Doctors Plan First Uterus Transplant in U.S.

January 16, 2007

The Washington Post ran a disturbing page-one story yesterday about the first planned uterus transplant in the United States, raising a number of questions about the ethics of performing a difficult and potentially dangerous procedure. The transplant could be attempted as early as this year.

“The desire to have a child is a tremendous driving force for many women,” said Giuseppe Del Priore of the New York Downtown Hospital, who is leading the transplant team. “We think we could help many women fulfill this very basic desire.”

The Post’s Rob Stein writes that the first uterus transplant was done in 2002 in Saudi Arabia, though the 46-year-old patient developed blood clots, forcing removal of the uterus after 99 days. Doctors still considered it a technical success.

A woman who receives a uterus would have to stay on anti-rejection drugs until the baby is born, via Caesarean section — at which time the uterus would also be removed so the woman could stop taking the drugs.

“We are calling it a temporary transplant,” said Del Priore. “This minimizes the time patients have to be on the medications and makes it a much more reasonable risk to take to have a baby.”

The doctor’s own desire for this procedure — and the presumed demand for it — reflects the potentially dangerous power of the images and expectations surrounding motherhood in modern culture. The idea that women are incomplete unless they give birth and nurture their own children not only might lead doctors and women to take medical risks, but it also does not allow women to see their self-worth in other contexts.

Despite the objections raised by some transplant experts, fertility specialists and medical ethicists, writes Stein, “Del Priore and others defend the effort, saying the procedure will be attempted only after careful vetting by independent experts.”

They note that thousands of women cannot bear children because they were born with a malfunctioning uterus or their wombs were damaged by cancer, accidents, pregnancy complications or other problems. Women who want the operation are being screened exhaustively to make sure they fully understand the risks and have seriously considered alternatives.

“I don’t think it’s really a doctor’s role to tell a patient that their values are not important. It’s up to us as doctors to advise our patients and safely escort them to the best life that they can have,” Del Priore said. Many women who lack a functioning womb suffer terribly, he said.

“It can be just heartbreaking,” said Del Priore, a gynecological oncologist. He described a pregnant woman who started hemorrhaging after a car accident. “She was a newlywed, about to deliver a baby. Suddenly her husband is dead, her baby is dead and her uterus is gone. It’s terrible suffering. I think she deserves every possibility.”

Some ethicists and other experts, while expressing reservations, agreed, as long as doctors are reasonably confident of success and prospective patients fully recognize the risks.

“I think patients deserve autonomy,” said Alan DeCherney, a fertility expert speaking on behalf of the American Society for Reproductive Medicine. “As long as they know all the facts, it should be their choice.”

Lori B. Andrews, a bioethicist at the Chicago-Kent College of Law, makes a very good counter-point: “This is not like a kidney transplant — it’s not medically necessary to the woman’s life. Without it, the woman can live a healthy life. She still has options. She can adopt. She can even still have her own biologic child with a surrogate.”

And Adrienne Asch, who studies family life at Yeshiva University, adds: “I’m not convinced that science and medicine and society as a whole should be putting so much emphasis on having this particular nine-month experience … Why is that the sine qua non of being a parent? The real work of parenting is in the time after a child is born and is in someone’s home.”

The language the doctors use to justify the risks — identifying having children as “a very basic desire” of women — is the first step along a slippery slope we’ve seen in science fiction texts, where forced pregnancy is a frequent theme.

Yes, the doctors are very careful to make it clear they are just giving women who desire a “natural” birth a choice — and I have no doubt they are sincere. But jumping the gun without a thorough ethical discussion and the guidelines that would result from that is spooky.

Some of the classic sf texts that explore this nightmare in a compelling and complex manner are Margaret Atwood’s “The Handmaid Tale” and Octavia Butler’s “Bloodchild” — which envisions male pregnancy, something which the transplant procedure could theoretically make possible.

One of the most recent takes would be the SciFi Channel’s “Battlestar Galactica,” specifically “The Farm” episode from season two.

“Organs can have tremendous symbolic meaning to people. It can vary from individual to individual and culture to culture,” Stuart J. Youngner, a bioethicist at Case Western Reserve University, told the Post. “The uterus is one of those that has a lot of symbolic meaning.”

So far, hundreds of women have inquired about the procedure, and between 40 and 50 women are currently being screened, according to the Post.

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