#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Ethical aspects of uterus transplantation


Authors: Roman Chmel 1,2;  Marta Nováčková 1,2;  Zlatko Pastor 1;  Jan Matěcha 1;  Miloš Čekal 1,3;  Jiří Froněk 1,2
Authors place of work: Gynekologicko-porodnická klinika 2. LF UK a FN Motol v Praze 1;  Klinika transplantační chirurgie IKEM, Praha 2;  Centrum reprodukční medicíny Gest, Praha 3
Published in the journal: Čas. Lék. čes. 2017; 156: 36-42
Category: Review Article

Summary

Uterus transplantation is an experimental treatment method with an ambition to become accepted treatment modality for women with absolute uterine factor infertility. The only legal alternative for these women to get parenthood is adoption which is accepted by most world societies and countries. Surrogate pregnancy is connected with many medical, ethical, legal, religious and social controversies in the great part of the world.

Donors (in living donation), recipients, partners and also unborn children must be incorporated into the analysis of ethical risks and benefits of uterus transplantation. The main ethical risks for the recipient are surgery, immunosuppression, pregnancy and delivery. All the potential recipients have to be advised about further ethical issues like organ rejection, infection, side effects of the drugs, unsatisfactory fertilization and different complications during pregnancy.

Uterus procurement in donor takes longer time than in standard hysterectomy due to preparation of uterine arteries and veins. Vessels with 2 mm diameter and their anatomical collision with ureter are connected with higher peroperative risk of uneventful surgical complications. Ethical issues might be connected with the uterus procurement in dead brain donors identically.

The deliveries after uterus transplantation are fruitful but the risk of preterm delivery and immaturity of the newborns cannot be underestimated as well.

Keywords:
ethics, infertility, uterus transplantation, absolute uterine factor infertility, efficacy, safety


Zdroje

1. Fageeh W, Raffa H, Jabbad H, Marzouki A. Transplantation of the human uterus. Int J Obstet Gynecol 2002; 76: 245−251.

2. Ozkan O, Akar ME, Ozkan O et al. Preliminary results of the human uterus transplantation from multiorgan donor. Fertil Steril 2013; 99: 470−476.

3. Brännström M, Johannesson L, Dahm-Kähler P et al. First clinical uterus transplantation trial: a six-month report. Fertil Steril 2014; 101: 1228−1236.

4. Brännström M, Johannesson L, Bokström H et al. Livebirth after uterus transplantation. Lancet 2015; 385: 607−616.

5. Kandela P. Uterus transplantation failure causes Saudi Arabian government clampdown. Lancet 2000; 356: 838.

6. Fageeh W. Apology to Dr Wafa Mohammed Khalil Fageeh, obstetrician and gynecologist and assistant professor at King Abdilaziz University, and her medical team. Lancet 2001; 358: 1076.

7. Benagiano G, Landeweerd L, Brosens I. Medical and ethical considerations in uterus transplantation. Int J Gynaecol Obstet 2013; 123: 173−177.

8. Catsanos R, Rogers W, Lotz M. The ethics of uterus transplantation. Bioethics 2013; 27: 65−73.

9. Lefkowitz A, Edwards M, Balayla J. Ethical considerations in the era of the uterine transplant: an update of the Montreal Criteria for the Ethical Feasibility of Uterine Transplantation. Fertil Steril 2013; 100: 924−926.

10. Steptoe PC, Edwards RG. Birth after a reimplantation of human embryo. Lancet 1978; 2: 366.

11. Robertson JA. Other women’s womb: uterus transplants and gestational surrogacy. J Law Biosci 2016; 3: 68−86

12. Singer PA, Siegler M, Whitington PF et al. Ethics of liver transplantation with living donors. N Engl J Med 1989; 321: 620−622.

13. Johannesson L, Kvarnström N, Mölne J et al. Uterus transplantation trial: 1-year outcome. Fertil Steril 2015; 103: 199−204.

14. Milliez J. Uterine transplantation FIGO Committee for the Ethical Aspects of Human Reproduction and Women’s Health. Int J Gynaecol Obstet 2009; 106: 270.

15. Lefkowitz A, Edwards M, Balayla J. The Montreal criteria for the ethical feasibility of uterine transplantation. Transpl Int 2012; 25: 439−447.

16. Palermo GD, Cohen J, Rosenwaks Z. Intracytoplasmic sperm injection: a powerful tool to overcome fertilisation failure. Feril Steril 1996; 65: 899−908.

17. Diaz-Garcia C, Akhi SN, Wallin A et al. First report on fertility after allogenic uterus transplantation. Acta Obstet Gynecol Scand 2010; 89: 1491−1494.

18. Wranning CA, Marcickiewicz J, Enskog A et al. Fertility after autologous ovine uterine-tubal-ovarian transplantation by vascular anastomosis to the external iliac vessels. Hum Reprod 2010; 25: 1973−1979.

19. Mihara M, Kisu I, Hara H et al. Uterus autotransplantation in cynomolgus macaques: the first case of pregnancy and delivery. Hum Reprod 2012; 27: 2332−2340.

20. Johannesson L, Enskog A, Mölne J et al. Preclinical report on allogeneic uterus transplantation in non-human primates. Hum Reprod 2013; 28: 189−198.

21. Dahm-Kähler P, Diaz-Garcia C, Brännström M. Human uterus transplantation in focus. Br Med Bull 2016; 117: 69−78.

22. Brännström M, Bokström H, Dahm-Kähler P et al. One uterus bridging three generations: first live birth after mother-to-daughter uterus transplantation. Fertil Steril 2016; 106: 261−266.

23. Williams N. Should deceased donation be morally preferred in uterine transplantation trials? Bioethics 2016; 30: 415−424.

24. Farrell RM, Falcone T. Uterine transplants: new medical and ethical considerations. Lancet 2015; 385: 581−582.

25. Johannesson L, Diaz-Garcia C, Leonhardt H et al. Vascular pedicle lenghts after hysterectomy. Towards future human uterus transplantation. Obstet Gynecol 2012; 119: 1219−1225.

26. Kvarnström N, Järvholm S, Johannesson L et al. Live donors of the initial observational study of uterus transplantation − psychological and medical follow up until 1 year after surgery in the 9 cases. Transplantation 2017; 101(3): 664−670.

27. Flyckt R, Farrell RM, Perni UC et al. Deceased donor uterine transplantation. Innovation and adaptation. Obstet Gynecol 2016; 128: 837−842.

28. Kisu I, Banno K, Mihara M et al. Current status of uterus transplantation in primates and issues for clinical application. Fertil Steril 2013; 100: 280−294.

29. Del Priore G, Gudipudi DK. Promise of uterine transplant – myth or reality? Maturitas 2014; 77: 20−23.

30. Framarino dei Malatesta M, Rocca B, Lappelli M et al. Fertility following solid organ transplantation. Transplant Proc 2007; 39: 2001−2004.

31. Deshpande NA, James NT, Kucirka LM et al. Pregnancy outcomes in kidney transplant recipients: a systematic review and meta-analysis. Am J Transplant 2011; 11: 2388−2404.

32. Söderström-Anttila V, Wennerholm UB, Loft A et al. Surrogacy: outcomes for surrogate mothers, children and the resulting families-a systematic review. Hum Reprod Update 2016; 22: 260−276.

33. Brännström M, Dahm-Kähler P, Diaz-Garcia C. Uterine transplantation is not a good use of limited resources: AGAINST: It is a highly effective infertility treatment. BJOG 2016; 123: 1440.

34. Johannesson L, Dahm-Kähler P, Eklind S, Brännström M. The future of human uterus transplantation. Womens Health 2014; 10: 455−467.

35. Del Priore G, Saso S, Meslin EM et al. Uterine transplantation – a real possibility? The Indianapolis consensus. Hum Reprod 2013; 28: 288−291.

Štítky
Addictology Allergology and clinical immunology Angiology Audiology Clinical biochemistry Dermatology & STDs Paediatric gastroenterology Paediatric surgery Paediatric cardiology Paediatric neurology Paediatric ENT Paediatric psychiatry Paediatric rheumatology Diabetology Pharmacy Vascular surgery Pain management Dental Hygienist
Prihlásenie
Zabudnuté heslo

Zadajte e-mailovú adresu, s ktorou ste vytvárali účet. Budú Vám na ňu zasielané informácie k nastaveniu nového hesla.

Prihlásenie

Nemáte účet?  Registrujte sa

#ADS_BOTTOM_SCRIPTS#