One out of every 4,500 women in the U.S. is born without a uterus. And a new procedure aims to give women like this the ability to carry a child through a uterine transplant. While these operations have been done before, the American trial program at the Cleveland Clinic is the first to use uteruses from deceased rather than living donors.
Ten women are on the docket to receive transplanted donor uteruses in the coming months, and hopefully enjoy a nice baby boom a year or two down the road. This comes on the heels of Swedish success, where a University of Gothenburg team successfully impregnated multiple women using donor organs, with a handful of bouncing babies born to date. Unsuccessful attempts have been made in Turkey and Saudi Arabia, but interest has spread to Great Britain, France, India and Argentina, among other countries.
"I support the research that is being done, and so far with what we have found, this could be a great opportunity for women to carry their own pregnancy that they could not have done so prior to this research and medical development," says fertility specialist Jane Frederick, M.D., via email.
Candidates for this type of transplant could include women born without uteruses as well as women who've received hysterectomies or experienced injuries or infections that damaged their uteruses. The Cleveland Clinic's trial features one major difference from the Swedish transplants, in that organs from deceased donors will be used, rather than uteruses obtained from living, typically related donors. This is new territory for surgeons.
“We don't yet know if the wombs transplanted from deceased patients will function as well as those from living, healthy patients,” explains Elizabeth Yuko, Ph.D, L.L.M, a bioethicist with Fordham University. “A lot of that, of course, depends on the donor's age and health at the time of her death and therefore can be controlled for, but there might end up being a difference between a uterus from a healthy living donor [and] a uterus from a healthy deceased donor.”
The Cleveland Clinic doctors wanted to use deceased donors to lessen risk. For a live donor, the procedure to remove a uterus is time-consuming and complicated with the chance of injury since the surgeons work near vital organs. A uterus from a deceased donor can live outside the body for six to eight hours if it is kept cold. For the recipient, the plan is to keep the new uterus inside her for just a few years (to allow two pregnancies at most) and then to remove it, so she doesn't have to take anti-rejection drugs for life. So that means two surgeries.
Although some women with uterine problems are undoubtedly jumping for joy at the prospect (who could blame them?), some medical practitioners are cautioning everyone to take a step back and consider the ethics argument.
“Because womb transplantation differs from other organ transplantation (i.e. heart or kidney) where the organ is required for the body to function, it raises the question of whether the recipient should even undergo such major surgery for a condition that is not life-threatening,” says Yuko.
“Do the benefits for the recipient outweigh the possible risks of the several invasive and potentially risky procedures involved with womb transplantation and pregnancy? Are the risks worth a woman having the ability to gestate her own child, or should she consider adoption or surrogacy as alternatives?” she asks. Organ rejection and the side effects of anti-rejection drugs on the recipients' body are a couple of other commonly touted concerns.
No matter how obvious the risks are, it's pretty tough not to see the joy in a young mother holding the child she never thought would exist. Still, experts are cautioning women not to put the horse before the cart just yet.
“While uterine transplants are promising options for some women, there's a lot of work left to be done,” writes Jaime Arruda, M.D. in her blog for the University of Colorado's gynecologic oncology department. “Right now, it isn't known if this procedure will be anything more than an interesting experimental procedure. It may never become a valid treatment option, and if it did it would only be an option for a small number of women.”