Uterus Transplant: An Islamic Perspective

Uterus Transplantation in the View of Islam: Rulings and Ethical Concerns

In this remarkable era of technology, new discoveries are being made that astonish humanity. Regardless of the nature of these discoveries, in an age of materialism, many people begin to support them without understanding the implications. As Muslims, it is our duty to seek guidance from Islamic scholars about these new discoveries, to ensure that we do not unknowingly become involved in prohibited actions. Islam is neither opposed to science nor to new inventions and discoveries, nor is it against modern tools and technologies. However, Islam presents a well-structured way of life with its own principles and teachings. If any new discovery or technology conflicts with the Islamic system, its use is not permissible for us.

Uterus transplantation is a recent discovery for the world, although experiments had been conducted for years. Initially, experiments were done on animals, and when successful, they were applied to humans. After numerous sacrifices and human fatalities, successful experiments have now taken place in three countries—Sweden, the United States, and India. In 2014, Sweden achieved success, followed by the United States and India in 2017.

On October 18, 2018, a woman named Meenakshi Viland from Gujarat gave birth to a daughter after receiving a transplanted uterus from her own mother at the Galaxy Hospital in Pune, India. While India proudly celebrates this achievement, people are filled with joy over the experiment and hold hopes for ending female infertility in the future.

Until now, people without children either endured patiently, rented a woman’s womb to have a child (surrogacy), or adopted a child. The process of surrogacy, where the man’s sperm and the woman’s egg are combined in a laboratory to create an embryo, which is then implanted in a woman’s uterus, is considered illegal in Islam.

There are different types of artificial insemination, and some are permissible. A detailed discussion on this will follow.

Reasons and Purposes of Uterus Transplantation:

• After marriage, a woman’s desire to become a mother is strong, but when she is unable to conceive, she searches for solutions and seeks help from doctors. This is one major reason behind uterus transplantation.
• Additionally, many women today are opting to have their uterus removed, and the large number of discarded uterine organs in hospitals caught the attention of doctors and scientists, prompting them to think about how these could be used productively.
• Scientists are always striving to introduce the world to new discoveries, and this led to the start of the uterus transplant experiment, despite the fatalities. This procedure is seen as opening a significant economic opportunity, as those unable to have children can offer a high price to realize their hope of parenthood.
• Some women face complications with their uterus, which forces them to have it removed, while others are born without a uterus, have a very small one, or face repeated miscarriages. Some women are simply unable to conceive. These factors also motivated uterus transplantation.

The goal of uterus transplantation, according to science and medicine, is to enable a woman who is infertile or unable to conceive to give birth using her own womb, instead of relying on a surrogate or adopting someone else’s child. This allows every woman who desires to become a mother the opportunity to fulfill her dream of bearing her own child.

The Procedure of Uterus Transplantation:

A uterus is removed from one woman and transplanted into another, with the uterus of a close female relative—mother, sister, or aunt—being preferred, as their tissue and cell compatibility are generally better. The entire procedure takes about 10-12 hours, and it is quite complicated. The main risk is that the body may reject the foreign organ, which could lead to it being removed. After transplantation, the patient needs to be closely monitored for about a year, and laboratory tests must confirm the uterus’s capability to support pregnancy. Once confirmed, the husband’s sperm and the wife’s egg are used to create an embryo in the laboratory, which is then implanted into the woman’s uterus. In Sweden’s successful case, eleven embryos were created and frozen, and one frozen embryo was later implanted into the transplanted uterus.

Fatalities from Uterus Transplantation:

Uterus transplantation is extremely risky. Not only can it lead to disease, but it can also be life-threatening. Many fatalities have occurred during the experimental stages of this procedure. The general risk is that the body may not accept the new organ, leading to its rejection. This can cause various diseases and complications. After the transplant, the patient is monitored closely, and immune-suppressing medications are used to help the body accept the new organ, but these medications also increase the risk of conditions like diabetes and can lead to fluctuating blood pressure. This makes it a dangerous procedure, and in some cases, it can be fatal.

Transplanting the uterus of a deceased woman has not been successful. Therefore, the organ must be taken from a living woman, and transplantation from a non-relative is considered harmful. This is why the uterus of a close relative is preferred, as it has better compatibility. In addition to the surgery itself, pregnancy and childbirth are incredibly challenging. Pregnancy does not occur easily, and labor and delivery are difficult. In some cases, the child is born prematurely and requires intensive care.

In 1931, a transgender person in Germany had a uterus transplanted, but the procedure was unsuccessful, and the person died. In 2002, a 26-year-old woman in Saudi Arabia underwent a uterus transplant from a 46-year-old stranger, but the organ had to be removed within weeks due to infection. In 2014, Sweden achieved its first successful birth from uterus transplantation, with the baby born at 31 weeks, experiencing irregular heartbeats at birth. In the case of Meenakshi, the baby was born after just 22 weeks, and she had to be under strict medical supervision for 17 months.

Dr. Shailesh, the doctor performing the uterus transplant on Meenakshi, stated that the procedure is extremely risky. He mentioned that so far, 11 pregnancies have been successful, with 9 in Sweden, 2 in the United States, and 12 babies born from these transplants. However, he also emphasized that this is not an easy surgery, and pregnancy is not easy to achieve.

In conclusion, this procedure carries significant risks. While many women worldwide have undergone uterus transplants, most have experienced complications, and so far, only twelve babies have been born. These are claims, and detailed information on all of them is not available. The most dangerous aspect of the procedure is that the entire process—surgery, pregnancy, and childbirth—depends on hope, as the outcome is uncertain, and the entire procedure is carried out with the expectation of success, even though anything could happen.

Conflict Between Birth Control and Uterus Transplantation:

Medical experts have promoted the slogan of prosperity, education, development, and health, advocating birth control and small families under the banner of family planning. This proposal by medical experts has had a detrimental effect on society, as methods of abortion and birth control have been adopted, to the point where sterilization and smaller families became a source of pride. Today, the public has reached the brink of destruction. The killing of innocent unborn girls in the womb is no longer considered a sin, and even after birth, newborn girls are thrown into trash cans. Not even dead bodies are discarded in such a manner. In such circumstances, only a few women are able to escape birth control. Many women in hospitals opt for the removal of their uterus after childbirth, with the Indian government providing this service for free in villages. On one hand, family planning leads to such destruction, while on the other, these same experts are now working on reattaching uteruses. The catchy slogan of family planning and its practical measures have led to the loss of countless innocent lives, prevented many from being born, and caused many women to lose their lives in this deadly process. In fact, birth control has increased infertility and sterility, as unnatural methods of pregnancy prevention have caused damage to the uterus (womb) and infertility has become widespread among women. The same people who promote birth control are the real culprits, spreading infertility and then offering treatments for it. Health centers often engage in this heinous activity, declaring healthy individuals as sick in the pursuit of money, offering expensive treatments even to those who do not need surgery. In some cases, despite a patient’s death, treatment continues for monetary gain.

Treating infertility between husband and wife within the permissible limits is not wrong, but tampering with the natural system of creation is an act of cruelty and savagery, whether done under the guise of birth control or reproduction. Islam permits temporary family planning in case of necessity, and if the uterus needs to be removed for medical reasons, there is allowance for this, but birth control out of desire, the wish for fewer children, or under the pretext of better upbringing and education is forbidden.

Modern Reproductive Methods and Their Islamic Ruling:

Modern scientific developments have led to the creation of the most advanced reproductive techniques, and it is difficult to predict how far these methods will advance in the future. Currently, there are various methods, such as Artificial Insemination, Test Tube Fertilization, Surrogacy, and Cloning, among others. Uterus transplants have been experimented with for many years, and after a few successes in this field, it is now considered a method of reproduction.

Artificial Insemination Method: In this method, sperm is obtained from the male, often through masturbation, and a large quantity of semen is injected into the lower abdomen of the woman (Pelvic Cavity) where it reaches the fallopian tubes and fertilizes the female egg, resulting in conception in the womb. The permissible aspect of this method is that only the husband’s sperm can be used and inserted into his wife’s uterus.

Test Tube Baby or In Vitro Fertilization (IVF): This method is different from artificial insemination. It involves collecting both male and female sperm and mixing them in a glass container. When the material becomes fertilized, it is then nurtured for a while before being placed into the uterus, where it completes its developmental stages. In this method, there is no need for the fallopian tubes. It is permissible if the sperm of the husband is used and inserted into the wife’s uterus.

Unlawful Methods of Artificial Insemination and Test Tube Fertilization: The permissible methods of artificial insemination and test tube fertilization have been outlined above, but many other unlawful methods exist. For Muslims, using these methods to produce a child is not allowed.

1. Using the husband’s sperm and another woman’s egg and inserting it into the wife’s uterus.
2. Using the sperm of another man and the wife’s egg and inserting it into the wife’s uterus.
3. Using the husband’s sperm and the wife’s egg, but inserting it into another woman’s uterus.
4. Using sperm from an unknown man and an unknown woman and inserting it into the wife’s uterus.
5. Using the husband’s sperm and the first wife’s egg, but inserting it into the second wife’s uterus.

Surrogacy: In surrogacy, the husband’s sperm is fertilized artificially and placed in another woman’s uterus, essentially renting the womb of another woman while the sperm comes from the husband and wife. This is absolutely forbidden. Some scholars have argued that surrogacy may be allowed in certain situations, such as if a man has two wives and the sperm of the husband and one wife is placed in the uterus of the other wife with her permission, or if the egg from the barren wife and the husband’s sperm are used in the fertile wife’s uterus. However, this ruling is incorrect, and it is not permissible to place one wife’s egg into the uterus of the other wife. This issue has been addressed in a seminar by the Islamic Fiqh Academy of the World Assembly of Muslim Scholars, which is summarized in Fatwa No. 23104 on Islam Q&A.

Human Cloning: Human cloning involves producing a genetic copy of an individual. This is done by obtaining non-sexual cells from two different bodies and mixing them together. One cell’s nucleus is extracted and placed into the nucleus of another cell, then the fertilized cell is placed into the body of the same organism or a third body to complete the reproductive process. Cloning using non-sexual cells from two different bodies can sometimes involve male and female cells, or two different female cells, or two cells from the same female.

The only permissible form of human cloning is where the cells of the husband and wife are placed into the wife’s body to create a clone. All other methods listed below are impermissible and unlawful.

1. Cloning humans using cells from two different bodies outside of marriage.
2. Cloning humans using cells from two different women.
3. Cloning humans using two cells from the same woman.
4. Using the cells of a married couple for cloning outside of the wife’s body.

Method of Uterus Transplant:

As outlined earlier, this involves transplanting a uterus from one woman into another. The sperm of the husband and wife is then used to create a fertilized embryo in a laboratory, which is later implanted into the uterus. This method of reproduction has several Islamic issues, particularly with regard to the ethical and moral concerns involved in removing and transplanting organs, as well as the potential for exploitation in these procedures.

Flaws in Uterus Transplantation According to Islamic Jurisprudence:

First Flaw: The first flaw is the lack of hijab (modesty) between the individuals involved. The donor, husband, and wife repeatedly expose their private parts to multiple doctors, despite the fact that, in cases of necessity, it is allowed to expose one’s private parts.

Second Flaw: Islam has honored human beings and provided golden health principles to protect the human body from destruction. According to health guidelines, it is not permissible to harm one’s body or remove an organ unless it is absolutely necessary. Removing the uterus, unless for a valid reason, is an act of rebellion against nature and is detrimental to health, as it can lead to significant side effects. Some of the physical risks of removing the uterus include weight gain or loss, genital shrinkage, urinary infections, intestinal contractions, blood clotting, weakened bones, and ovarian cysts. Women who have their uterus and ovaries removed may suffer from mental stress, emotional instability, loneliness, and inferiority complex, along with a higher risk of heart disease due to lower estrogen levels. Therefore, not only are there numerous health risks related to the removal of the uterus, but also the process of uterus transplantation can result in dangerous outcomes. Islam does not permit harmful actions like this.

Third Flaw: The process of artificial ejaculation is used, where the husband’s sperm is obtained through surgery from the wife’s ovaries. Allah has provided a natural method of reproduction, and this method involves natural intercourse where ejaculation happens within the wife’s body. For uterus transplantation, a significant amount of sperm is often collected through masturbation, and multiple sperm are frozen. In an emergency situation, this method could be permissible.

Fourth Flaw: Uterus transplantation requires a donor, a woman willing to give her uterus. Donating blood is not problematic, as it regenerates in the body, but donating an organ that the body needs and is essential for its function is not permissible without necessity. Removing an organ like the uterus, which carries the risk of significant harm, is not allowed. Many scholars have declared organ donation, whether during life or after death, impermissible because the body does not replenish vital organs, unlike blood. Furthermore, the act of organ removal and transplantation is considered mutilation, and the sale of any organ is unanimously declared haram. Uterus transplantation, which typically involves a donor’s uterus removed through surgery, cannot be justified unless it’s for a life-threatening situation. The desire for children cannot justify removing a healthy uterus from someone and implanting it into another person.

Fifth Flaw: A Muslim believes that children are granted by Allah. If a couple does not have children after a few years of marriage, they should not lose hope or lessen their reliance on Allah. Seeking children through illegal means, such as going to shrines, seeking help from anyone other than Allah, or interfering with the natural process of conception like uterus transplantation, is against trust in Allah. Yes, using permissible methods to seek children does not contradict reliance on Allah. We should be patient, pray to Allah for children, and if necessary, pursue permissible treatments while accepting Allah’s will. If Allah has written children in one’s destiny, they will come eventually, and thus, one should not lose faith in this process. The real goal in life is not merely to have children but to prepare for the Hereafter.

Sixth Flaw: Allah has made the woman’s private parts lawful for her husband through marriage. The uterus is part of this private area where a husband has the right to ejaculation through intercourse. Introducing a man’s sperm into another woman’s uterus is not outright zina (fornication), but it is akin to it. Just as surrogate motherhood is impermissible, this too is another form of it, as in surrogacy the sperm of the husband is used in another woman’s womb, and similarly, in uterus transplantation, the husband’s sperm is implanted in another woman’s womb. One may argue that after a uterus transplantation, it is now considered the woman’s organ, but could the same logic apply to a scientist implanting a woman’s reproductive organs into someone who was born without them? Would that make sexual intercourse permissible?

Seventh Flaw: Nowadays, sperm banks, similar to blood banks, exist where thousands of sperm samples are frozen and stored. Sperm is donated in large quantities, frozen, and used for artificial insemination. This practice often leads to unethical activities like sperm being sold or distributed for monetary gain, and sperm from deceased individuals being used without consent. There is a high likelihood of sperm mixing, as sperm is collected long before it is used, and there is a possibility of misidentification. This is akin to illicit practices, and sperm banks are considered haram. Just as a person’s blood can be transfused into another’s body, sperm cannot be used in the same manner. The sperm of a husband must only be used in his wife’s womb. The exploitation in sperm banking and the mixing of sperm can lead to serious consequences.

Eighth Flaw: There is wastefulness involved in uterus transplantation, as there are less expensive alternatives, such as adopting a child, which can also fulfill the desire for parenthood while offering the opportunity to care for an orphan or a needy child. The Prophet Muhammad (صلى الله عليه وسلم) promised companionship in Paradise for those who raise an orphan, which is a noble cause.

Ninth Flaw: Opening the door to such practices will lead to numerous immoral acts, such as the violation of women’s dignity, tampering with nature, the birth of illegitimate children, unnatural ejaculation, the procurement of female reproductive cells through surgery, sperm mixing, the spread of illicit wealth, human organ trade, and more.

Tenth Flaw: This method is a tool for exploiting people financially, deceiving them, and destroying the economy. The profits made from sperm banks, laboratory tests, and surgeries lead to the commodification of human organs, and these practices are deeply unethical. The money earned from a single case could cover the expenses of an orphanage for months.

What is Infertility?

Allah is the Creator of mankind, and He has created every individual with the essential elements needed for life. He has established reproduction between men and women through marriage as the only lawful means. Having children is a blessing from Allah, and infertility, when a couple is unable to conceive, is also part of Allah’s will.

Sura Ash-Shura, verses 49-50:

لِّلَّهِ مُلْكُ السَّمَاوَاتِ وَالْأَرْضِ ۚ يَخْلُقُ مَا يَشَاءُ ۚ يَهَبُ لِمَن يَشَاءُ إِنَاثًا وَيَهَبُ لِمَن يَشَاءُ الذُّكُورَ (49) أَوْ يُزَوِّجُهُمْ ذُكْرَانًا وَإِنَاثًا ۖ وَيَجْعَلُ مَن يَشَاءُ عَقِيمًا ۚ إِنَّهُ عَلِيمٌ قَدِيرٌ (50)(الشوری)

Translation: To Allah belongs the dominion of the heavens and the earth; He creates what He wills. He gives daughters to whom He wills, and He gives sons to whom He wills, or He combines them, males and females, and He makes whom He wills barren. Indeed, He is All-Knowing, All-Powerful.

This verse highlights Allah’s power in granting children, and also in making someone infertile. Infertility is part of Allah’s plan, and it should be seen as a test for the believer. In cases of infertility, the believer should be patient, make sincere supplications, and seek permissible medical treatments. If a person desires children, they should trust in Allah’s will and be content with His decree.

What Should Someone Do if They Cannot Have Children?

Allah is just, and He has treated all His creations fairly, both those with children and those without. Therefore, infertility should not cause a loss of faith or trust in Allah. Regardless of the situation, we should always praise Allah. If Allah takes away a blessing, He provides a greater reward for those who are patient. We should constantly worship Allah, make supplications for righteous offspring, and, if possible, consider remarriage or adopting a child. Alternatively, one can care for orphans and needy children in their community, which will earn great rewards from Allah. At the same time, we should focus on reflecting on the trials faced by others and be content with Allah’s decree, understanding that having children is not the ultimate goal of life—preparing for the Hereafter is.

Final message and advice to Muslim doctors:

If you believe in Allah and His Messenger, you must follow their commands. The profession of medicine should not be pursued merely for worldly gain. Through this knowledge, while serving the nation and community, first seek guidance from the scholars regarding what is halal and haram in the field of treatment and medical care, then treat patients in a permissible manner. Surely, many times you may encounter situations where committing a haram act could earn you millions of rupees, but you must avoid such haram earnings. You will be presented before Allah, and you will be fully accountable for what you have done. Know that this world and its pleasures are fleeting and momentary, while its end is both dreadful and everlasting.

Another point is that infertility is not today’s biggest challenge; the real challenge is to address the reasons why infertility is spreading or being propagated among women. Babies are thrown alive on streets, in hospitals, at stations, and garbage bins. Hundreds of innocent children are forced into labor. Thousands of orphans are growing up in orphanages, struggling between life and death. Millions of girls are turning to prostitution. The solution to all these children’s problems must be found.

Often, a woman’s uterus is removed after two to three children under the pretext of health risks, just for monetary gain; this should be controlled. Adequate care and financial support for the upbringing of needy children, and complete assistance for the marriages of poor girls, should be provided at the government level. The lives of girls who are growing up at home, turning to prostitution, or committing suicide due to lack of money should be saved. These are our social challenges. Instead of focusing on them, unnecessary matters are being prioritized, and there is tampering with the natural system, which must stop.

اللَّهُمَّ رَبَّنَا تَقَبَّلْ مِنَّا إِنَّكَ أَنتَ السَّمِيعُ الْعَلِيمُ، وَإِلَيْكَ مَرْجِعُ كُلِّ شَيْءٍ.