Many women long for the chance to have a biologically related child.
Since the introduction IVF in 1978Many people in Australia and other countries have found support and resources to help them realize their reproductive goals.
Some women have had to wait because they don’t have a functioning uterus. This is true for women who have a congenital condition, such as Mayer-Rokitansky-Küster-Hauserpatients who have had a hysterectomy to treat medical reasons or those with syndrome.
These women have no other options than surrogacy or adoption for their childbearing. It is not always easy to get both.
The future of uterus transplants is bright. Australia will begin trials of uterus transplants in the next year.
But there are also risks and ethical concerns that need to be addressed before the treatment is accepted into mainstream clinical practice.
What is the process?
Transplantation of the uterus is an option. Set of medical proceduresIn which a donor’s uterus can be surgically removed and transplanted into a recipient.
Hormones can be used to stimulate the recipient’s menstruation. After the recipient’s uterus is healthy, an IVF-created embryo can then be transferred into the woman’s uterus.
The baby is born via Cesarean section after successful implantation.
Because a uterus transplant pregnancy can be considered high-risk, the woman may not feel contractions. Congenital absence of the uterus means that women with this condition will not be capable of giving birth vaginally.
To prevent rejection of the donor organ, immunosuppression medication is given to the recipient uterus. These drugs are only administered at safe levels for the developing foetus.
To ensure safety for both mother and foetus, close monitoring is maintained throughout pregnancy.
Immunosuppression continues up to the birth of at least two healthy babies, or until five years after the transplant.
The uterus is then surgically removed via hysterectomy, enabling immunosuppression – which carries risks and side effects – to be ceased.
There are several risks associated with immunosuppression, including infection, reduced blood cells count, heart disease and suppression bone marrow growth. These risks increase over time.
Uterus transplantation can be described as an “ephemeral” or temporary transplant. It is a non-life-saving, temporary procedure that enables reproduction. These features distinguish it from other transplants on the medical and ethical side.
When did uterus transplants start?
In the 1970s, scientists began developing uterus transplantation for animals. The first attempts at transplantation in humans were made in 2000 (Saudi Arabia) 2011 (Turkey)Both of these failed.
After 14 years of intensive research, Professor Mats Brannstrom joined his team at Sweden’s Sahlgrenska University Hospital to begin the first human trials. This was in 2013. 2014 saw the completion of the The first healthy baby was born.
It is estimated that more than 25 countries are currently planning or performing uterus transplants. At least 80 proceduresMore than 40 live births have been achieved.
Although not all transplants succeed, live birth rates from a uterus functioning well after transplantation are high. Estimated at more than 80 percent.
Australia Two trialsApproved and will commence within the next 12-18 month.
Who donates?
The majority of uterus transplants have so far been done by altruistic living donor, which is typically a mother who donates to her daughter or aunt who donates her niece.
Also, cases that used uteruses donated by deceased donors were successful. At least four live births are reported as healthy.
Most of the time, uteruses from deceased donors can be obtained through family consent for medical research. They may be available through modified organ donor registration processes that include the uterus.
Only pre-menopausal women are eligible to become uterus donors. Living donors must have had a healthy pregnancy in order to be eligible. However, this is changing. You may not be requiredDead donors must be registered as such, which could allow younger donors to take their place and make it easier for them to get pregnant.
One of the approved Australian trials (led at Royal Hospital for Women for whom I provide independent ethical advice), will perform both deceased and living donor uterus transplantation. Royal Prince Alfred hospital, the other, will only be able to test living donor transplantation.
Participants in these uterus-transplant trials will not be allowed to participate while the research phase of uterus donation is underway. This will be subject to funding availability.
What are the risks involved in living donor?
Recipients face the most serious surgical risks: organ rejection, infection, blood clots, or thrombosis. There are also risks associated with the average 5 hour surgery, such as blood loss (including in the lungs) and immunosuppression.
Although it is difficult, These risks are now minimizedThrough close monitoring and early intervention using blood thinners.
Living donors face physical risks from prolonged surgery (6-11 hours) as well as operative and postoperative complications. The most common is infection and urinary tract injury.
There are also ethical risks and psychological ones. There is the chance that a potential donor may feel pressured or be obligated to donate to a loved one.
With the right counseling and support, these risks can be minimized. These risks cannot be eliminated completely, as is the case with all altruistic organ donor.
What about deceased donation?
Although there are risks associated with deceased donor transplantation, it is less time-intensive than live donor transplantation (typically between 1-2 hours). This means that less medical personnel and resources are required.
Declined donor transplantation might be less ethically risky. The deceased donor must be declared brain-dead and suitable for multi-organ donation. There is no risk of guilt, pressure or surgical risk. The deceased donor’s organs can only be obtained with their consent. This must be done in accordance to the established protocols and procedures.
As in other parts of Australia, organ donors are rare. However, deceased donors can be found through existing donor registries or consent processes such as those maintained by DonateLife NSW Organ and Tissue Donation Services.
There are two types of donation. Why not investigate them both?
It is crucial to be able of compare the outcomes for living and deceased donations in similar recipients and settings. This information will help to develop future policies and guidelines for uterus donation and decide if it is possible to make it a mainstream clinical practice.
New evidence suggests A deceased donor may produce better results for recipients. By using deceased organ donors, it is possible to obtain longer veins or arteries. This allows for greater blood flow to the uterus and can lead directly to more success in pregnancy and transplants.
Even though there are fewer cases currently of deceased donors, there is good medical and ethical reason to do uterus transplant research in Australia using both living and deceased donors.
Mianna Lotz, Associate Professor in Philosophy & Chair of Faculty of Arts Human Research Ethics Committee, Macquarie University
This article was republished by The ConversationUnder a Creative Commons License Please read the Original article.
