New frontiers in surgery

Abstract

Various types of organ transplantations are now considered standard procedures: heart and liver transplants lengthen lives; kidney transplants also do so, as well as improving quality of life by reducing or eliminating the need for dialysis. The transplantation of faces and limbs, a more novel set of techniques, improves quality of life without necessarily lengthening or ‘saving’ lives. An even more recent development is uterus and penis transplantations, which also do not save or lengthen life, but increase reproductive and sexual function and thereby improve quality of life. This chapter identifies and discusses central ethical issues that are likely to arise in the development of uterus and penis transplantations. These include general issues related to the ethics of surgical research, and specific concerns regarding the rationale of these particular procedures in the context of reproductive and sexual medicine. How should prospective patient-subjects be selected for innovative surgeries? Are these procedures appropriate as treatment for gender dysphoria, or should they be restricted to people whose reproductive and sexual organs have been damaged by illness or accident? Who is most likely to benefit and how are benefit and risks to be judged? What are the alternatives to these transplant surgeries? How should donor organs be sourced? Finally, more broadly, how should we think of these procedures from the perspective of cost-effectiveness – are these expensive, non-life-saving procedures a good use of scarce health resources in light of pressing global needs?