Bioethics. 2018;1–10. wileyonlinelibrary.com/journal/bioe | 1 © 2018 John Wiley & Sons Ltd 1 | INTRODUCTION In the fast‐expanding literature on the ethics of uterus transplanta‐ tion (UTx) close consideration of key features of the socio‐moral con‐ text in which it will be offered, and of the alternatives to it, remains underdeveloped. In this paper, I address that deficit by challenging current assumptions about what constitutes an alternative to UTx, and by directing attention to certain weighty moral imperatives re‐ lating to the procreative context in which UTx is offered. I argue that these moral imperatives are currently neglected to an unacceptable extent. My focus is specifically on the adoption alternative, since I regard that to be the most readily dismissed UTx alternative, and since I believe it is in relation to adoption, rather than gestational surrogacy, that the most pressing unmet needs exist and therefore the most important reforms are called for. My argument rests on two core suppositions. The first is that injustice occurs when persons are denied something to which they are morally entitled. The second is that significant moral needs establish entitlement in a way that preferences and desires, however deeply socially embedded and le‐ gitimized, do not. My predominant focus on adoption rather than gestational sur‐ rogacy may be queried and warrants justification at the outset. 1 It might be argued that gestational surrogacy is surely the most salient UTx alternative, given that it secures biological relatedness to one or both commissioning parents (depending on whether third‐party donor gametes are used) in a way that adoption cannot; and given also that it is a significantly less resource‐ and risk‐intensive mode of procreation than UTx. Why, then, do I set it aside in favour of adop‐ tion reform as the strongest imperative? My reason for doing so is threefold. First, surrogacy is a highly ethically contested procreative practice. Depending on the type of surrogacy under consideration—commercial or altruistic—signifi‐ cant and vexed ethical questions arise regarding women’s consent and autonomy as well as potential commodification and 1 Thanks to an anonymous referee of this journal for prompting me to make clearer my reasons for not advocating gestational surrogacy as the most salient UTx alternative. Received: 15 December 2017 | Revised: 22 April 2018 | Accepted: 20 May 2018 DOI: 10.1111/bioe.12490 SPECIAL ISSUE: UTERUS TRANSPLANTS Uterus transplantation as radical reproduction: Taking the adoption alternative more seriously Mianna Lotz Correspondence Mianna Lotz, Faculty of Arts, Department of Philosophy, Macquarie University, Sydney, New South Wales 2109, Australia. Email: mianna.lotz@mq.edu.au Abstract This paper urges reconsideration of analyses of the alternatives to reproductive uterus transplantation (UTx). I focus here specifically on the adoption alternative. Importantly, my purpose is not to oppose UTx provision. Rather, it is to propose ways in which ethical analysis and provision of UTx can potentially accommodate the con‐ cerns discussed here. I argue that the adoption alternative to UTx is too readily dis‐ missed, and that this is a dismissal with significant moral costs. I suggest that the radical nature of UTx as a form of assisted reproduction calls for an equivalently radi‐ cal socio‐moral agenda for reform and transformation of adoption law, policy and practice, as well as of the norms that prevail within our presently strongly bio‐norma‐ tive reproductive context. In doing so I widen the ethical frame of responsible provi‐ sion of assisted reproduction to encompass not just obligations towards donors and recipient, but also our broader social responsibilities to ensure that we are doing our best to meet the significant needs of some of the most vulnerable members of our society. KEYWORDS adoption, assisted reproduction, ethics, reproduction, uterus transplantation