The opportunity to conceive, conceive and give birth to a biologically related child is a deep desire of many women and their partners.

Since the introduction of in vitro fertilization in 1978, millions of people in countries such as Australia have had access to support and resources to help them achieve their reproductive goals.

For some women, a non-functioning uterus makes that opportunity inaccessible. Includes those who had a hysterectomy for medical reasons.

For these women, the only options for parenthood are surrogacy or adoption. Access to both is often difficult.

A uterine transplant is changing that. A uterus transplant is being trialed in Australia next year.

However, there are risks and ethical concerns that must be addressed before it becomes a mainstream clinical treatment.

How does the process work?

Uterine transplantation is a series of medical procedures in which a donated uterus is surgically removed from a suitable donor and transplanted into a qualified recipient.

Hormones are used to stimulate menstruation in the recipient, and when the uterus is functioning normally, the embryo created by in vitro fertilization is implanted into the woman’s uterus.

After successful implantation and healthy development, the baby is delivered by caesarean section.

This is because uterine transfer pregnancies are considered high-risk, and contractions may not be felt. Women who do not have a congenital uterus cannot have a vaginal delivery.

As with all transplants, uterine recipients are prescribed immunosuppressants to prevent rejection of the donor organ. These drugs are administered at levels considered safe for the developing fetus.

Close monitoring is continued during pregnancy to ensure the safety of both the woman and the fetus.

Immunosuppression continues until the birth of up to 2 healthy babies or up to 5 years after transplantation, whichever comes first.

A hysterectomy can then surgically remove the uterus to stop immunosuppression with its risks and side effects.

Immunosuppressive risks include infections, low blood counts, heart disease, and suppression of bone marrow growth. And these risks increase over time.

A uterine transplant is an “ephemeral” transplant: a temporary, non-life-saving transplant intended only to enable reproduction. These features medically and ethically distinguish it from other transplants.

When did uterus transplantation start?

Scientists began developing uterine implants in animals in the 1970s. First attempts in humans were made in his 2000 (Saudi Arabia) and his 2011 (Turkey), both of which were unsuccessful.

After 14 years of research, Professor Matt Brannstrom and his team at Salgrenska University Hospital in Sweden started the world’s first human trial in 2013. In 2014, our first healthy baby was born.

It is estimated that at least 80 procedures have been performed in more than 25 countries where uterine transplants are currently performed or planned, resulting in more than 40 healthy live births.

Although not all transplants are successful, it is estimated that more than 80% of births are from uteruses that function normally after transplantation.

Two trials have been approved in Australia and are expected to begin in the next 12-18 months.

who donates?

Most uterine transplants to date have used altruistic living donors, usually mothers donating to their daughters or aunts donating to their nieces.

However, there have also been successful cases using uterus from deceased donors, with at least four healthy births reported.

Uteri from deceased donors are most often donated through standard family consent methods for medical research. In the future, however, it may be provided through an organ donor registration process modified to include the uterus.

Currently, only premenopausal women can become uterine donors, and living donors must have a successful pregnancy to be eligible to donate. However, this may not be a requirement for deceased donors. Potentially allows younger donors and increases the availability of the uterus for transplantation.

Of the two trials approved in Australia, only one (led by the Royal Hospital for Women, with independent ethical advice provided by It offers). The other (through the Royal Prince Alfred Hospital) will attempt live-donor-only transplants.

Participation in these uterine transplant trials remains restricted while uterine transplantation is still in the research phase and depends on the availability of funding.

What are the risks of lifetime gifts?

The main surgical risks for recipients are organ rejection, infection, thrombosis or thrombosis, as well as risks arising from thrombosis (including pulmonary) and immunosuppression due to the duration of surgery (average 5 hours).

Although difficult, these risks are minimized through close monitoring and early intervention with blood thinners, and by encouraging recipients to move soon after surgery.

For living donors, there are surgical times (6-11 hours) and physical risks due to surgical and postoperative complications. The most common are injuries and infections of the urinary tract.

There are also ethical and psychological risks. These include the possibility that potential donors feel pressured to donate to their families, and the possibility that they may experience guilt or failure if the transplant is unsuccessful or has adverse consequences. included.

These risks may be mitigated with proper counseling and support. However, as with all altruistic organ donations, they cannot be completely eliminated.

What about deceased donations?

Transplantation of dead donors is also risky, but the surgery takes less time (usually 1-2 hours) than transplantation of living donors, placing less demand on medical and personnel resources.

Transplantation of dead donors may be less ethically problematic. There is no prospect of pressure, guilt, or surgical risk for deceased donors who have been declared brain dead and are eligible for multiple organ donation. Their organs can only be procured with proper consent following normal protocols and procedures.

In Australia, like everywhere else, there is a shortage of organ donors. However, deceased donors may be found through existing donation registries and consent processes, such as those administered by DonateLife and NSW Organ and Tissue Donation Services.

Why investigate both types of donations?

It is important to be able to compare the results of living and deceased donations with similar recipients and situations. This will inform future guidelines and policies regarding uterine donation and determine whether it will become mainstream clinical practice.

Emerging evidence suggests that deceased donation may result in better outcomes for the recipient. may improve and increase the chances of successful transplants and pregnancies.

So, although there are currently few cases of dead donors, there are medical and ethical justifications for Australian uterine transplant studies involving both dead and living donors.

Mianna Lotz, Associate Professor of Philosophy, Macquarie University, Chair of Human Research Ethics Committee, Faculty of Letters

This article is republished from The Conversation under a Creative Commons license. Please read the original article.