Deceased Donor Uterine Transplantation

Abstract

This commentary endeavors to share our practical experience in developing and implementing the first uterine transplant clinical trial in the United States. Uterine transplant is a promising novel treatment for uterine factor infertility. After reported successful live births after uterine transplant in Sweden, research teams around the world are either embarking on or are considering the development of uterine transplant protocols. Our observations on the applied rather than theoretical aspects of uterine transplantation research in human subjects are detailed in this article. Important among these considerations are composing a broad and experienced multidisciplinary team as well as performing adequate preclinical preparations, including ideally animal studies and practice organ procurements. Ethical preparation is tantamount to clinical preparation for the complexities inherent in uterine transplant, and our suggestions for updating the current ethical criteria for uterine transplant are outlined here. We also describe our perspectives on the strengths and weaknesses of living compared with deceased donor models. Finally, we describe how a strong program can recover and adapt in the face of setbacks to continue a path toward innovation.

Clinical applications of uterus transplantation in China: Issues to take into consideration

“…Also, UTx from DD is a good way to set up the logistical workflow for UTx in clinical settings and develop of a cohesive and wellfunctioning multidisciplinary team. 29 Moreover, a prospective study conducted by the France team showed that URBD (uterus retrieval from brain-dead donors) did not interfere with vital organ retrieval, although uterus is usually the last organ to be retrieved. 30 However, evaluation before using the uterus from DD should include preoperative medical investigations like that for LD, including radiology like magnetic resonance imaging/computed tomography (MRI/CT), Pap smear and blood chemistry, and the Czech team even perform hysteroscopy in DD to rule out endometrial pathology.…”

“…57 Practice in DD is also important to reduce the surgical risks for the LD, which can outline the key steps in a live UTx protocol and face less ethical issues as well as postoperative psychological evaluation and intervention issues for the donors. 29,58,59 Here, we summarized the preliminary work from the international team regarding ethical issues to help regulate and promote the human UTx in China. First, it is important to confirm the social need for UTx to prevent premature use of this new technique in China.…”

“…Using uterine veins for uterus outflow may save the ovarian vein for the living donor but can also encounter massive bleeding, ureteral injury in the donor as well as vessel thrombosis in the recipient postoperatively. 2,29,59 Moreover, to whom the donor is in their menopause, hormone replacement therapy should be used for about 3 months to ascertain menstrual functionality of the uterus and to possibly increase uterine artery blood flow preoperatively. This hysterectomy will increase the risk of thrombus intraoperatively and postoperatively.…”

Uterus transplantation: Toward clinical application in Japan

“…2015, planned UTx using deceased donors to 10 recipients (18-36 years old) was revealed at Imperial College, London, UK 106. Likewise, in November of the same year, for eight recipients(25- 35 years old) at Limoges Hospital, Limoges, France, 107 and 10 recipients (21-39 years old) at Cleveland Clinic, Cleveland, OH, USA, UTx was planned by using deceased donors 108. Furthermore, in November, 2015, Xijing Hospital in Xi'an, China,…”

First Latin uterine transplantation: we can do it!

“…The first relevant report worldwide involved a 22-year-old Turkish woman who received a uterus from a dead donor in 2011 12. The second report described a transplantation performed at the Cleveland Clinic in 2016; this was the first American surgical trial of uterine transplantation in a woman of reproductive age 15. Recently, in September 2016, a Brazilian team also attempted cadaver donor transplantation in this context.…”