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This project examines the ethical permissibility of heterologous ovarian transplantation to treat infertility, ovarian insufficiency, or both. Based on currently available data regarding the procedures’ risks, outcomes, and alternatives, it argues that the procedure is ethically permissible under a research protocol to treat ovarian insufficiency, but not infertility, because of the risks immunosuppression poses to potential future offspring. Reviewing the history and current empirical literature regarding heterologous ovarian transplantation, the project compares the procedure to relevant alternatives: hormone replacement therapy (HRT) and in vitro fertilization (IVF). It analyzes the risks and potential benefits for each of the parties immediately involved in heterologous ovarian transplantation: recipients and donors, as well as potential future children of recipients. Depending on the particular interests and values or conception of the good embraced by recipients and donors, and despite the alternative of hormone replacement therapy, heterologous ovarian transplantation can be an ethically permissible intervention for ovarian insufficiency. Because of the risks to fetal development presented by requisite immunosuppression in recipients, the procedure does not have an acceptable risk:benefit profile for treatment of infertility. The project concludes by addressing two concerns that may be raised in opposition to developing heterologous ovarian transplantation: that desires for the procedure are insufficiently autonomous or authentic, and that the procedure reinforces ethically problematic social norms and beliefs in biological essentialism. It concludes that considerations of justice and respect for the autonomy of decision makers support studying and making available heterologous ovarian transplantation for treatment of ovarian insufficiency.

There is a major shortage of organs in the United States resulting in thousands of deaths per year. One main approach for responding to this crisis has been to consider expanding criteria for donation to increase the pool of available organs. The HIV Organ Policy Equity Act (HOPE Act) legalized HIV+ to HIV+ organ transplants, allowing HIV+ organs to be used in transplants in the U.S. for the first time. But even with this policy there is still untapped potential in considering HIV+ organs for transplant. Under current law HIV+ living donors cannot donate to HIV- recipients even if no alternative organ is available. Similarly, HIV- potential organ recipients are forbidden from accepting an HIV+ organ even if the organ would otherwise be discarded or would be given to a person on the waitlist who is in less desperate need of it. In the early years of the HIV pandemic these prohibitions were logical as HIV was a deadly disease with no effective treatment. Yet today this is no longer the case and people living with HIV can live long fulfilling lives. As such, legalizing HIV+ to HIV- organ transplantation in the United States has great potential to save lives and improve quality of life. This essay will explore the risks and benefits of this procedure and argue that it is prudent to legalize HIV+ to HIV- transplantation.