The first-ever transplants of dead donor uteruses will be performed at the renowned Cleveland Clinic and will offer hope of pregnancy to women who suffer from uterine factor infertility. Women between the ages of 21 and 39, who were born without a uterus, had a hysterectomy or have a uterus that no longer functions will be candidates.
One year ago, the world’s first successful birth following a live donor transplant procedure occurred in Sweden. On Thursday, Cleveland Clinic announced a research study on first-ever uterus transplants from deceased donors to 10 women. The New York Times noted the first operation will take place within the next three months.
— The New York Times (@nytimes) November 13, 2015
The surgery will be based on techniques used by a team of surgeons at Sweden’s University of Gothenburg where nine uterus transplants were performed resulting in five pregnancies and four live births. Two of the nine women had to have the uteruses removed, one due to blood clots and other due to a chronic infection. Surgical methods in Sweden involved live donors who were close relatives, including a mother-to-daughter transplant, noted the Guardian.
The Clevland doctors will use deceased donors to minimize risk. According to director of organ transplant surgery, Dr. Andreas G. Tzakis, the complications for a live donor are greater than with a hysterectomy, because surgeons also have to remove part of the donor’s vagina and attached tissue, which will be placed in the recipient. Blood vessels have to be separated without harming the donor.
“You have to work near vital organs. The uterine vessels are wound around the ureters, which carry urine from the kidneys to the bladder. They’re like worms wrapped around a tube. It’s very tedious to separate them. With deceased donors, there is no need to worry about injuries.”
According to a Cleveland Clinic News Wire release, patients will undergo a multi-step procedure which involves the stimulation of ovaries to produce multiple eggs. The eggs are then fertilized with a partner’s sperm and frozen. This is the normal in vitro fertilization process. The next step is searching for a donor whose next of kin signs a consent for donation. A donor uterus is implanted into the recipient, and it takes over 12 months for the uterus to heal. (Because the fallopian tubes are not connected to the transplanted uterus, a natural pregnancy is not possible.) After this, the frozen embryos are implanted into the patient one at at time, until she becomes pregnant. During the pregnancy, the woman takes anti-rejection drugs and is monitored by a high-risk obstetrical team. A cervical biopsy is performed monthly to check for organ donation. If all goes well, the woman will deliver a baby via cesarean, which prevents straining of the donor uterus.
Cleveland hospital first in US to offer uterus transplant for infertility https://t.co/yrdwyfju8g
— The Straits Times (@STcom) November 13, 2015
Unlike other transplant surgeries, the first-ever uterus transplants are ephemeral (temporary), which means after one or two babies, the woman will have a hysterectomy to remove the transplanted uterus. This is done to reduce long-term use of transplant medicines for a surgery that is optional. Another option is stopping the medicine and allowing the uterus to disintegrate.
Per The New York Times, Tzakis added that thousands of women with other transplanted organs, such as livers and kidneys, continue taking anti-rejection medicines through the pregnancy. They have a higher incidence of high blood pressure, and their babies are often smaller. However, it is unclear whether this is due to the drugs or underlying illness.
Prospective participants in the Cleveland study will be screened. Part of the criteria is having ovaries and being in a stable relationship. Interviews are conducted to determine if the women are being pressured to take part in the uterus transplant study. A psychological evaluation is also administered.
As in other studies, the first-ever uterus transplant patients will also be screened to determine whether they have social support, because those with strong support systems have better outcomes. Although participants don’t have to pay for the experimental procedure, financial resources factor in because they have to pay for food and housing while in Cleveland.
[Photo by Ian Waldie/Getty]