Monday, January 13, 2014

Womb Transplants in Sweden

A team of surgeons in Sweden have transplanted donated uteruses into 9 women who were born without them, or who had lost them to cervical cancer. The aim is to permit the women to bear their own children. From the story:
"The transplant operations did not connect the women's uteruses to their fallopian tubes, so they are unable to get pregnant naturally. But all who received a womb have their own ovaries and can make eggs. Before the operation, they had some removed to create embryos through in-vitro fertilization. The embryos were then frozen and doctors plan to transfer them into the new wombs, allowing the women to carry their own biological children."
There are several ethics issues here, clearly. First, there's the danger to the donors of the uteruses. Doctors said they preferred live uterus donors to dead donors because they could be certain, with live donors, that the uteruses were functioning properly and didn't have any problems like HPV infection. But the uterine donation is a major surgery--more dangerous than a hysterectomy, since it involves removal not only of the uterus but also of surrounding blood-vessel needed to keep the uterus alive in the donee. The procedure thus subjects donors to serious risk for the sake of a donation that isn't lifesaving.

Perhaps more troubling is the question of how the pregnancies will proceed. Will the developing fetuses be affected by the anti-rejection drugs the women are taking? What happens if rejection occurs part-way through a pregnancy? Will the uteruses be strong enough to carry the fetuses to term safely? Will placental formation and blood flow be sufficient to ensure the fetuses are healthy? At what stage and for what reasons will pregnancies be terminated?

If pregnancy is achieved, doctors plan to remove the uteruses to prevent the women's having to take anti-rejection drugs for life. (The drugs can have serious side-effects.) Two earlier attempts at human uterine transplantation (using uteruses from dead donors) failed: one in 2000 in Saudi Arabia, which had to be abandoned when a blod clot formed; and another in Turkey last year, in which the pregnancy failed at 2 months. Uterine transplants have been done in mice, sheep and baboons, but the baboon transplants did not result in pregnancy.

An American team announced its intention to perform a uterine transplant some years ago, raising some ethical issues, but no such procedure has yet been performed in the US.  

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