05 December 2018

Don't take your organs to the grave

The uterus of a dead woman helped to give birth to a child for the first time

Daria Spasskaya, N+1

Brazilian scientists have described the first case of the birth of a child in a woman who had a uterus transplanted from a dead donor. The story is published in The Lancet (Brännström et al., Livebirth after uterus transplantation).

About ten percent of couples of reproductive age cannot have children due to infertility of one of the partners. In one of 500 such cases, a woman may have a damaged or missing uterus – as a result of a congenital disorder or acquired disease.

Although usually such women are offered to adopt a child, or, in extreme cases, resort to surrogacy, there are several clinical cases of successful uterus transplantation, after which patients managed to give birth to a child on their own. In all cases, women were transplanted a reproductive organ from living donors – relatives or close friends.

In Brazil, at the clinic of the University of Sao Paulo in 2016, doctors performed a uterus transplant operation from a dead donor, which for the first time ended in a successful pregnancy. A 32-year-old woman who did not have a uterus as a result of a rare congenital syndrome had an organ transplanted from a 45-year-old woman who died of a stroke. During her lifetime, the donor was a mother of three children.

During the operation, which lasted more than 10 hours, doctors stitched blood vessels, ligaments and the vaginal canal. After transplantation, the woman was prescribed several immunosuppressants, which she had to take before trying to give birth to a child. The organ took root successfully, and the woman even began regular menstruation. A few months before the operation, the patient's eggs were taken and an in vitro fertilization procedure was performed.

The resulting embryos were frozen, and seven months after the uterus transplantation, the mothers were planted. The first procedure led to pregnancy, and at 36 weeks the patient gave birth to a girl. The baby was removed by Caesarean section, and during the procedure, the "alien" uterus was removed again so that the mother did not have to take drugs that suppress immunity.

The described case expands the possibilities of women who would like to have a baby, but cannot do so due to the absence of a uterus, says Dr. Dani Ejzenberg, the first author of the article.

Although transplants from living donors have resulted in a successful pregnancy several times, it is extremely difficult to find such a donor. At the same time, in many countries, legislation allows people to bequeath their organs for the benefit of medicine after death. In total, the history of uterine transplants includes 39 cases of transplants from living women and 10 cases of transplants from dead donors.

The first transplant was performed in Saudi Arabia in 2000, however, it did not lead to pregnancy. The first case of a patient having a child after such an operation was registered in Sweden in 2013. After that, 10 more successfully completed pregnancies were described in women who had a reproductive organ transplanted from living donors. Seven of them were held in Sweden, two in the USA, and one in Serbia. In the USA, clinical trials of this procedure were launched in 2015, within the framework of which it was planned to recruit ten female volunteers. 

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