A survey of public attitudes toward uterus transplantation, surrogacy, and adoption in Japan

Autoři: Akari Nakazawa aff001;  Tetsuya Hirata aff001;  Tomoko Arakawa aff001;  Natsuki Nagashima aff001;  Shinya Fukuda aff001;  Kazuaki Neriishi aff001;  Miyuki Harada aff001;  Yasushi Hirota aff001;  Kaori Koga aff001;  Osamu Wada-Hiraike aff001;  Yoshio Koizumi aff002;  Tomoyuki Fujii aff001;  Minoru Irahara aff003;  Yutaka Osuga aff001
Působiště autorů: Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan aff001;  Department of Obstetrics and Gynecology, Doai Kinen Hospital, Tokyo, Japan aff002;  Department of Obstetrics and Gynecology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan aff003
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0223571


This study aimed to evaluate the attitudes of male and female members of the public toward uterus transplantation (UTx), surrogacy, and adoption in Japan via a web-based survey. One thousand six hundred participants were recruited with equal segregation of age (20s, 30s, 40s, and 50s) and gender. We assessed the association between ethical view and gender, age, infertility, and the knowledge level of UTx, using a questionnaire. The findings were as follows. First, 36.5% and 31.0% of respondents agreed that UTx and gestational surrogacy should be approved, respectively. Second, the respondents would potentially choose to receive UTx (34.4%), gestational surrogacy (31.9%), and adoption (40.3%), if they or their partners experienced absolute uterine factor infertility. Third, 10.1%, 5.8%, and 14.3% of the respondents chose UTx, gestational surrogacy, and adoption as the most favorable option, respectively. Fourth, if their daughters suffered from absolute uterine factor infertility, 32.3% of female respondents might want to be donors, and 36.7% of male respondents might ask their wives to be donors. These data were affected by age, gender, infertility, or the knowledge level of UTx. UTx was a more acceptable option than gestational surrogacy and adoption. The effects of gender, age, infertility, and the level of knowledge of UTx are important in understanding the attitude toward UTx. On the other hand, there were concerns about the safety of UTx for recipients, donors, and babies. It is important to continue to understand public attitudes to inform the development and safety of UTx, which will enhance the discussion on the ethical consensus on UTx.

Klíčová slova:

Age groups – Infertility – Obstetric procedures – Questionnaires – Surveys – Female infertility – Male infertility – Uterus


1. Brannstrom M, Johannesson L, Bokstrom H, Kvarnstrom N, Molne J, Dahm-Kahler P, et al. Livebirth after uterus transplantation. Lancet. 2015;385(9968):607–16. Epub 2014/10/11. doi: 10.1016/S0140-6736(14)61728-1 25301505.

2. Testa G, Koon EC, Johannesson L, McKenna GJ, Anthony T, Klintmalm GB, et al. Living Donor Uterus Transplantation: A Single Center's Observations and Lessons Learned From Early Setbacks to Technical Success. Am J Transplant. 2017;17(11):2901–10. Epub 2017/04/23. doi: 10.1111/ajt.14326 28432742.

3. Ejzenberg D, Andraus W, Baratelli Carelli Mendes LR, Ducatti L, Song A, Tanigawa R, et al. Livebirth after uterus transplantation from a deceased donor in a recipient with uterine infertility. Lancet. 2019;392(10165):2697–704. Epub 2018/12/12. doi: 10.1016/S0140-6736(18)31766-5 30527853.

4. Brannstrom M, Dahm Kahler P, Greite R, Molne J, Diaz-Garcia C, Tullius SG. Uterus Transplantation: A Rapidly Expanding Field. Transplantation. 2018;102(4):569–77. Epub 2017/12/07. doi: 10.1097/TP.0000000000002035 29210893.

5. Kisu I, Banno K, Mihara M, Suganuma N, Aoki D. Current status of uterus transplantation in primates and issues for clinical application. Fertil Steril. 2013;100(1):280–94. Epub 2013/04/06. doi: 10.1016/j.fertnstert.2013.03.004 23557761.

6. Kisu I, Banno K, Matoba Y, Adachi M, Aoki D. Current Status of Uterus Transplantation and Approaches for Future Clinical Application in Japan. Transplant Proc. 2018;50(9):2783–8. Epub 2018/10/23. doi: 10.1016/j.transproceed.2018.02.198 30343882.

7. Semba Y, Chang C, Hong H, Kamisato A, Kokado M, Muto K. Surrogacy: donor conception regulation in Japan. Bioethics. 2010;24(7):348–57. Epub 2009/12/17. doi: 10.1111/j.1467-8519.2009.01780.x 20002072.

8. Kisu I, Banno K, Mihara M, Iida T, Yoshimura Y. Current status of surrogacy in Japan and uterine transplantation research. Eur J Obstet Gynecol Reprod Biol. 2011;158(2):135–40. Epub 2011/06/03. doi: 10.1016/j.ejogrb.2011.04.037 21632170.

9. Kisu I, Banno K, Soeda E, Kurihara Y, Okushima M, Yamaguchi A, et al. Survey of Attitudes toward Uterus Transplantation among Japanese Women of Reproductive Age: A Cross-Sectional Study. PLoS One. 2016;11(5):e0156179. Epub 2016/05/21. doi: 10.1371/journal.pone.0156179 27203855; PubMed Central PMCID: PMC4874691.

10. Yamamoto N, Hirata T, Izumi G, Nakazawa A, Fukuda S, Neriishi K, et al. A survey of public attitudes towards third-party reproduction in Japan in 2014. PLoS One. 2018;13(10):e0198499. Epub 2018/11/01. doi: 10.1371/journal.pone.0198499 30379816; PubMed Central PMCID: PMC6209135.

11. Hariton E, Bortoletto P, Goldman RH, Farland LV, Ginsburg ES, Gargiulo AR. A Survey of Public Opinion in the United States Regarding Uterine Transplantation. J Minim Invasive Gynecol. 2018;25(6):980–5. Epub 2018/03/11. doi: 10.1016/j.jmig.2018.03.001 29524724.

12. Brannstrom M, Johannesson L, Dahm-Kahler P, Enskog A, Molne J, Kvarnstrom N, et al. First clinical uterus transplantation trial: a six-month report. Fertil Steril. 2014;101(5):1228–36. Epub 2014/03/04. doi: 10.1016/j.fertnstert.2014.02.024 24582522.

13. Vitale SG, La Rosa VL, Rapisarda AM, Lagana AS. Psychology of infertility and assisted reproductive treatment: the Italian situation. J Psychosom Obstet Gynaecol. 2017;38(1):1–3. Epub 2016/10/19. doi: 10.1080/0167482X.2016.1244184 27750491.

14. La Rosa VL, Barra F, Chiofalo B, Platania A, Di Guardo F, Conway F, et al. An overview on the relationship between endometriosis and infertility: the impact on sexuality and psychological well-being. J Psychosom Obstet Gynaecol. 2019:1–5. Epub 2019/08/31. doi: 10.1080/0167482X.2019.1659775 31466493.

15. Guntram L, Williams NJ. Positioning uterus transplantation as a 'more ethical' alternative to surrogacy: Exploring symmetries between uterus transplantation and surrogacy through analysis of a Swedish government white paper. Bioethics. 2018;32(8):509–18. Epub 2018/07/27. doi: 10.1111/bioe.12469 30048000; PubMed Central PMCID: PMC6221143.

16. Soderstrom-Anttila V, Wennerholm UB, Loft A, Pinborg A, Aittomaki K, Romundstad LB, et al. Surrogacy: outcomes for surrogate mothers, children and the resulting families-a systematic review. Hum Reprod Update. 2016;22(2):260–76. Epub 2015/10/11. doi: 10.1093/humupd/dmv046 26454266.

17. Sunkara SK, Antonisamy B, Selliah HY, Kamath MS. Perinatal outcomes after gestational surrogacy versus autologous IVF: analysis of national data. Reprod Biomed Online. 2017;35(6):708–14. Epub 2017/09/28. doi: 10.1016/j.rbmo.2017.08.024 28951002.

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2019 Číslo 10
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