The first baby is born after a controversial transplant of the uterus of a corpse | Science



A 32-year-old woman has become the first in the world to give birth to a healthy baby after receiving a transplanted uterus from a cadaver. The recipient had intact ovaries and produced eggs, but was born without a uterus because of a congenital disease that affects one in every 4,500 women.

During an operation of more than 10 hours, doctors transplanted the uterus of a 45-year-old woman who had died of a stroke. The procedure requires a complicated surgery and high doses of immunosuppressive drugs to avoid rejection. Seven months after the graft, the doctors implanted the patient with one of her previously fertilized ova. After a normal gestation he had a healthy girl. After the cesarean birth, the doctors removed the transplanted uterus so that he would not have to continue with the intense immunosuppressive medication. The details of the operation, carried out in 2016, they are published today in the medical journal The Lancet.

These transplants are complex from the technical point of view, unsuccessful and pose ethical dilemmas. In total, 39 transplants have been attempted among living people, of which only 11 have achieved healthy babies. In most cases, the donors are mothers, sisters or close friends of the recipients, with which the availability of organs is very limited.

The National Transplant Organization advised against applying this technique in Spain because it offers more risks than benefits

So far, 10 transplants with deceased donors had been tried, all without success. The medical team of the Hospital das Clínicas de Sao Paulo, linked to the university of that city, considers that this achievement will facilitate "the widespread adoption" of this type of transplants. Those responsible for the work point out that this intervention could not only help infertile women with congenital ailments, but also those who have had the organ removed after infections or oncological treatments. For all these people, the only options available were adoption or access to surrogate mothers, until in 2013 the gynecologist team Mats Brännström announced the birth of the first baby by uterus transplant between live, they stand out. However, they caution that the use of cadaveric organs is a technique that is "very recent and considered experimental in many countries."

"This is a technical achievement that is very questionable from an ethical point of view," he explains. Beatriz Domínguez-Gil, director of the National Transplant Organization (ONT). In 2016, the ethical committee of this organization analyzed this type of procedures and dismissed them, because they pose more risks for the mother and the embryo than benefits, explains the person responsible for the ONT. "The risks assumed by the mother and the impact on the fetus do not compensate the final goal of conceiving a baby and there are also viable alternatives, such as adoption," he explains. "In the case of women who are born without a uterus, this intervention gives priority to the right of women to motherhood, but in our opinion it is more important to respect the principle of nonmaleficence [no hacer daño] and also to make an adequate use of public resources, "he emphasizes. The transplants performed by the Swedish team had a cost of about 65,000 euros, although the cost of each intervention varies greatly depending on the country in which they are performed. In Spain this type of operation requires the approval of the hospital, the Autonomous Community and the ONT.

This technique probably extends, it could even become a routine "

"This technique probably extends, it could even become a routine," says Cester Díaz, gynecologist of the Valencian Institute of Infertility, a private entity. Diaz collaborated with the Swedish team that got the first transplant. The doctor now works in London and says he has permission to perform two transplants between donors and living recipients in a trial coordinated by the University of Oxford. One of the two recipients is a woman who had to have her uterus removed after a birth, a problem that affects about four mothers in 100,000. Other complications are much more common. For example, one in 100 women suffers from the removal of the uterus from benign tumors in the wall of this organ.

Diaz believes that these procedures are completely in line with medical ethics and that "the number of patients who could benefit from a transplant is great." "In all cases you have to make an analysis of risks and benefits, but you have to take into account that the person who is at risk is the same person who has the greatest benefit from the intervention. Infertility is one of the most disabling diseases and in this we should also look for a principle of equity, infertile people also pay taxes, denying them the transplant would be like not giving palliative treatment to a patient that you know is going to die of cancer " , he thinks.

Brännström explained in 2015 to ABC that he was receiving requests "from people who have changed sex and want to be mothers ". It is a technically viable intervention according to experts that poses even more complex ethical dilemmas.

Only for women in good physical condition

In 2013, a 61-year-old woman decided to have her uterus removed to implant it to one of her best friends, a 35-year-old Swedish woman who was born without this organ because of a congenital disease. Although the donor had reached menopause seven years earlier, her uterus allowed the birth of the first baby by this technique. Since then the Swedish transplant program has also been applied to women who lost their uterus after cancer and has achieved eight births. Being able to use organs from deceased people increases the availability of organs in countries with national transplant systems and eliminates complications that can suffer from living donors, argue Brazilian doctors. This type of transplants requires that the recipients be healthy and in good physical condition to withstand the possible complications, such as moderate bleeding, and to withstand the high doses of immunosuppressive drugs.

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