 A Swedish research team practises before an operation to transplant a womb from a living donor
A woman in Brazil has successfully given birth after receiving a womb from a dead donor, the first time such a procedure has been successful.
While researchers in countries including Sweden and the US have previously succeeded in transplanting wombs from living donors into women who have gone on to give birth, experts said the latest development was a significant advance.
“With a deceased donor, you reduce the risk because you don’t have the risk to the donor – and you reduce the costs, too, because you don’t have the hospitalisation and the very long surgery of the donor,” said Dr Dani Ejzenberg of the University of São Paulo, who led the research.
Ejzenberg said that finding a living donor could also be difficult, while coordinating operations was logistically challenging.
It is not the first time a womb transplant from a dead donor has been tried, but none had resulted in a live birth until now. The team said the baby girl was healthy and developing normally.
Writing in the Lancet, Ejzenberg and colleagues report how they removed a womb from a 45-year-old woman who had died from a burst blood vessel in the brain and who had previously given birth three times. The recipient was a 32-year-old woman with a condition that meant she was born without a womb, although she had ovaries – meaning that eggs could be collected and used in IVF.
The team carefully dissected the uterus from the donor before carrying out the 10-and-a-half-hour operation in September 2016 to insert the organ, which weighed 225g. They attached a stump of the donor’s vagina to that of the recipient, as well as connecting blood vessels and ligaments.
The woman was given immunosuppressants to prevent rejection of the womb, while the team took biopsies of the cervix at regular intervals to check for signs of rejection.
Just over a month after the transplant, the woman’s periods started, and seven months after the operation the team transferred an embryo from the IVF treatment into her womb – several months earlier than was attempted in previous cases with living donors. The pregnancy went smoothly and a baby girl was delivered by caesarean section at just over 35 weeks.
Once the baby was delivered, the team removed the womb in the same operation. Ejzenberg said that was done because it would have been expensive to keep the woman on immunosuppressive drugs and the team hoped to use scarce funds to allow other women to undergo the procedure.
The team said the procedure could bring hope of fertility to women with a number of conditions, including those who have had a hysterectomy for medical reasons. “You have a substantial number of patients that can benefit from this technique [of womb transplant],” said Ejzenberg.
The team said the success meant that women for whom surrogacy or adoption was previously the only option for starting a family might soon have another path they could choose.
However, in an accompanying editorial, experts from the fertility company IVI-RMA Global noted the process would need to be refined and more research done before it could be more widely used.
Stuart Lavery, a consultant gynaecologist at Hammersmith hospital who was not involved in the latest study, said the birth was “quite a significant step”, noting that using wombs from deceased donors improves safety. Lavery said that, at least theoretically, the procedure could be used to allow trans women to carry a baby.
In 2015, an initial approval was granted in the UK for a clinical trial of womb transplants. The team, led by Richard Smith, a surgeon with the charity Womb Transplant UK, have already laid the groundwork, including carrying out animal studies, and are now looking to perform transplants involving both living and deceased donors. source: https://www.theguardian.com/society/2018/dec/04/woman-gives-birthusing-womb-transplanted-from-dead-donor |
