A 32-year-old woman was the first in the world to give birth to a healthy baby after receiving a transplanted uterus from a cadaver. The recipient was intact and overexpressed, but born without an uterus because of a clinical disorder that affects one in every 4500 women.
During an operation of more than 10 hours, the doctors transplanted the uterus from a 45-year-old woman who died from a swing. 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 has a healthy girl. After the cesarean birth, the doctors removed the transplanted uterus so that he would not have to continue with the deep immunosuppressive medication. The details of the operation, conducted in 2016, are published today in the medical journal The Lancet.
The transplants are complex from the technical point of view, unsuccessful and pose ethical dilemmas. In total, 39 transplants have been tried among living people, of which only 11 have brought healthy babies. In most cases, the donners are mothers, sisters or close friends of the recipients, with the availability of organs being 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 enhanced donors are trying, all without success. The clinic's medical team at Clinic de São Paulo, with the university of the city, believes that the achievement will facilitate the "widespread audience" of the type of transplants. The responsible for the work point out that this intervention can not only help infertile women with congenital ailments, but also those who have had the organ removed after infections or oncological treatments. For all the people, the only options available are the adaptation or access to ceramic mothers, until 2013 the gynecologist team Matt Branshorst announced the birth of the first baby by transplanting uterus between living, emphasizing them. However, they warn that the use of cadaveric organs is a technique that is "very recent and considered experimental in many countries."
"This is a technical achievement, which is very fragile of the ethical point of view," explains Beatriz Domínguez-Gil, director of the National Transplant Organization (ONT). In 2016, the ethical commission of the organization has analyzed this type of procedure and dismissed them, because they are more likely to be responsible for the mother and the embryo as benefits, declaring the person responsible for the party. "The risk that the mother and the test on the fetus feel, do not compare the ultimate goal of conceiving a baby and there are also viable alternatives, such as adaptation," he explains. "In the case of women who are born without an uterus, this intervention gives priority to women's right to motherhood, but in our opinion it is more important to respect the principle of non-monspiration [no hacer daño] And also to make adequate use of public resources, "he emphasized.The transplants performed by the Swedish team had a price of about € 65,000, although the cost of each intervention was very important to the country in which they were done. Spain This type of operation requires the approval of the hospital, the Autonomous Community and the party.
This technique probably extends, it can even be a routine "
"This technique probably extends, it can even be a routine," says César Díaz, a gynecologist at the Valencian Infertility Institute, a private entity. Diaz together with the Swedish team who got the first transplant. The doctor now works in London and says he has the permission to perform two transplants between donors and living recipients in a process co-ordinated by the University of Oxford. One of the two recipients is a woman who has to have her underground after birth, a problem that affects about 4 mothers in 100,000. Other complications are much more common. For example, one in 100 women suffers from the removal of the uterus from the greatest tumors in the wall of the organ.
Diaz believes that the procedures are completely in line with medical ethics and that "the number of patients who can benefit from a transplant is great." "In all cases you have to make an analysis of the risks and benefits, but you need to take into account that the person who is at risk is the same person who has the greatest benefit of the intervention.Infability is one of the most disabling diseases And in this we should also look for a principle of equity, infertile people also pay taxes, dying them the transplant would be like not giving palytic treatment to a patient that you know is going to die from cancer, "he thinks.
Brensström explains in 2015 to ABC that she was receiving requests "of people who have changed sex and want to be mothers." It is a technically viable intervention according to experts that presents even more complicated ethical dilemmas.
In 2013, a 61-year-old woman decided to have her uterine removed to implant it to one of her best friends, a 35-year-old Swedish woman who was born without the organ because of a specific disease. Although the donor has reached menopause seven years earlier, her uterus leave the birth of the first baby by this technique. Since the Swedish transplant program has also applied to women who have lost their uterus after cancer and has achieved eight births. They can use organs of deceased people to increase the availability of organs in countries with national transplant systems and eliminate complications that can suffer from living donners, Maintain 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.