Organ and tissue transplants have become common nowadays. The usual organs transplanted are the kidneys, heart, lung, pancreas, intestines and urinary bladders. Tissues, such as, bone marrow, bone and tendons, cornea, skin, heart valves, stem cells, veins and arteries are also the candidates for transplant. Recently, another organ, the uterus, has joined the list raising ethical questions and challenging the surgical skills of the doctors.
Who needs a uterine transplant? Approximately, out of 5,000 female baby births, one girl is born without a uterus or born with a small one, but has normal ovaries and external genetalia. The condition is named after its doctors who discovered it, Mayer Rokitansky Kuster Hauser Syndrome, or MRKH for short. The disorder is usually noticed when a girl reaches puberty. These and other women who had their uteri removed for cancer, or because of an accident or other reasons may want to carry their own child, feel the kicks and enjoy the pregnancy. They opt for a uterine transplant. About 50,000 women are candidates for such an operation in the country. They don’t want surrogates or adoption.
Uterine transplants, mainly from live donors, are successfully being carried out in Sweden at the Gothenburg University. After the transplant, the woman is given immune suppressive medicines to prevent organ rejection and observed for one year. Because the woman’s Fallopian tubes are not connected to the transplanted uterus, the recipient cannot become pregnant with her own egg but needs previously preserved, in-vitro fertilized eggs. They are implanted once a month, one by one, into the uterus till she becomes pregnant. The mother is given hormones and immune suppressive therapy which are continued during pregnancy. The child is delivered early by a caesarian section to minimize complications. After she has had one or two children, the transplanted uterus will be removed and the immune suppressive medications are discontinued.
Nine women received donor’s uterus and out of them four recipients successfully had given birth to premature children, but were healthy otherwise. Two transplants failed. In five instances, an elderly mother donated her uterus to her daughter, the daughter giving birth to a child from the same uterus from which she was born.
Recently, at the Cleveland Clinic, Weston, Florida, the hospital’s Ethics Committee gave permission to try 10 cadaver uterine transplants. Consequently, on February 24, 2016, a deceased donor’s uterus was transplanted into a 26-year-old woman, Lindsey, who lacked the organ. She was anxious to carry her child in the womb, feel the child’s kicks and experience the morning sickness. The nine hour operation was successful. This was the first such operation in the United States.
Two weeks later, Lindsey with the transplanted uterus developed severe complications. The doctors at the Cleveland Clinic removed the uterus. The cause of the complication is under investigation.
Baylor University medical Center at Dallas is also poised to perform uterine transplants. The doctors will try donor and cadaver uterine transplants. If the procedure becomes successful, it will be a boon for women born without a uterus or those in whom the organ was removed due to cancer, bleeding or an accident.
(Dr. Raghavendra Rao is a pediatrician in Porterville. He writes periodically for The Recorder.)