Whether you look at it as a medical milestone or an act of Providence, the fact remains that a 32-year old Brazilian recipient of a uterus from a dead donor has given birth to a healthy baby-girl in an absolute first of its kind.
The organ came from a 45-year-old unnamed woman who had voluntarily agreed to donate her organs before her death from brain hemorrhage; she had had three normal vaginal deliveries during her short lifespan.
The beneficiary, whose identity is also not being made public, was suffering from a condition called Mayer-Rokitansky-Küster-Hauser(MRKH) syndrome – a female reproductive-system-disorder that causes underdeveloped or totally missing uterus.
With no apparent abnormalities to the external genitalia of MRKH syndrome sufferers, the condition usually stays undiscovered until the affected woman is diagnosed with primary amenorrhea – failure to get menstrual periods by the age of sixteen.
The transplant took place in 2016, with the recipient giving birth to a perfectly normal baby girl weighing 2.5 kilograms (5.6 pounds) on Dec 15, 2017, through Caesarean section.
The achievement is all the more impressive if you consider that ten similar attempts in the U.S., Czech Republic and Turkey had ended in failure, although successful birth using a uterus from a living donor has been achieved eleven times since the first success in 2013.
Despite that, it’s not a perfectly viable option, in that finding a woman who would willingly give away her uterus is never going to be easy unless a family member or a close friend agrees to make the sacrifice.
However, the latest breakthrough opens the door for women with MRKH syndrome, or other uterine infertility issues, to have children of their own rather than going for adoption or surrogacy options.
Lead researcher of the procedure, Dr. Dani Ejzenberg, from Hospital das Clínicas at the University of São Paulo in Brazil, has published his “proof of concept” in the journal ‘Lancet.’
“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,” said Dr. 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,” he explained.
“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,” Dr. Ejzenberg added.
What also works in favor of using uteruses from deceased donors is the fact that it eliminates the risks attached to a live transplant, in addition to the relatively low costs it entails.
Out of the ten failed attempts using the dead donor method, one involved a 23-year-old woman who also had MRKF syndrome.
While the woman was successful in achieving pregnancy after getting a uterus from a dead donor in Turkey, he motherhood aspirations came to an abrupt halt when her pregnancy was terminated due to unforeseen complications merely six weeks after conception.
The recent success is a testimony to the determination of researchers who believed in the concept and continued to pursue the idea of effecting birth using the uterus of a dead donor.
Not only has the research opened a promising new avenue for childless couples throughout the world, but it also provides access to important information on how to see such pregnancies through to a full term for a successful delivery.
“Uterine transplant and subsequent pregnancies, including from live donors, have previously been reported, but this is the first case of a successful pregnancy from a deceased donor,” Andrew Shennan – professor of obstetrics at King’s College London, who was not part of the research – was quoted by the Independent as saying.
“Successful pregnancy, without evidence of any compromise in spite of the uterus (womb) being without oxygen for eight hours before transplant, was unique,” Shennan told the online newspaper.
While there could have been a number of reasons behind Dr. Ejzenberg and his team’s success, timing was the key factor, believe the researchers.
The procedure involved removing sixteen eggs from the recipient’s functional ovaries five months prior to the transplant, out of which fifteen were fertilized and eight resulted in embryos which were preserved for implantation at a later date.
Seven months after the Sep 2016 transplant, with regular menstrual periods and no signs of organ rejection, one of the preserved embryos was implanted.
It was the timing of this implant that proved to be the key factor in achieving success.
In all of the failed attempts in the past, the embryo implant was done at least a year after the uterus transplant.
While it is not confirmed that the early implant actually made the difference between success and failure, researchers believe it’s a highly plausible rationale.
As is typically the case in transplants like this, the uterus was removed during delivery to eliminate complications from having to take immunosuppressants to fight rejection.
“The only other pregnancy following a uterine transplantation from a deceased donor was in 2011 in Turkey,” said Dr. Srdjan Saso, from the Imperial College London – also quoted by the Independent.
“This attempt was unsuccessful and led to miscarriage two years later, which led to doubts whether deceased donation could work,” he reportedly said.
“Our hope, as we plan to kick-start the UK programme at the beginning of 2019, is for the deceased donor uterine transplant programme to grow alongside its ‘live donor’ counterpart, prove achievable and successful so that both women with willing donors in their families, and those not, can have a real option of carrying a healthy pregnancy,” Dr Saso concluded.