Uterine transplant

A uterine transplant is the transplantation of a uterus in order to replace one which has undergone necrosis. Though the procedure has significant potential, it has been performed only a few times.

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History

In 1896 Knauer published the first study of ovarian transplantation and Grigor’ve that lead to the investigation of uterine auto-transplantation in 1918. Erslan, Hamernik and Hardy, in 1964 and 1966, were the first to perform an animal auto-transplantation of the uterus and subsequently deliver a pregnancy for that uterus (Erslan et al. 1966). With the availability of IVF in 1978, investigation of uterine transplantation was deferred (Confino et al. 1986). In 2000, a human uterine transplant was performed in Saudi Arabia by Dr. Wafa Fagee. Post-operatively, the patient had two spontaneous menstrual cycles, followed by amenorrhea; exploratory laparotomy confirmed uterine necrosis. The procedure has raised some moral and ethical concerns.

Research

Much of the animal research that has been investigated in the past have explored the feasibility of uterine auto transplantation and have neglected the role of uterine allo-transplantation as well as the influence of immunosuppressive therapy on fertility. Infertility and surrogacy, which also has been considered another alternative for infertility, have been subjected to legal, moral, ethical and religious restrains. This has then led for us as physicians to investigate cautiously the indications for human uterine transplants. The prime candidates for human uterine transplants are:

1. those with a congenital absence the uterus (e.g. Mayer Rokitansky Kuster Hauser Syndrome),
2. those who have lost their uterus secondary to an obstetrical complication (e.g. post-partum hemorrhage), and
3. those who have lost their uterus for benign causes (e.g. pelvic inflammatory disease, fibroid uterus, pelvic tuberculosis) or early invasive cervical or ovarian malignancies at an early age.

Ethical and religious issues

Due to the uterus' debatable status as a non-vital organ, debate over the ethicality of uterine transplants persists. Some groups consider the uterus a vital organ due to its ability to sustain the life of the fetus, and concerns exist that the successful transplantation of a uterus might give rise to birth defects should the recipient ever attempt to bear children. There is also religious debate surrounding the morality of uterine transplants, with a myriad of views which vary based on religion and personal preference.

Successful transplants

In Saudi Arabia in 2000, a uterine transplant was performed on a patient whose own uterus had hemorrhaged after childbirth. The transplanted uterus functioned for 99 days, however it ultimately needed to be removed after its failure due to blood clotting. Within the medical community there is some debate as to whether or not the transplant can truly be considered successful, however due to the operation's duration, general consensus favors success.