Until now, the few transplants of a uterus that had been made came from a donor to live. The technique, however, raises controversy
the name is Not known. Just that it’s a girl, who was born 15 December 2017 and that will mark a milestone in the medical literature by being the first baby fruit of a uterine transplantation from a donor who has died.
The small came to the world in Sao Paulo (Brazil) almost a year ago, although the news of his birth has not transpired until now. An article in The Lancet publishes all the details of the intervention that allowed her to give birth in the Hospital das Clínicas of the mentioned brazilian city.
Her case is the first to achieve a birth after you have transplanted a uterus from a corpse because, until now, the few transplants of a uterus that had been carried out had always obtained the organ from a donor to live. From 2014, 11 babies have come into the world for this procedure.
Before his birth, had tried other 10 transplant of uterus from corpse, in the USA, the Czech Republic and Turkey, but none of them helped bring a pregnancy to term.
For all this, the architects of the intervention believe that their results not only provide a “proof of concept” that demonstrates that the strategy is effective, but which offer “a new alternative to women with infertility uterine” that can open the door to a greater use of the technique.
however, not all specialists are shown in the same view. The procedure, which has already raised controversy on other occasions, gives rise to Beatriz Domínguez-Gil, director of the National Organization of Transplants, “a series of ethical issues that deserve the less cautious” at the time of your assessment.
“Not all interventions that can be made, which are technically possible, should be made,” he says.
An intervention pioneer
The problems of infertility, affecting between 10% and 15% of couples in reproductive age; however, only a small percentage of them are due to alterations in the uterus, such as congenital malformations, disorders associated with infections or the total lack of the body because of a hysterectomy.
In this case, the mother, 32-year-old was born without a womb due to a congenital syndrome, the so-called Mayer-Rokitansky-Küster-Hauser, who had not been associated with other medical complications. The young man had undergone, months before the intervention, a treatment of in vitro fertilization, which resulted in eight embryos that were cryopreserved.
In September 2016, the doctors found that there was a possible donor to see the death because of a stroke in a woman of 45 years compatible with the donor, and put in place all the procedure.
In an intervention that lasted nearly 11 hours, surgeons removed the uterus of the donor and implanted in the body of the receiver, by connecting the organ with blood vessels, ligaments and other surrounding tissues.
After the surgery, the recipient, who had to stay several days in the hospital, began to receive immunosuppressive medication to reduce the risk of rejection. In addition, during the first few days, the patient also took antibiotics and anticoagulant therapy to avoid complications.
The embryo is implanted, seven months after transplant, after doctors observed on several occasions that there was no abnormality and the patient evolved well and had regular periods.
There was no impact on the pregnancy and, after 35 weeks of gestation was scheduled for a c-section for December 15, 2017. The baby was born healthy, with 2.550 grams of weight and 45 cm in length and in the same intervention, withdrew the uterus implanted to the patient without introducing any complication. Both evolved adequately, and seven months after birth-when the researchers sent the text for publication-, the baby grew and fed normally.
the conclusions of their work, the researchers, led by Dani Ejzenberg, they underscore that their data suggest that “the choice to transplant the uterus can expand the fulfillment of the desire of many women to carry to term their own pregnancies.”
The fact that it is not necessary to have a donor living will greatly facilitate the process, the researchers say, that they are convinced that this strategy “can be a real option” for many women.
On the same line is pronounced César Díaz-García, a specialist corporation devoted to assisted reproduction IVI-RMA. Diaz-Garcia has worked closely with the team, Mats Brännström, the architect of the first baby born after transplantation of uterus (Sweden, 2014).
“This technique could be an alternative for women who cannot have children for reasons other than congenital anomalies,” he explains. “In fact, in the first series of transplantation in which we participate, one of the patients who was included and who today has two children healthy after the transplant was a patient who had their uterus removed due to a cancer”.
any way, in a commentary accompanying the work in the medical magazine, Díaz-García recalls that the technique is still in its infancy and still has many issues to resolve.
“Only have been performed 50 transplants in the world, least of which have been done with a cadaveric donor, but it is a very important step, above all because with this type of approach would eliminate the surgical risks that exist in the case of uterine transplantation with donor alive.”
For the director of the ONT, the fact that it is not necessary to a living donation “resolves one of the ethical considerations” raised by the procedure, “but not all”.
Without taking into account possible failures of the technique, which must be validated, points out Domínguez-Gil, you must balance the intervention supposed to submit to a two major surgery -to implant and subsequently remove the body – to a person who “even if it is infertile it is healthy”.
in Addition, it is necessary to expose that woman and her future baby to the effects of immunosuppressive therapy that is indicated to avoid the risk of rejection. “Is it worth taking all these risks for both to get a result, in this case to be a mother, which may be obtained by other routes such as adoption? I think the answer is no,” he says.
According to Dominguez-Gil, the committee of bioethics of the National Transplant Organisation has issued a negative report on the use of this type of trasplantes in our country.
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