Woman gives birth us­ing womb trans­planted from dead donor

The Guardian Australia - - Science - Ni­cola Davis

A woman in Brazil has suc­cess­fully given birth af­ter re­ceiv­ing a womb from a dead donor, the first time such a pro­ce­dure has been suc­cess­ful.

While re­searchers in coun­tries in­clud­ing Swe­den and the US have pre­vi­ously suc­ceeded in trans­plant­ing wombs from liv­ing donors into women who have gone on to give birth, experts said the lat­est devel­op­ment was a sig­nif­i­cant ad­vance.

“With a de­ceased donor, you re­duce the risk be­cause you don’t have the risk to the donor – and you re­duce the costs, too, be­cause you don’t have the hos­pi­tal­i­sa­tion and the very long surgery of the donor,” said Dr Dani Ejzen­berg of the Uni­ver­sity of São Paulo, who led the re­search.

Ejzen­berg said that find­ing a liv­ing donor could also be dif­fi­cult, while co­or­di­nat­ing op­er­a­tions was lo­gis­ti­cally chal­leng­ing.

It is not the first time a womb trans­plant from a dead donor has been tried, but none had re­sulted in a live birth un­til now. The team said the baby girl was healthy and de­vel­op­ing nor­mally.

Writ­ing in the Lancet, Ejzen­berg and col­leagues re­port how they re­moved a womb from a 45-year-old woman who had died from a burst blood ves­sel in the brain and who had pre­vi­ously given birth three times. The re­cip­i­ent was a 32-year-old woman with a con­di­tion that meant she was born with­out a womb, although she had ovaries – mean­ing that eggs could be col­lected and used in IVF.

The team care­fully dis­sected the uterus from the donor be­fore car­ry­ing out the 10-and-a-half-hour op­er­a­tion in Septem­ber 2016 to in­sert the organ, which weighed 225g. They at­tached a stump of the donor’s vagina to that of the re­cip­i­ent, as well as con­nect­ing blood ves­sels and lig­a­ments.

The woman was given im­muno­sup­pres­sants to pre­vent re­jec­tion of the womb, while the team took biop­sies of the cervix at reg­u­lar in­ter­vals to check for signs of re­jec­tion.

Just over a month af­ter the trans­plant, the woman’s pe­ri­ods started, and seven months af­ter the op­er­a­tion the team trans­ferred an em­bryo from the IVF treat­ment into her womb – sev­eral months ear­lier than was at­tempted in pre­vi­ous cases with liv­ing donors. The preg­nancy went smoothly and a baby girl was de­liv­ered by cae­sarean sec­tion at just over 35 weeks.

Once the baby was de­liv­ered, the team re­moved the womb in the same op­er­a­tion. Ejzen­berg said that was done be­cause it would have been ex­pen­sive to keep the woman on im­muno­sup-

pres­sive drugs and the team hoped to use scarce funds to al­low other women to un­dergo the pro­ce­dure.

The team said the pro­ce­dure could bring hope of fer­til­ity to women with a num­ber of con­di­tions, in­clud­ing those who have had a hys­terec­tomy for med­i­cal reasons. “You have a sub­stan­tial num­ber of pa­tients that can ben­e­fit from this tech­nique [of womb trans­plant],” said Ejzen­berg.

The team said the suc­cess meant that women for whom sur­ro­gacy or adop­tion was pre­vi­ously the only option for start­ing a fam­ily might soon have another path they could choose.

How­ever, in an ac­com­pa­ny­ing editorial, experts from the fer­til­ity com­pany IVI-RMA Global noted the process would need to be re­fined and more re­search done be­fore it could be more widely used.

Stu­art Lav­ery, a con­sul­tant gy­nae­col­o­gist at Ham­mer­smith hospi­tal who was not in­volved in the lat­est study, said the birth was “quite a sig­nif­i­cant step”, not­ing that us­ing wombs from de­ceased donors im­proves safety. Lav­ery said that, at least the­o­ret­i­cally, the pro­ce­dure could be used to al­low trans women to carry a baby.

In 2015, an ini­tial ap­proval was granted in the UK for a clin­i­cal trial of womb trans­plants. The team, led by Richard Smith, a sur­geon with the char­ity Womb Trans­plant UK, have al­ready laid the ground­work, in­clud­ing car­ry­ing out an­i­mal stud­ies, and are now look­ing to per­form trans­plants in­volv­ing both liv­ing and de­ceased donors.

Gote­borg /AP Pho­to­graph: Jo­han Wing­borg/Uni­ver­sity of

A Swedish re­search team prac­tises be­fore an op­er­a­tion to trans­plant a womb from a liv­ing donor.

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