Baby born via uterus transplant from deceased donor
Healthy girl arrives after world-first procedure. Nick Carne reports.
The first baby has been born following a uterus transplantation from a deceased donor, according to a case study from Brazil published in The Lancet.
The transplant surgery took 10.5 hours and involved connecting the donor’s uterus and recipient's veins, arteries, ligaments and vaginal canals.
Fertilised eggs were implanted seven months later. A healthy baby girl was born via caesarean section at 35 weeks and three days, weighing 2550 grams.
The researchers from the University of São Paulo say the findings demonstrate the feasibility of the technique, but note that the outcomes and effects of organs sourced from live and deceased donors are yet to be compared.
They say there have been 10 previous reported attempts to transplant a uterus from a deceased donor – in the US, Turkey and the Czech Republic – but theirs is the first to result in a live birth. There have been 39 transplants from living uterus donors, with 11 livebirths. The first was in Sweden in 2014.
"The first uterus transplants from live donors were a medical milestone, creating the possibility of childbirth for many infertile women with access to suitable donors and the needed medical facilities,” says research leader Dani Ejzenberg.
“However, the need for a live donor is a major limitation as donors are rare, typically being willing and eligible family members or close friends. The numbers of people willing and committed to donate organs upon their own deaths are far larger than those of live donors, offering a much wider potential donor population."
The whole question of uterus transplants presents ethical challenges, of course, and earlier this year a group of British doctors warned that “the procedure remains experimental and success of the practice still requires further strictly controlled clinical trials”.
The Brazilian recipient was a 32-year-old woman born without a uterus as a result of Mayer-Rokitansky-Küster-Hauser syndrome, a disorder that mainly affects the reproductive system. She had one in-vitro fertilisation cycle four months before transplant, resulting in eight fertilised eggs which were cryopreserved.
The 45-year-old donor, who died of subarachnoid haemorrhage, had had three successful vaginal deliveries.
The surgery took place in September, 2016. Five months after transplantation, the uterus showed no signs of rejection, ultrasound scans showed no anomalies and the recipient was having regular menstruation.
The fertilised eggs were implanted after seven months – compared with about a year for previous uterus transplants – and the recipient was confirmed to be pregnant 10 days later. There were no reported issues during the pregnancy, other than a kidney infection at 32 weeks.
The baby girl was born less than four weeks later, in December, 2017, and the transplanted uterus was removed during the caesarean section, showing no anomalies. Mother and baby were discharged three days after birth, with what the researchers say was an uneventful early follow-up.
They note that the transplant involved major surgery and recipients would need to be healthy to avoid complications during. In addition, the surgery used high doses of immunosuppression, which could be reduced in future, and involved moderate levels of blood loss, although these were considered manageable.
The recipient and her partner received monthly psychological counselling from professionals specialised in transplants and fertility throughout before, during and after the transplant.