Analysing vulnerability in candidates for uterus transplantation

Abstract

Vulnerability is frequently conceptualized as a group attribute, with all members of that group automatically receiving additional safeguards, including denial of access. There has, however, been a move to recognize more nuanced, context-driven concepts of vulnerability. In the research setting, this has taken the form of a taxonomy that identifies eight types of vulnerability (cognitive, juridic, deferential, social, medical, situational, allocational, and infrastructural) that can lead a potential research subject to make choices against their own best interests. In the consumer context, vulnerability is conceptualized as a lack of control arising from the interaction of personal states, personal characteristics, and external conditions that hinder marketplace navigation. This study examines both the research and consumer conceptualizations of vulnerability for candidates for uterus transplantation (UTx)—a procedure that is transitioning out of the context of clinical trials, and into a consumer marketplace. It identifies the potential for most types of vulnerability defined in the research taxonomy, as well as the strategies, such as a psychosocial evaluation during the screening process, that can be carried forward from UTx clinical trial protocols to manage these vulnerabilities. Likewise, the consumer-driven model for vulnerability indicates similar risks for UTx as have been identified for in vitro fertilization: specifically, a willingness among women with low chances of success to repeatedly incur physical, financial, and emotional risks in the pursuit of pregnancy, and the need to support a sense of control through managing expectations and validating decisions about appropriate treatment endpoints.