Limited Availability of Deceased Uterus Donors: A Transatlantic Perspective

Abstract

J.K. collected and analyzed data and wrote the article. L.J. contributed in designing the study and helped the first author collect and analyze data and write the article. G.T. edited the manuscript. R.C. contributed to the design and data analysis. M.O. contributed in designing the study and analyzing data. N.Kv. contributed in designing the study, analyzing data, and editing of the manuscript. N.Ka. contributed to the design and data analysis. J.F. brought the concept of the study forward and contributed to the design, data collection, supervision of the writing, and editing of the manuscript.

Uterine Transplantation Using Living Donation: A Cross-sectional Study Assessing Perceptions, Acceptability, and Suitability

“…Recent donor criteria have been suggested for implementation in the context of DD. 37 If extrapolated into LD, their suggested standard donor criteria, which excludes women with miscarriage or cesarean section, would reduce the number of suitable donors to just 25, before comprehensive clinical evaluation and investigation, representing just 16% of the initial cohort. Given that the majority of miscarriages are sporadic and because of problems completely unrelated to the uterus, such as embryonic aneuploidy, 38 and that 15%–20% of women experience miscarriage, 39 accepting donors with previous sporadic miscarriages could increase donor availability without detracting from the quality of the graft.…”

“… 4 Moreover, even in healthcare systems with well-established DD programs, concerns have been expressed about the potential availability of donors to meet future demand. 21 , 37 Although increasing donation after brain death conversion rates is essential, increasing potential DD supply may also be possible by considering uterine donation after circulatory death. However, this is a prospect that requires further research to determine whether the prolonged warm ischemic time in such cases is detrimental to UTx outcomes.…”

Deceased Donation Uterus Transplantation: A Review

“…However, as noted by Williams, should there "be both no shortage of DD uteri and the use of LD is no more likely/only slightly more likely to prove successful, [it may be claimed] that LD should not be utilized" [11]. It must be recognised that there is limited availability of deceased uterus donors; one recent review approximated a maximum number of 2.33 potential donors per million people [31]. Whilst there may be limited availability, DD UTx is desirable as it avoids the ethical and medical risks associated with LD.…”

“…The obstetric success and desirability of live and deceased nulliparous donors is debated in the literature [31,32]. This is a more prominent problem in deceased donation as live donations are often from parous donors, often the recipient's mother.…”

Uterus procurement from deceased donor for transplantation

“…The limitations of the present study were as follows: The population was not homogeneous because there were no restrictions to organ procurement and patients who would not be candidates for uterus donation were included (patients 4, 5, 6, 8,11, 13, and 14), as a result of the shortage of organs that meet the inclusion criteria [28]; the technique was being improved throughout the study and surgical times were not measured for all donors, which may compromise the comparison of these parameters in the group as a whole.…”