The opportunity to conceive, conceive, and give birth to a biologically related child is a deep desire of many women and their partners. Since presenting IVF in 1978In countries such as Australia, many people have received support and resources to help achieve their reproductive goals.
For some women, the lack of a functioning uterus has kept this opportunity out of reach. This includes those with a congenital condition such as Mayer Rokitansky Kosterhauser Syndrome, those who underwent a hysterectomy for medical reasons.
For these women, the only option for parenthood was surrogacy or adoption. It is often difficult to access both.
Uterine transplants change that. As of next year, a trial of uterine transplantation is underway in Australia. However, there are inherent risks and ethical concerns that must be addressed before it becomes the dominant clinical treatment.
How does this process work?
Uterine transplantation is a group of medical procedures Where a donor uterus is surgically removed from a suitable donor and transplanted into a qualified recipient.
Hormones are used to stimulate menstruation in the recipient, and once the uterus is functioning normally, the embryo from IVF is transferred to the woman’s uterus.
After successful cultivation and healthy development, the baby is delivered by caesarean section. This is because a uterine transplant is considered high-risk, and a woman may not be able to feel the contractions. Women with congenital absence of the uterus will not be able to give birth vaginally.
As with all transplants, uterine recipients are prescribed immunosuppressive medications to prevent rejection of the donor organ. These medications are administered at levels considered safe for a developing fetus. Close monitoring continues throughout the pregnancy to ensure the safety of both the woman and the fetus.
Immunosuppression continues until the birth of up to two healthy babies or five years after transplantation, whichever comes first.
The uterus is then surgically removed via a hysterectomy, allowing the immune suppression to be turned off – which carries risks and side effects. Immunosuppression risks include infection, low blood cell counts, heart disease, and inhibition of bone marrow growth. These risks increase with time.
Uterine transplantation is a “ephemeral” transplant: a temporary, non-life-saving transplant intended solely to enable reproduction. These features make it clinically and ethically distinct from other implants.
When did uterine transplants start?
After 14 years of research, Professor Mats Branstrom and his team at Sweden’s Sahlgrenska University Hospital began the world’s first human trials in 2013. In 2014, The first healthy child was born.
It is estimated that more than 25 countries are now performing or planning uterine transplants No less than 80 procedures More than 40 healthy live births have been performed. Although not all transplants are successful, the rate of live births from a successfully functioning womb after implantation is estimated at more than 80%.
in Australia, two experiences It has been approved and plans to start within the next 12-18 months.
Most uterine transplants to date have used living altruistic donors, usually a mother donates to her daughter or an aunt to her niece.
But cases of using deceased donors have also been successful At least four healthy live births have been reported.
Presentation of uterus from deceased donors is mostly done through standard family consent methods for medical research. But in the future it can be made available through organ donor registrations modified to include the uterus.
Currently, only premenopausal women can be uterine donors, and living donors need to have had a successful pregnancy to be eligible to donate. but this You may not need Being a requirement for deceased donors, which may empower younger donors and increase the availability of the uterus for transplantation.
Of the two approved Australian trials, only one (led by the Royal Hospital for Women, for which I provide independent ethical advice) will perform a live and deceased donor uterus transplant. The other (through the Royal Prince Alfred Hospital) will only attempt to transplant living donors.
Participation in uterine transplant trials will remain limited while uterine transplantation is still in the research phase, and will depend on the availability of funding.
What are the risks of a live donation?
For the recipient, the main surgical risks are organ rejection, infection, blood clots or thrombosis, as well as risks arising from the duration of surgery (5 hours on average) such as blood clots (including in the lung) and from immunosuppression.
during the challenge, These risks have been reduced Through close monitoring and early intervention using blood thinners and encouraging recipients to move soon after surgery.
For living donors, physical risks arise from the duration of surgery (6-11 hours) and surgical and postoperative complications, the most common of which are urinary tract infection and infection.
There are also moral and psychological risks. These include the possibility that a potential donor will feel pressured to donate to a family member, and feelings of guilt and failure if the transplant is unsuccessful or counterproductive.
These risks can be reduced with appropriate counseling and support. But as with all altruistic organ donations, it can’t be completely eliminated.
What about a deceased donation?
A deceased donor transplant also carries risks but requires less surgical time than a living donor transplant (usually 1-2 hours) and thus lowers the demand on medical resources and personnel.
A deceased donor transplant may be less ethically risky. There is no potential for stress, guilt or surgical risk for the deceased donor, who must have been declared brain dead and be suitable for multiple organ donation. Their organs may only be purchased with valid consent, following usual protocols and procedures.
Do you donate your uterus when you die?
In Australia, as elsewhere, there is a shortage of organ donors. But deceased donors can be found through existing donation records and approval processes, such as those you manage donate life And the Organ and tissue donation services in New South Wales.
Why investigate both types of donation?
It is important to be able to compare living and deceased donation outcomes in similar recipients and contexts. This will guide future guidelines and policies around uterine donation, and determine whether it can become a mainstream clinical practice.
Emerging evidence indicates Deceased donation may lead to better outcomes for recipients. The use of deceased donor organs allows for the recovery of longer veins and arteries, allowing better blood flow to the uterus and potentially greater success in transplants and pregnancies.
So although there are currently fewer cases of deceased donors, there are sound medical and ethical reasons for conducting Australian uterine transplant research with both deceased donors and living donors.