New York Team To Attempt First U.S. Uterus Transplant, Raises Ethical Concerns

Main Category: Women's Health / Gynecology
Also Included In: Fertility;  Sexual Health / STDs
Article Date: 19 Jan 2007 - 6:00 PDT

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A New York City-based team has begun to screen women who are unable to have their own children for the first uterus transplant in the U.S., and the plans are "stirring objections among some transplant experts, fertility specialists and medical ethicists," the Washington Post reports (Stein, Washington Post, 1/15). According to the AP/San Francisco Chronicle, Giuseppe Del Priore of New York Downtown Hospital and colleagues might perform the transplant using organs from deceased donors and would wait three months after the surgery to ensure the uterus is functioning in the recipient and is stabilized with antirejection drugs. The team would then perform in vitro fertilization using the patient's previously frozen embryos to attempt pregnancy, according to the AP/Chronicle. If pregnancy is achieved, the fetus would be delivered through a caesarean section to reduce risks to the woman and fetus. Doctors would remove the transplanted uterus after the birth -- or after two years if pregnancy attempts are not successful -- to minimize the woman's risks from antirejection drugs (Marchione, AP/San Francisco Chronicle, 1/15). A similar procedure was performed in Saudi Arabia in 2000 and reported in 2002 (Washington Post, 1/15). In the March 2002 issue of the International Journal of Gynecology & Obstetrics, doctors from the King Fahad Hospital and Research Center in Jeddah, Saudi Arabia, described the April 2000 operation in which the healthy uterus of a 46-year-old woman with ovarian cysts was transplanted into a 26-year-old woman who had undergone a hysterectomy because of uncontrolled bleeding after the birth of her first child. The recipient's body first rejected the organ, but 10 days of intensive immunosuppressive drug therapy "eliminated that reaction." Although the transplanted uterus was ultimately removed from the recipient, some doctors said that the operation should "not be considered a failure," noting that the transplant lasted an "encouraging" 99 days (Kaiser Daily Women's Health Policy Report, 3/7/02). According to the AP/Chronicle, uterine transplants have been successful in mice, rats, rabbits and pigs, although births have resulted only in rodents (AP/San Francisco Chronicle, 1/15).

Approved Plan, Reaction
The ethics board of New York Downtown Hospital has approved the plans for the procedure but will reconsider the approval after a patient is chosen from among 40 to 50 women being screened to undergo the procedure (Washington Post, 1/15). Bruce Logan, president of the hospital, said, "Every step in this long research process must be handled in a measured, prudent manner. Our first concern is always the safety of our patients." The procedure could cost more than $500,000, with the cost being divided among New York Downtown Hospital, organizations that support infertility research, the patient and insurers, Del Priore said (AP/San Francisco Chronicle, 1/15). "The desire to have a child is a tremendous driving force for many women," Del Priore said, adding, "We think we could help many women fulfill this very basic desire." Some experts have said the procedure has not gone through sufficient tests on animals and have questioned whether the benefit of a potential pregnancy is greater than the risks for the woman and her fetus. In addition, some experts have questioned whether it is ethical to subject women to the risks involved in the procedure "for a condition that is not life threatening," the Post reports. Lori Andrews, a bioethicist at Chicago-Kent College of Law, said, "This is not like a kidney transplant -- it's not medically necessary to the woman's life. Without it, the woman can live a healthy life. She still has options. She can adopt. She can even still have her own biologic child with a surrogate." According to the Post, some ethicists have said that the "emotional value" of a uterus might make many people uncomfortable with transplanting the organ (Washington Post, 1/15). The New York Organ Donor Network in a recent six-month trial to determine the willingness to donate organs found that nine out of 150 families agreed to donate a relative's uterus, eight of which were removed. Some experts also have questioned whether a woman should have to consent to have her uterus donated after her death (AP/San Francisco Chronicle, 1/15).

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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