conference entitled ‘Islamic Bioethics: The Interplay of Islam and the West’ held at Georgetown University, Qatar, on 24 June 2012.
[iv] Décision no 6/8/59 in IOMS, Transplantation de certains organes humains du point de vue de la Ch ria, , Actes du Sexieme colloque orgnaise par I’IMOS, Koweit, Octobre 1989. , Rabat, IESCO, 1999, 776 ; D. Atighetchi Islamic Bioethics: Problems and Perspectives 181.
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