F or the first time, a woman has given birth after receiving a uterine transplant from a deceased donor, researchers…
F or the first time, a woman has given birth after receiving a uterine transplant from a deceased donor, researchers reported Tuesday. So far, only uterine transplants from living donors have led to successful births.
The whole area of uterine transplant is in its early days. However, researchers said that if transplant groups reliably use uterus from deceased donors, it could increase the availability of organs and reduce the risk of living donors during surgery to remove the uterus.
“This is really an exciting moment,” said Dr. Rebecca Flyckt, a reproductive endocrinologist at the Cleveland Clinic, who was not involved in the research. “There is evidence that a deceased donor is really a good model.”
In the new case report, published in Lancet, researchers at the University of Sao Paulo, Brazil, removed a womb from a 45-year-old woman who died of brain bleeding and had three children. The organ was transplanted into a 32-year-old woman who had a disease that left her without a womb. Seven months after transplant, physicians transferred an embryo made via in vitro fertilization from the woman’s egg and her husband’s sperm in her uterus.
Women’s pregnancy was normal and physicians performed a caesarean section on December 1
5, 2017, after about 36 weeks (a full term is about 40 weeks). When the researchers wrote the paper describing the case – about seven months after birth – both mother and childhood girls were healthy.
“The use of deceased donors could significantly increase access to this treatment,” says Dr. Dani Ejzenberg, who led the research, said in a statement. He added: “The number of people willing and committed to donating organs of their own death is much greater than the offer of living donors and offers a much wider potential donor population.”
Experts hope for uterine transplant will one day be more accessible to women without uterus or with injured organs – or even transgender women – trying to conceive. In Sweden 2014, doctors currently helped a woman with a transplanted uterus were born; Since then there have been a dozen such children born around the world. Last year, doctors at Baylor University Medical Center in Dallas delivered the first American baby to be carried in a transplanted uterus.
In all these cases, uterus came from living women – often a family member or recipient’s friend. However, any donor must undergo radical hysterectomy, a long procedure (it took 10 to 12 hours once and is now four to six hours), which comes with own risks and recovery.
Thus, the hope that the deceased donors could be another source of organ.
Researchers in Turkey performed a uterine transplant 2011 from a deceased donor but have not had any successful pregnancies. Flyckt and her colleagues in Cleveland have also performed two transplantations from deceased donors. In the first case, the uterus must be removed from the recipient after an infection occurred; Flyckt said she could not say where it was in the second case than the recipient did well.
Part of the challenge of transplanting a uterus from a deceased donor is that the process – getting a body that matches a recipient based on blood type and other qualities, and completes surgery – can take time. The uterus can only survive away from blood supply for so long. Transplantations from living donors are scheduled and can take place in adjacent operating rooms.
The researchers in Brazil reported that the uterus was ischemic – which means a blood supply – for almost eight hours, substantially twice the reported time from any of the living donor transplants. It suggested that transplant groups looking for uterus could broaden the geographical area where they are looking for donors.
“This actually says that the uterus is very resistant,” said Flyckt.
Like with other organ recipients, in this case, the immune system was used to reduce the risk of her body rejecting the transplant. Surgeons also performed a hysterectomy – they took out the womb – under the C-section. Retinal transplants are considered “ephemeral”, which means that they only stop to allow the recipient to have children and then taken away.
Researchers who did not participate in the study warned that, bearing in mind all the biological constraints, the pool of potential uterine dementia is actually quite small, even with regard to deceased donors. But they said relying on deceased donors could increase the opportunities for women who do not have a friend or family member willing to donate or that would be a good match. Most transplant groups look a day out with uterus from both living and deceased donors.
“This is a very important birth for the whole uterine transplant community,” says Dr. Liza Johannesson, a uterine transplant surgeon at Baylor who previously worked with the Swedish research team. “It’s a landmark birth.”