Deceased donor uterine transplantation

Abstract Introduction In 2014, Brännström and colleagues reported the first human live birth following uterine transplantation (UTx). Research into this treatment for absolute uterine factor infertility has since grown with clinical trials currently taking place across centers in at least thirteen countries worldwide. Sources of data This review summarizes and critiques the academic literature on ethical and policy issues raised by UTx. Areas of agreement There is general agreement on the importance of risk reduction and, in principle, to the sharing and maintenance of patient data on an international registry. Areas of controversy There are numerous areas of controversy ranging from whether it is ethically justified to carry out uterus transplants at all (considering the associated health risks) to how deceased donor organs for transplant should be allocated. This review focuses on three key issues: the choice between deceased and living donors, ensuring valid consent to the procedure and access to treatment. Growing points UTx is presently a novel and rare procedure but is likely to become more commonplace in the foreseeable future, given the large number of surgical teams working on it worldwide. Areas timely for developing research Uterus transplantation requires us to re-examine fundamental questions about the ethical and social value of gestation. If eventually extended to transgender women or even to men, it may also require us to reconceptualize what it is to be a ‘father’ or to be a ‘mother’, and the definition of these terms in law.

Download Full-text

Deceased Donor Uterine Transplantation

Obstetrics and Gynecology ◽

10.1097/aog.0000000000001617 ◽

2016 ◽

Vol 128 (4) ◽

pp. 837-842 ◽

Cited By ~ 50

Author(s):

Rebecca L. Flyckt ◽

Ruth M. Farrell ◽

Uma C. Perni ◽

Andreas G. Tzakis ◽

Tommaso Falcone

Keyword(s):

Deceased Donor ◽

Uterine Transplantation

Download Full-text

Uterine transplantation in an era of successful childbirths from living and deceased donor uteri: Current challenges

Biomedical Papers ◽

10.5507/bp.2019.020 ◽

2020 ◽

Vol 164 (1) ◽

pp. 115-120 ◽

Cited By ~ 1

Author(s):

Roman Chmel ◽

Zlatko Pastor ◽

Jan Matecha ◽

Libor Janousek ◽

Marta Novackova ◽

...

Keyword(s):

Deceased Donor ◽

Uterine Transplantation

Download Full-text

Uterine Autotransplantation in the Nonhuman Primate With Preservation of the Uterine and Ovarian Vascular Pedicles

Reproductive Sciences ◽

10.1177/1933719118765976 ◽

2018 ◽

Vol 26 (10) ◽

pp. 1329-1335 ◽

Cited By ~ 1

Author(s):

Michelle N. Han ◽

Hugo Ramirez ◽

Luis Ruvalcaba ◽

Juan Luis Contreras ◽

Atunga Nyachieo ◽

...

Keyword(s):

Nonhuman Primate ◽

Deceased Donor ◽

Behavior Changes ◽

Primate Research ◽

Ischemia Time ◽

Uterine Arteries ◽

Gastric Aspiration ◽

Uterine Transplantation ◽

Internal Iliac ◽

Food And Drink

Purpose: To evaluate the technical feasibility of performing a uterine autotransplantation in the nonhuman primate while preserving the uterine and ovarian vascular pedicles. Methods: Eight (n = 8) female baboons at a primate research facility underwent a uterine autotransplant procedure with preservation of the vascular pedicles. The uterine arteries were separated from their amorphous tissue and skeletonized toward the internal iliac arteries bilaterally. A segment of the internal iliac artery was removed bilaterally along with both uterine arteries. Both ovarian veins were preserved to assist with the reperfusion of the uterine organ. Due to larger vascular pedicles in one of the primates, the uterine arteries were separated and reattached directly via end-to-end anastomosis. In another baboon, the deep uterine vein was used as a vascular pedicle rather than the ovarian vein on the left side due to adequate size and visualization. Results: Immediate tissue reperfusion occurred intraoperatively in 5 of the animals, with slower perfusion in 3 of the animals. Average warm ischemia time was 43.8 minutes while the average cold ischemia time was 174 minutes (2 hours, 54 minutes). Average total surgical time was 5.9 hours. All animals were sheltered into separate cages and monitored for behavior changes and food and drink consumption. Three of the primates expired immediately postoperatively, 2 from severe dehydration and 1 from gastric aspiration. Conclusions: This pilot study describes a modified surgical approach for uterine transplants in the nonhuman primate. This surgical technique may be applicable to living and deceased donor uterine transplantation.

Download Full-text

Live Birth Following Uterine Transplantation From a Nulliparous Deceased Donor

Transplantation Journal ◽

10.1097/tp.0000000000003346 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Jiri Fronek ◽

Libor Janousek ◽

Jakub Kristek ◽

Jaroslav Chlupac ◽

Marek Pluta ◽

...

Keyword(s):

Live Birth ◽

Deceased Donor ◽

Uterine Transplantation

Download Full-text

Metabolic alterations of uterine grafts after extended cold ischemic storage: experimental study in ewes

MHR Basic science of reproductive medicine ◽

10.1093/molehr/gaz041 ◽

2019 ◽

Vol 25 (10) ◽

pp. 647-659 ◽

Cited By ~ 3

Author(s):

Yannick Tholance ◽

Jeremy Tricard ◽

Thierry Chianea ◽

Pierre Marquet ◽

Sébastien Ponsonnard ◽

...

Keyword(s):

Aerobic Glycolysis ◽

Blood Gases ◽

Deceased Donor ◽

Cold Ischemia ◽

Metabolic Alterations ◽

Precise Knowledge ◽

Glucose Ratio ◽

Uterine Transplantation ◽

Uterine Infertility ◽

Apoptotic Signal

Abstract Uterine transplantation from a deceased donor could become an available option for widely treating uterine infertility. However, this procedure requires more precise knowledge about the graft’s tolerance to extended cold ischemia. Here, we sought to assess the uterine metabolic alterations after extended cold ischemic storage in a model of auto-transplantation in ewe. A total of 14 uterine auto-transplantations were performed, divided into 2 groups: 7 after 3 h of cold ischemia time (CIT) and 7 after 24 h. Venous uterine blood was collected before uterus retrieval and during reperfusion (30, 60 and 90 min); thereafter, blood gases, lactate, glucose and amino acids (AAs) were analyzed. Apoptosis analyses were performed before uterus retrieval and following reperfusion in uterus biopsies. A total of 12 uterine auto-transplantations were successfully performed and 7 ewes were alive ≥8 days after transplantation. After reperfusion, a decrease in pH, a rise of lactate and lactate/glucose ratio and a delayed decrease of pO2 were found in the 3 h CIT group. No significant variation of these parameters was observed in the 24 h CIT group. Significant decreases of AAs were observed during reperfusion and these decreases were more pronounced and concerned a larger number of compounds in the 24 h CIT group than in the 3 h CIT group. There was no significant uterine apoptotic signal in either group. Overall, these results suggest that extended CIT storage delayed restoration of aerobic glycolysis and induced an increase in AA requirements of the uterus after reperfusion. However, this biochemical alteration did not reduce success rate for uterine transplantation.

Download Full-text