Dive Brief:
- The Cleveland Clinic hopes to be the first medical center in the U.S. to provide uterus transplants for women who lack a uterus - either because they were born without one, had it removed, or had uterine damage. The transplanted uterus will be removed after the woman has a maximum of two babies so she can discontinue transplant anti-rejection medication.
- If it proves successful, up to 50,000 women nationwide could be potential candidates.
- The procedure is not without risks, including the surgery itself, transplant anti-rejection drugs (which the fetus will also be exposed to), and the pregnancies will be considered high-risk. Eight women have already begun the screening process to be selected for transplants.
Dive Insight:
The Cleveland Clinic says it will perform the procedure 10 times in a clinical trial to decide whether to continue. Sweden has successfully performed uterine transplants from live donors in nine women, four of whom have given birth. However, the U.S. team will use deceased donors to avoid the risks of lengthy surgeries of up to 11 hours for live donors.
Candidates will be carefully screened, including psychologically, since the transplant process is complicated and long. Recipients must be fertilized via in vitro fertilization, but not until one year post-transplant to heal from the surgery and adjust to the required anti-rejection medication.
If the recipient becomes pregnant, the baby will be delivered by cesarean section prior to the due date to protect the transplanted uterus from the stress of labor. The uterus will be removed after the baby is born (or up to two babies) so the recipient can discontinue the anti-rejection medication. There is a possibility just stopping the medication may enable the immune system to reject the uterus, which may gradually disintegrate.
Cleveland Clinic's chairman of the ethics board, Dr. Alan Lichtin, told The New York Times the medical team and the board deliberated about it for a year before they produced an approved plan. "I think our initial impression was: 'Wow. This is really pushing the envelope.' But this is the way human progress occurs."