Are uterus transplants a replacement for surrogacy?

In August, an Alaskan woman traveled to Texas, where abortion is banned, to give birth to a baby against the wishes of the intended parents. McKenna West was serving as a surrogate for a California couple who wanted her to terminate the pregnancy after doctors detected a heart defect in the fetus. 

A legal battle ensued after the baby was born, and West ultimately lost custody to the couple that had hired her, but not before the case raised alarms about the lightly regulated surrogacy industry in the U.S., which relies on a patchwork of regulations that vary considerably from state to state. 

Now, an emerging fertility option is offering a potential alternative to surrogacy: uterus transplants. But it comes with new ethical, legal and safety concerns.

The procedure involves a donor, living or deceased, who donates their uterus to a woman who lacks a functional uterus or has a severe uterine defect. Uterus transplants were pioneered in Scandinavian countries—where around 5,000 women have this condition—as an alternative to surrogacy, which is allowed there only in rare cases, according to a study.

“With surrogacy, the emotional risks are shifted to the surrogate,” says Glenn Cohen, a bioethicist and law professor at Harvard Law School. With uterus transplants, both the physical and psychological risks remain with the parents, which Cohen says may be better ethically. Cohen spoke at a recent event on the future of fertility hosted by IVF Law Group at the New York Academy of Sciences. 

Since the first live birth following a uterus transplant in 2014 in Sweden, around 130 transplants have resulted in more than 70 live births. Half of these births have occurred in the United States, including at least 31 at Baylor University Medical Center in Dallas. 

The American Society for Reproductive Medicine recognizes these transplants as the first successful treatment for women who completely lack a uterus, which affects up to 1 in 500 women of childbearing age. An estimated 3% to 5% of the world’s female population lack a fully functioning uterus, though the exact number is not known. Uterine defects can either be present from birth or acquired during reproductive years.  

The procedure offers an alternative to people who previously had to rely on adoption or surrogacy to build a family. But it’s still highly experimental. Cohen points out that in the 2026 paper from Baylor, 30% of women had complications and 37% of the babies born following a uterus transplant were admitted to the neonatal intensive care unit. And these procedures are usually done in a clinical trial, though Baylor University Medical Center claims it’s the first transplant program in the world to offer uterus transplants outside of one. 

“Expanding access will require more trained centers, standardized protocols, and improved insurance and financial support for patients,” Liza Johannesson, the medical director of the uterus transplant program at Baylor and author of the 2026 study, told Physician’s Weekly. 

Cohen says there are also legal and ethical questions surrounding the procedure, including how the law will adapt to handle organ donation issues that arise from transplants. In an article for the University of Chicago legal forum, Cohen raises the scenario of a uterus donor asserting parental rights to the child born from their uterus, similar to the Texas surrogacy case. He says it’s unclear how the law would respond to a case like that. 

The law tends to move slowly with fertility medicine, even though the science of fertility medicine moves fast, says Andrew Rader, founder of IVF Law Group. “Many of the laws we’re applying today were written for a medical world that no longer exists.” For example, as assisted reproductive technologies like vitro fertilization (IVF) become more common, accounting for around 2% of births in the U.S. in 2018, so too has the transport of embryos. If a couple moves or a clinic moves, embryos also move. The law, Rader says, hasn’t caught up to address what happens if that genetic material is lost or damaged during transport. “We shouldn’t have to wait for catastrophic cases to answer those questions,” he says. 

Besides the safety and legal aspects, Cohen says this technology challenges how we think about pregnancy. “Is it a right to experience pregnancy?” Cohen asks. If it is, should we be extending this technology to people with male pelvises, including transgender women? “I’ll let you decide,” he says.