Uterus transplant planned in U.S.

First came kidney, liver and heart transplants. Then a few doctors started transplanting hands. French surgeons even did a face.

Now, doctors are planning the first womb transplant in the United States.

A team based in Manhattan has begun screening women left barren by cancer, injuries or other problems who want a chance to bear their own children.

“The desire to have a child is a tremendous driving force for many women,” said Giuseppe Del Priore, who is based at the New York Downtown Hospital and is leading the team. “We think we could help many women fulfill this very basic desire.”

But the planned operation, which Del Priore and his colleagues could attempt later this year, is stirring objections among some transplant experts, fertility specialists and medical ethicists. They question whether the procedure has been tested enough on animals and whether the benefit of being able to carry a pregnancy outweighs the risks for the woman and fetus.

“This raises a set of very difficult medical and ethical questions,” said Thomas Murray, who heads the Hastings Center, a biomedical ethics think tank in Garrison, N.Y. “I think it’s very questionable. This would be very hard to justify.”

The operation marks a confluence of two medical specialties – transplant surgery and reproductive medicine – that frequently spark controversy.

“It is the convergence of two fields that are already embedded in large ethical disputes,” said Lori Andrews, a bioethicist at the Chicago-Kent School of Law. “This represents the worst of both worlds.”

Several experts said the plans highlight the unique status childbearing holds in the United States and elsewhere, and the lengths to which some women will go to experience it, even with the availability of options such as adoption and surrogacy.

“I’m not convinced that science and medicine and society as a whole should be putting so much emphasis on having this particular nine-month experience,” said Adrienne Asch, who studies family life at Yeshiva University. “Why is that the sine qua non of being a parent? The real work of parenting is in the time after a child is born and is in someone’s home.”

But Del Priore and others defend the effort, saying the procedure will be attempted only after careful vetting by independent experts.

They note that thousands of women cannot bear children because they were born with a malfunctioning uterus or their wombs were damaged by cancer, accidents, pregnancy complications or other problems. Women who want the operation are being exhaustively screened to make sure they fully appreciate the risks and have seriously considered alternatives.

“I don’t think it’s really a doctor’s role to tell a patient that their values are not important. It’s up to us as doctors to advise our patients and safely escort them to the best life that they can have,” said Del Priore. Many women who lack a functioning womb suffer terribly, he said.

“It can be just heartbreaking,” said Del Priore, a gynecological oncologist. He described a pregnant woman who started hemorrhaging after a car accident. “She was a newlywed, about to deliver a baby. Suddenly her husband is dead, her baby is dead and her uterus is gone. It’s terrible suffering. I think she deserves every possibility.”

Some ethicists and other experts, while expressing reservations, agreed, as long as doctors are reasonably confident of success and prospective patients fully appreciate the risks.

“I think patients deserve autonomy,” said Alan DeCherney, a fertility expert speaking on behalf of the American Society of Reproductive Medicine. “As long as they know all the facts, it should be their choice.”

After practicing on baboons and goats, doctors on Saudi Arabia reported in 2002 that they had performed the first human uterus transplant on a 26-year-old woman whose womb had been removed six years earlier because of hemorrhaging after the birth of her first child. The donor was a 46-year-old woman with an ovarian condition that required removal of her ovaries and uterus. Although blood clots forced surgeons to remove the organ after 99 days, doctors called the procedure a technical success.

Del Priore and his colleagues repeated the transplant in rats, pigs, rabbits and a rhesus monkey, in which they plan to try a pregnancy. They also showed that human wombs could be removed from deceased organ donors in the United States. The problem that occurred with the Saudi Arabian patient can be avoided, Del Priore’s team believes, by transplanting larger arteries with the uterus.

“I think we’re ready,” Del Priore said. “There is always more you could do. But knowing what my colleagues in the field have done and what we have done, we think it’s absolutely doable.”

After performing the complex surgery, doctors would wait, probably about three months, to make sure the organ is functioning and has been stabilized with anti-rejection drugs.

“We’d want to make sure it was ready to provide a safe environment for the child,” said Jeanetta Stega, who is working with Del Priore.

An embryo created through in-vitro fertilization would then be placed in the womb. If all goes well, the baby would be delivered by Caesarean section to minimize any risks from labor and allow doctors to simultaneously remove the uterus, so the woman could discontinue the anti-rejection drugs.

“We are calling it a temporary transplant,” Del Priore said. “This minimizes the time patients have to be on the medications, and makes it a much more reasonable risk to take to have a baby.”