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Uterus transplantation
Published in David K. Gardner, Ariel Weissman, Colin M. Howles, Zeev Shoham, Textbook of Assisted Reproductive Techniques, 2017
Liza Johannesson, Pernilla Dahm-Kähler, Lars Nilsson, Michael Olausson, Mats Brännström
In summary, uterus transplantation was a breakthrough in the field of reproductive medicine and has so far had a remarkably successful outcome. Bearing this in mind, this procedure is still only a proof of concept for uterus transplantation as a treatment for uterine factor infertility in a live related donor setting by laparotomic technique. The model will surely be expanded and demonstrated in other settings in the near future. New methods to evaluate the recipients, donors, and organs, like angiographic mapping of vessels preor even peri-operatively, will possibly simplify the procedure and improve the outcome. Other surgical options and modifications like laparoscopic and robotic-assisted methods, providing the possibility to reduce the surgical duration and concurrent risks for both recipients and live donors, are expected to improve upon the results of the initial trials. Only five years ago, prior to the clinical introduction of uterus transplantation, it was disputed whether it was ethically and morally defensible to perform such a transplantation. Now that it is proven to be successful, the medical society instead faces the issue of whether it will be justifiable not to develop the uterus transplantation procedure further.
Uterine transplantation
Published in Climacteric, 2019
Clearly, this procedure has many medical, ethical, and social issues that require discussion. The Japan Society for Uterus Transplantation, created in 2014, suggests researchers proceed with caution and stated that ‘the safety and efficacy remain unclear, despite several clinical applications’30. The American Society for Reproductive Medicine (ASRM) recognizes uterus transplantation as the first successful medical treatment of absolute uterine factor infertility, while cautioning health professionals, patient advocacy groups, and the public about its highly experimental nature. ASRM position statements on uterine transplantation remind us that ‘As with all our patients seeking to build their families, it is important to understand the full array of options available to them, including adoption, gestational carriers, and child-free living’31,32.
Living Donation, Listing, and Prioritization in Uterus Transplantation
Published in The American Journal of Bioethics, 2018
Not only does donor hysterectomy have an acceptable risk profile and offer potentially substantial psychological benefit to donors, but it also has at least three distinct advantages over deceased donor hysterectomy. First, living donors can provide a comprehensive medical and social history and they undergo a more thorough preoperative workup, which includes infectious disease testing, ultrasound and magnetic resonance imaging (MRI), and hysteroscopy when indicated (Lavoué et al. 2017). Of particular importance is MRI, which can identify intrinsic uterine pathology, such as adenomyosis, that would decrease the chance of successful recipient pregnancy. These donors can be ruled out up front, which increases the overall potential for successful embryo implantation and pregnancy in recipients. Furthermore, the extensive workup of living donors decreases the likelihood of an unexpected finding that would cause one to abort the recipient operation or put the recipient at higher risk of graft failure or infectious disease. Second, living donor uterus transplantation is an elective procedure, allowing the recipient to undergo transplantation when she is physically and emotionally ready. Finally, the donor and recipient cases can be timed in such a way as to minimize the time between the donor hysterectomy and implantation. Because of the preceding reasons, living donor uterus transplantation can be justified in its own right without a reliance on the scarcity of deceased donor uteri, and it should remain an option even if deceased donor uterus transplantation proves to be a viable alternative.
Uterus Transplantation: The Ethics of Using Deceased Versus Living Donors
Published in The American Journal of Bioethics, 2018
Bethany Bruno, Kavita Shah Arora
Absolute uterine factor infertility (AUFI) affects 1 in 500 women of reproductive age, or approximately 85,000 women in the United States (Johannesson et al. 2014) and 1.5 million women worldwide (Flyckt et al. 2017). These women either lack a uterus for congenital (e.g., Mayer-Rokitansky-Kuster-Hauser [MRKH] syndrome) or iatrogenic (e.g., hysterectomy for cervical cancer, leiomyoma, uncontrolled postpartum bleeding) reasons, or possess a uterus that is nonfunctional due to some anatomical or physiological defect (e.g., intrauterine adhesions, severe adenomyosis, congenital uterine malformation). At present, three options exist for women with AUFI to attain parenthood: (1) adoption, (2) gestational surrogacy, and (3) uterus transplantation. Of these, uterus transplantation is the only option that provides an opportunity for both genetic and gestational motherhood. Unfortunately, access to all three options is limited. Adoption can be a long and difficult administrative procedure, surrogacy is expressly allowed in only 14 American states (Finkelstein et al. 2016) and outright banned in much of Europe and the Middle East (Twine 2015), and uterus transplantation remains in the clinical trial stage.