Uterine Transplants at Cleveland Clinic » Nursing Jobs Blog – Nurses Insights at Nursing Jobs.org

Uterine Transplants at Cleveland Clinic

November 20th, 2015  |  The Blog

Doctors at Cleveland Clinic are preparing to perform the first ever uterine transplant. This ground-breaking surgical option will change the lives of women who have no uterus.

Sweden, at the University of Gothenburg, is the only country in the world to have done successful uterine transplants. The Swedish results include:

  • 9 women have undergone the transplant surgery
  • 4 have given birth; the first baby was born in September 2014 and another is due in January 2016
  • All babies were born healthy but were premature
  • 2 transplants failed; 1 due to a blood clot and 1 due to infection

The Qualifications for the Study

About 50,000 women in the U.S. are potential candidates for uterine transplantation. There are some basic qualification, which include:

  • Must be in good health
  • Must be in a stable relationship due to the support and help they need through the process
  • Must have ovaries
  • Must be born without a uterus, uterus previously removed or damaged

The Study Plan

The uterine transplant will be temporary. It will be removed after the recipient has one or two babies. The removal is mandated so the recipient can stop taking the sometimes harsh transplant anti-rejection drugs.

Transplanted uteruses will be harvested from deceased donors, rather than putting a live donor at risk. A live donor harvesting takes seven to eleven hours, due to the tiny uterine vessels that are wrapped around the ureters. A uterus can be removed from a deceased donor much faster than from a live donor.

A uterus can survive outside the body for six to eight hours, if it is kept cold.

Candidates undergo psychological testing before committing to the study. They need to be financially stable because they will need to live in Cleveland during portions of the study.

How the Process Works

The candidate will be given hormone therapy to stimulate egg production.

Ten eggs are needed so the woman may need multiple cycles of hormone treatment. Eggs are harvested, fertilized with her partner’s sperm and frozen.

When there are ten frozen embryos, she is placed on the transplant waitlist. The recipient and donor must have matching blood and tissue type.

The actual transplant surgery takes about five hours because it involves:

  • Attaching an artery and a vein on either side of the uterus to the recipient’s blood vessels
  • Part of the donor’s vagina will be attached to the recipient’s vagina
  • Tissue attached to the uterus will be used to stabilize the organ in the pelvis
  • No nerves connected during the surgery

The woman must wait one year after the transplant, while the anti-rejection drugs are regulated, before getting pregnant.

Fallopian tubes are not connected to the uterus so natural pregnancy is not an option. Transplant recipients undergo in vitro fertilization. One embryo at a time will be implanted until the woman becomes pregnant.

The baby will be delivered via cesarean section before the actual due date to prevent the transplanted uterus from the undue strain of labor.

Final Uterine Removal

After delivering one baby, the mother can opt to keep the uterus intact and have a second baby. For safety reasons, there is a two baby limit imposed on a transplanted uterus.

The uterus can be surgically removed or, some believe, the woman can stop the anti-rejection drugs and let her body reject the organ and it will wither away.

Pros

  • Will help women who, for personal, cultural or religious reasons, will not adopt or engage a surrogate to have a child

Cons

  • Pushes the limits medially and ethically
  • Risks associated with surgery
  • Risks associated with taking anti-rejection drugs for a transplant that is not life-saving like a kidney, liver, heart or lung transplant. One important caveat: there are many women whom have had organ transplants, specifically kidney and liver, and have been taking anti-ejection drugs before getting pregnant. These women have gone onto have healthy babies.
  • Women who do take anti-rejection drugs have a higher risk of pre-eclampsia, an issue with high blood pressure for the mom, and their babies have a low birth weight. The question remains whether these potential complications are due to pre-existing medical conditions, involving their transplant, or if they are side effects of the anti-rejection drugs.
  • The pregnancy will be high-risk
  • Fetuses will be exposed to anti-rejection drugs

The Outcome

Eight women are currently in the screening process. Cleveland Clinic will perform ten uterine transplants, assess the outcomes and decide if they will move forward with the program.

Uterine transplants are expanding the role of organ transplantation. When organ transplantation was first done, over 50 years ago, it was a means to save lives. Today, it not only saves lives but also improves the quality of life. This is demonstrated in face transplants, hand transplants and now the potential of uterine transplants that will bring a miraculous gift to the recipient-a baby.

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