Uterus graft: A high risk ethical and medical technique

28/10/2022

In the context of an as yet experimental protocol, a second uterus graft has just been accomplished in France at the Foch hospital in Suresnes. The patient was affected by the Rokitansky syndrome (MRKH), in other words, she was born without a uterus, which makes pregnancy impossible. It is a highly technical graft procedure, which involved three teams of surgeons for 18 hours.

“Grafting a uterus is a delicate operation due to the particularly deep anatomical position of the organ, which makes it difficult to access. Moreover, the blood vessels to be manipulated are extremely fine”, according to the surgeon during an interview. He additionally stated that it is preferable to have a living relative donor (pregnancy with a uterus obtained from a deceased donor is less likely to succeed) and immunological compatibility tests are of course performed. The graft received by the young patient was from her sister. The process for her and her partner will necessarily involve medically assisted procreation. Embryos have been conceived in vitro and frozen in anticipation of this delicate operation. The first attempts at implantation will take place in a few months’ time. In the event of pregnancy, very strict medical monitoring will be required, due to the high risks involved with this type of pregnancy for both the mother and the child.

The first such graft performed in France in 2019 was conducted on a woman affected by the same syndrome. She received a uterus transplanted from her mother. The young woman gave birth to a child in February 2021 and is currently expecting her second. Around 80 grafts of this type have already been performed worldwide. The first was performed some ten years ago, the first child born after this very special operation arrived in 2014 in Sweden.

A study conducted over the last five years, in three hospitals in Texas, Ohio and Pennsylvania, was published in Jama Surgery in September. Out of 33 patients transplanted, one in four had to have the graft removed urgently as it had failed. The others still had the graft after one year. Eventually, 19 of them were able to give birth to at least one child. In this study, the children are reported to be in good health. According to the doctor in charge of the study, the rate of miscarriage does not appear to be higher. But the risk of pre-eclampsia (high blood pressure which may endanger the life of the mother and the child) is greater, in particular due to the immunosuppressive treatments necessary to avoid rejection of the graft or the risk of renal anomalies associated with the MRKH syndrome. The pregnancies are very closely monitored. Concerning childbirth, it has to be by caesarian section and most often before term, in particular due to the risk of pre-eclampsia. The grafted uterus is planned to be removed at the same time as the caesarian section, or at a later date, if the caesarian section goes well, that the patient is in good health and is hoping for another child.

Uterus grafts may concern women born without a uterus, those having undergone a hysterectomy due to cancer or a haemorrhage during delivery, for example.

These grafts are a subject of controversy from an ethical and medical standpoint due to the complications mentioned. The risk may be vital whereas the graft itself is not.

In India, a surgeon is considering this type of experiment on men. Risky experimentations, beyond the bounds of ethics, without any ethical frame nor precautionary approach: this should alert the international scientific and medical community.

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