Uterine Transplant: Some Facts

Dr. Satabdi Dey

Fertility specialist, Nova IVF Fertility , Siliguri

Organ transplant dates back to ancient INDIA and its mythology. Lord Ganesha, our very own elephant headed God is an example of head transplant. Another example is of Rishi Dadhichi gave up his life so that his bones could be used to fashion Varja , which was used by Indra in his fight against the demons. He is believed to have said, “It is better that my bones help you attain victory , rather than rot in the ground”.

A uterine transplant, commonly known as womb transplant, helps child bearing in females who either do not have a womb or have a womb that is weak and unable to maintain a pregnancy. This is estimated to affect approximately one in 500 women. Options for those who wish to start a family include adoption and surrogacy, but these are usually associated with lots of legal, cultural and ethical consequences that may not be acceptable to some women and their families. It is done when the woman is ready to start a family, it’s a temporary procedure and the uterus is removed following the completion of her family.

Uterine transplant was first done in 2002 in Saudi Arabia, in a place called Jeddah, in a 26 year old woman, she had profuse bleeding while giving birth and had to get her uterus removed. She was fortunate to get an uterus from a female who was getting her uterus removed and agreed to donate the same. The procedure was fairly successful as the girl had two menstrual cycles and finally had to get her transplanted uterus removed after 3 months due to loss of blood flow.

A team of transplant specialists in Sweden documented the first live birth in a transplanted uterus. The recipient was a 35 year old female born without an uterus ( Mullerian Anomaly ). The donor was a 61 year old lady. The pregnancy resulted in a live birth though the baby was premature by 2 months.

In India, the first uterine transplant was performed by Dr. Shailesh Puntambekar and his team in Pune in 2017. A 21 year old girl born without a uterus received an uterus from her 41 year old mother. In May 2017, a female from Vadodara, became the second woman in the country to undergo a uterine transplant, she delivered India’s first uterine transplant baby, weighing 1.45 kg. The baby girl was born 17 months after she underwent an uterine transplant. 9 uterine transplants have been done till date in India and 93 procedures have been done across the world.

There are various physical risks associated with the procedure, both for the donors and recipients . The recipients have to undergo three surgeries and multiple rounds of IVF treatments. The female has to be on anti rejection medications and deal with its side effects. The donor has to undergo a surgery for the removal of the organ. However this risk can be minimised if we promote more and more recovery of uteri from deceased females.

The psychological implications of the procedure include the trauma associated with the possibility of failures even after the transplant procedure is successful. In case of a preterm birth, the parents have to deal with the consequences of prematurity . The family has to be prepared beforehand about all the implications associated with the procedure.

The biggest advantage in our society about undergoing an uterine transplant is that the female is socially pregnant, and we often tend to underestimate the importance of the same. Though other options for a female with absolute uterine factor infertility seem to be associated with lesser complications, but the mental satisfaction and the social recognition associated with carrying a pregnancy and having the power to experience the same should be given importance and preference where deemed feasible.

Though evidence is limited, it has been seen that both living and deceased donors have almost similar results, deceased donors can provide a graft with longer vascular pedicles and is free of potential complications that could otherwise arise with a living donor. . After brain death , all prospective donors should be evaluated according to the protocol of multi-organ donors and families of these women have to be motivated for the same. As a matter of fact, like other organ donations, we need to raise awareness regarding uterine donation and encourage women to come forward to pledge about the same. This will help us in securing the social status of more and more females in times to come.