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A critique of whole body gestational donation

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Abstract

In her controversial paper, Anna Smajdor proposes that brain-dead people could be used as gestation units for prospective parents unable or unwilling to undertake the act themselves—what she terms whole body gestational donation (WBGD). She explores the ethical issues of such an idea and, comparing it with traditional organ donation, asserts that such deceased surrogacy could be a way of outsourcing pregnancy’s harms to a populace unable to be affected by them. She argues that if the prospect is unacceptable, this may reveal some underlying problems with traditional cadaveric organ donation. Smajdor’s analysis, however, overlooks several problems arising from WBGD. This paper provides an account of those issues and argues that, in addition to WBGD being viscerally unpleasant, it is also ethically unviable. The paper starts by providing an account of WBGD before acknowledging its negative response within traditional and social media. After arguing that such cursory and gut reactions are insufficient to reject the proposal outright, this paper then provides three concerns regarding WBGD omitted by Smajdor: (i) the co-opting of life-saving organs for reproduction, (ii) the discrepancy between using cadaveric organs to save a life versus creating one, and (iii) the universalization of feminist concerns regarding reproductive body commodification. The paper concludes by tentatively agreeing with Smajdor that considering WBGD may help reveal vulnerable assumptions regarding organ donation and surrogacy, but that the significant ethical issues raised may prove insurmountable and make the intervention—thought experiment or otherwise—untenable.

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Notes

  1. While Smajdor’s paper omits it, the idea of brain-dead gestation had been proposed before Ber’s 2000 publication when, in 1998, bioethicist Paul Gerber floated the idea [4].

  2. She links this to the Hebrew saying, “Gain for one, loss for none” [3, p. 165].

  3. This latter claim is substantial, yet Ber explores neither its practical nor principled implications.

  4. Interestingly, this lifting of the medical necessity criteria mirrors a point raised in the UK’s Law Commission report on surrogacy, where they recommend that “there should be no requirement that a surrogacy agreement has been used because of medical necessity” [8, p. 158].

  5. This paper follows Smajdor’s lead when it comes to the terminology of men and women. However, it is important to acknowledge here that the relationship between sex, gender, and reproduction is complex, and holding the view that only women can get pregnant is, amongst other things, detrimentally reductive and exclusionary. Indeed, a whole paper could be written about WBGD’s potential impact on gender and sexuality.

  6. At the time of writing, according to Altmetric data, the paper has been directly referenced in over 2400 tweets.

  7. Although according to Anna Nelson, it was perhaps more usefully directed toward existing injustices and harms against birthing persons [14].

  8. For example, see the reactions to the modern era’s early attempts at organ transplantation [20, 21].

  9. Kass acknowledges this in his 1997 paper when he writes, “Revulsion is not an argument; and some of yesterday's repugnances are today calmly accepted-though, one must add, not always for the better” [19, p. 20].

  10. For a fuller justification of such a deliberative stance on WBGD, see J.Y. Lee’s JME Blog post [23].

  11. As identified by the Nuffield Council on Bioethics 2011 report [28], other considerations include altruism, autonomy, dignity, justice, maximizing health and welfare, reciprocity, and solidarity.

  12. It might be possible to replace the biological units with mechanical ones, such as the heart or lungs, with a cardiopulmonary bypass machine, thereby maintaining functionality while enabling organ donation. However, this would substitute a valuable organic resource for a mechanical one and bring a whole new host of issues regarding infection and maintenance. Moreover, ultimately, there is a limit to how long mechanical units can support one’s body.

  13. Some individuals may opt out of all classical forms of donation and choose only to donate their organs for WBGD. This potentiality, however, does not address the issues here; it merely means there would be a sub-set for whom such a concern may not apply.

  14. This implies that such organs are viable for usage. When this is not the case and there is no potential for transplant, said organs would not be wasted.

  15. For example, Maria Pippias et al. found that in cases of living kidney donation, the risk of pre-eclampsia increased from roughly one to three percent pre-donation to approximately four to ten percent post-donation [31].

  16. Whether and what kinds of harm the dead can be subject to is complex. For the sake of brevity and simplicity, this paper takes no definitive stand on this point. Instead, it works on the premise that, regardless of one's stance, the specific harms associated with dying do not apply to those already brain-dead.

  17. Smajdor alludes to the potential of post-death gestation in her paper, but this does not touch upon the prospect of said organs having to compensate for their complimentary organ removal.

  18. WBGD would indirectly enhance the lives of the prospective genetic parents, however, by providing them with the desired offspring. This indirect effect is something the WBGD shares with classical organ donation. Yet, the direct beneficiary is less obvious. For classical donation, it is the person receiving the organ or tissue. But, for WBGD, and keeping in mind Derek Parfit’s non-identity problem [33], this person does not exist. So, claiming they are the subject of benefits or harms is less straightforward.

  19. One might refute this, arguing that WBGD would exist to negate the risks and harms gestators face. I would contest, however, that the two are inseparable. Gestation’s harms can be avoided by not gestating. Yet, this does not bring about the desired outcome—genetically related offspring. For WBGD to succeed, it must bring a new being into the world and relocate gestation’s risks to those incapable of being harmed by them.

  20. This point becomes a little murkier regarding the distinctions between life-enhancing transplants and WBGD.

  21. This claim is somewhat speculative. Empirical work would be needed to ascertain its validity. However, for now, it seems a reasonable assumption to make.

  22. It must be acknowledged that feminism is a broad church containing multiple, sometimes contradictory, ideologies. As such, some generalizations regarding what it aims to achieve will be undertaken here. This is not done as a means of dismissal but for practical purposes to move the paper forward.

  23. Of course, not all men are masculine in the same way, if at all, and other aspects of one’s identity intersect with how masculinity is expressed, conformed to, and rebelled against. For an insightful dissection of masculinities’ multifactorial nature, see Nancy E. Dowd’s work [43,44,45].

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Acknowledgements

I would like to express my thanks to Drs. Chloe Romanis, Anna Nelson, and Dunja Begovic for their invaluable, kind, and critical insights and comments. Thanks must also be paid to the faculty, postdocs, and students at IBHH UTMB for their advice and encouragement. Finally, I would like to thank the anonymous reviewers.

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No funding was received to assist with the preparation of this manuscript. The authors have no relevant financial or non-financial interests to disclose.

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  1. Institute for Bioethics and Health Humanities, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555, USA

    Richard B. Gibson

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Gibson, R.B. A critique of whole body gestational donation. Theor Med Bioeth 44, 353–369 (2023). https://doi.org/10.1007/s11017-023-09637-z

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