AST Statement on Supreme Court's Overturning of Roe v. Wade

The American Society of Transplantation (AST) is a diverse organization dedicated to advancing the field of transplantation and improving patient care by promoting research, education, advocacy, organ donation, and service to the community through a lens of equity and inclusion. We are committed to supporting and guiding our patients and health care providers through all aspects of pre- and post-transplant care, including reproductive care. We provide this statement primarily to protect the health of our patients.

On June 24, 2022, the Supreme Court overturned the Roe vs. Wade US Supreme Court decision from 1973 sending a wave of uncertainty and concerns regarding women’s access to abortion care and even contraception care nationwide.

AST supports patients’ right to exercise self-determination over their bodies and reproductive decisions. The overturning of Roe v. Wade ignores not only 50-years of precedent but also evidence-based research that affirms the right to an abortion is essential to protect the health and wellness of women with organ transplants. The ruling sets a dangerous precedent for government intervention in the practice of medicine and undermines the patient-provider relationship which impacts providers’ ability to administer safe and quality medical care.

Fertility improves after a successful transplant and post-transplant pregnancies are possible, but these are high risk pregnancies with significantly increased risk of maternal and fetal complications, including death. As the AST healthcare community, we care for patients with end-stage organ diseases and those following transplantation and routinely prescribe immunosuppressive medications, which can have teratogenic effects. Thus, we routinely counsel our patients of child-bearing potential on contraception options based on the health of the transplanted organ and other comorbidities.  However, 40% of pregnancies reported in Transplant Pregnancy Registry International were unplanned, with the proportion of unplanned pregnancies highest in the adolescent/young adult transplant recipients (75%). Additionally, women transplant recipients with planned pregnancies may also need to undergo termination of their pregnancy due to aforementioned complications (1-3). Because of the increased risk of complications during and after pregnancy and misconceptions around fertility after transplant, abortion must remain a safe and accessible option for transplant patients. Overturning of Roe vs. Wade has direct implications for the care and well-being of our patients.

We are concerned that restrictive abortion policies will lead to adverse birthing outcomes that will disproportionately impact Black individuals, those of lower socioeconomic status, and those with lower education levels. The overturning of Roe v. Wade has the potential to exacerbate disparities already present in the transplant field (5).

We are committed to the well-being of our patients, which includes access to routine and emergency contraception as well as safe abortion care when required. AST stresses the importance of discussing routine contraception options and family planning with all our patients of child-bearing age. The AST expresses our unwavering support to our colleagues who provide reproductive care services, including abortion, to our vulnerable patients. 

1. Coscia L, Daly T, Nathan H, Armenti D, Kliniewski D, Constantinescu S, et al. Transplant pregnancy registry international. Transplantation. 2017;101:S64.
2. Unintended pregnancy [Internet]. Published 2019 [cited 6/7/2022].
3. Shah S, Verma P. Overview of Pregnancy in Renal Transplant Patients. International Journal of Nephrology. 2016;2016:4539342.
4. French VA, Davis JS, Sayles HS, Wu SS. Contraception and fertility awareness among women with solid organ transplants. Obstetrics & Gynecology. 2013;122(4):809-814. doi: 10.1097/AOG.0b013e3182a5eda9.
5. Dehlendorf C, Harris LH, Weitz TA. Disparities in abortion rates: a public health approach. Am J Public Health. 2013;103(10):1772-1779. doi:10.2105/AJPH.2013.301339.