{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T13:10:35Z","timestamp":1778332235236,"version":"3.51.4"},"reference-count":34,"publisher":"Knowledge E DMCC","issue":"2","license":[{"start":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T00:00:00Z","timestamp":1776211200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":["knepublishing.com"],"crossmark-restriction":true},"short-container-title":["IJRM"],"abstract":"<jats:p>Background: Commercial surrogacy, as a method of assisted reproductive technology, raises profound ethical and legal challenges, exacerbated in developing countries due to economic disparities and the absence of comprehensive regulations. The purpose of this study is to examine the ethical, legal, and social challenges arising from a real case of international commercial surrogacy in Iran. \nCase Presentation: This article analyzes a real-life case in Iran involving a surrogate mother who, at 32 wk pregnant with twins, underwent an emergency cesarean section due to severe vaginal bleeding. The case raised significant concerns due to the absence of the American genetic parents at the time of birth, delays in issuing birth certificates, the temporary transfer of the newborns to welfare services, and the erasure of the surrogate mother\u2019s identity from legal documents. These issues spotlight questions regarding autonomy, exploitation, discrimination, and children\u2019s rights.\nConclusion: Focusing on the ethical dimensions specific to this case in Iran, the study examines the broader challenges of surrogacy. The analysis reveals the impact of economic pressures on the surrogate\u2019s autonomy, discriminatory practices in recording the surrogate\u2019s identity in international cases, the lack of mechanisms to verify the eligibility of commissioning couples, and the urgent need for comprehensive legal and ethical frameworks to mitigate harm and ensure justice. The case positions Iran as an emerging destination for commercial surrogacy, highlighting the potential for exploitation due to the commercialization and erasure of surrogate mothers\u2019 identities. It is recommended that until precise regulations are enacted through public discourse and stakeholder participation, all commercial surrogacy, particularly international cases, be suspended.<\/jats:p>","DOI":"10.18502\/ijrm.v24i2.21056","type":"journal-article","created":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T07:35:09Z","timestamp":1776238509000},"page":"163-172","update-policy":"https:\/\/doi.org\/10.18502\/knecrossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Ghost mothers: Ethical challenges in Iran as an emerging destination for cross-border surrogacy: A case report"],"prefix":"10.18502","volume":"24","author":[{"given":"Maryam","family":"Modabber","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alireza","family":"Parsapour","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammadreza","family":"Jafari","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mahshid","family":"Malbakhsh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ehsan Shamsi","family":"Gooshki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"7770","published-online":{"date-parts":[[2026,4,15]]},"reference":[{"key":"330304","unstructured":"[1] Ellenbogen A, Feldberg D, Lokshin V. 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Governing transnational surrogacy practices: What role can national and international regulation play. In: Davies M. Babies for sale? Transnational surrogacy, human rights and the politics of reproduction. UK: Zed books; 2017: 344-375.","DOI":"10.5040\/9781350218567.ch-020"},{"key":"330310","unstructured":"[7] Guzman VR. A comparison of surrogacy laws of the US to other countries: Should there be a uniform federal law permitting commercial surrogacy. Hous J Intl L 2016; 38: 619."},{"key":"330311","unstructured":"[8] Curtin R. Suspension of citizenship: Ethical concerns in international commercial surrogacy and the legal possibility of stateless children. Vanderbilt Law Rev 2022; 55: 805."},{"key":"330312","doi-asserted-by":"crossref","unstructured":"[9] Ghodrati F. A comparative study of surrogacy rights in Iran and European countries, a review article. 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Hum Fertil 2022; 25: 912-923.","DOI":"10.1080\/14647273.2021.1937716"},{"key":"330317","unstructured":"[14] Bugrein H, AlJaber HM. Commercial surrogacy between ethics and legalization. Obstet Gynecol Open Access [Internet]. 2025 May 7 [cited 2025 June 5]; Available at: https:\/\/www.gavinpublishers.com\/article\/view\/commercial-surrogacy-between-ethics-and-legalization."},{"key":"330318","doi-asserted-by":"crossref","unstructured":"[15] Roz\u00e9e V, Unisa S, de La Rochebrochard E. The social paradoxes of commercial surrogacy in developing countries: India before the new law of 2018. BMC Womens Health 2020; 20: 234.","DOI":"10.1186\/s12905-020-01087-2"},{"key":"330319","doi-asserted-by":"crossref","unstructured":"[16] Lee JY. Surrogacy: Beyond the commercial\/altruistic distinction. J Med Ethics 2023; 49: 196-199.","DOI":"10.1136\/medethics-2021-108093"},{"key":"330320","doi-asserted-by":"crossref","unstructured":"[17] Brand\u00e3o P, Garrido N. Commercial surrogacy: An overview. Rev Bras Ginecol Obstet 2022; 44: 1141-1158.","DOI":"10.1055\/s-0042-1759774"},{"key":"330321","unstructured":"[18] Cooperman J. International mother of mystery: Protecting surrogate mothers\u2019 participation in international commercial surrogacy contract. Gold Gate UL Rev 2018; 48: 161."},{"key":"330322","doi-asserted-by":"crossref","unstructured":"[19] Timms O. Ending commercial surrogacy in India: Significance of the surrogacy (regulation) bill, 2016. Indian J Med Ethics 2018; 3: 99-102.","DOI":"10.20529\/IJME.2018.019"},{"key":"330323","doi-asserted-by":"crossref","unstructured":"[20] Tobin J. To prohibit or permit: What is the (human) rights response to the practice of international commercial surrogacy? Int Comp Law Q 2014; 63: 317-352.","DOI":"10.1017\/S0020589314000049"},{"key":"330324","unstructured":"[21] Ganguli-Mitra A. Exploitation through the lens of structural injustice: Revisiting global commercial surrogacy. In: Exploitation: From practice to theory. Rowman and Littlefield, Inc.; 2017."},{"key":"330325","doi-asserted-by":"crossref","unstructured":"[22] Wilkinson S. The exploitation argument against commercial surrogacy. Bioethics 2003; 17: 169-187.","DOI":"10.1111\/1467-8519.00331"},{"key":"330326","doi-asserted-by":"crossref","unstructured":"[23] Wang Y, Shi H, Chen L, Zheng D, Long X, Zhang Y, et al. Absolute risk of adverse obstetric outcomes among twin pregnancies after in vitro fertilization by maternal age. JAMA Netw Open 2021; 4: e2123634.","DOI":"10.1001\/jamanetworkopen.2021.23634"},{"key":"330327","unstructured":"[24] Khan Mohammad Beigi P. In vitro fertilization (IVF) and twin pregnancy outcomes [M.Sc. thesis]. University of British Columbia; 2022."},{"key":"330328","doi-asserted-by":"crossref","unstructured":"[25] Reddy S, Patel T, Tanderup M, Nielsen BB. Breastfeeding and bonding: Issues and dilemmas in surrogacy. In: Cossidy T, El Tom A. Ethnographies of breastfeeding. 1st Ed. London: Routledge; 2020.","DOI":"10.4324\/9781003085294-11"},{"key":"330329","doi-asserted-by":"crossref","unstructured":"[26] Salama M, Isachenko V, Isachenko E, Rahimi G, Mallmann P, Westphal LM, et al. Cross border reproductive care (CBRC): A growing global phenomenon with multidimensional implications (a systematic and critical review). J Assist Reprod Genet 2018; 35: 1277-1288.","DOI":"10.1007\/s10815-018-1181-x"},{"key":"330330","doi-asserted-by":"crossref","unstructured":"[27] Shamsi Gooshki E, Allahbedashti N. The process of justifying assisted reproductive technologies in Iran. Indian J Med Ethics 2015; 12: 57-96.","DOI":"10.20529\/IJME.2015.027"},{"key":"330331","unstructured":"[28] Law on Civil Registration. Law on Civil Registration of the Islamic Parliament of Iran, Article 19. Available at: https: \/\/rc.majlis.ir\/fa\/law\/show\/97466."},{"key":"330332","unstructured":"[29] Law on Civil Registration. Law on Civil Registration of the Islamic Parliament of Iran, Article 48. Available at: https: \/\/rc.majlis.ir\/fa\/law\/show\/97466."},{"key":"330333","unstructured":"[30] Shamsi Gooshki E, Parsapour A, Jafarian A, Momeni F, Larijani B. Proposed policy brief by the medical ethics and bioethics philosophy group of the academy of medical sciences on unrelated kidney donation with financial compensation. IJHP 2019; 2: 409-411."},{"key":"330334","doi-asserted-by":"crossref","unstructured":"[31] Shamsi-Gooshki E, Parsapoor A, Asghari F, Parsa M, Saeedinejad Y, Byroudian S, et al. Developing \u201ccode of ethics for medical professionals, medical council of Islamic Republic of Iran\u201d. Arch Iran Med 2020; 23: 658-664.","DOI":"10.34172\/aim.2020.83"},{"key":"330335","doi-asserted-by":"crossref","unstructured":"[32] Shamsi Gooshki E. Defensive medicine: A serious threat to Iran\u2019s healthcare system. Iran J Med Ethics Hist Med 2024; 17: 26.","DOI":"10.18502\/ijme.v17i26.18624"},{"key":"330336","doi-asserted-by":"crossref","unstructured":"[33] Eftekhari MH, Parsapoor A, Ahmadi A, Yavari N, Larijani B, Shamsi Gooshki E. Exploring defensive medicine: Examples, underlying and contextual factors, and potential strategies: A qualitative study. BMC Med Ethics 2023; 24: 82.","DOI":"10.1186\/s12910-023-00949-2"},{"key":"330337","unstructured":"[34] Ministry of Health, Medical Education. Medcare of Ministry of Health, Medical Education. 2025. Clinical standards and guidelines. 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