Living uterus donation and transplantation: experience of interest and screening in a single center in the United States

Johannesson, Liza; Wallis, K.; Koon, E. C.; McKenna, Greg J.; Anthony, Tiffany; Leffingwell, Sara G.; Klintmalm, Göran B.; Gunby, Robert T.; Testa, Giuliano

doi:10.1016/j.ajog.2017.11.594

Cited by 45 publications

(61 citation statements)

References 6 publications

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“…5 The main reasons for not proceeding were either that the donor did not meet the basic inclusion criteria of the trial, self-withdrawal, or comorbidities. The majority of the donors were screened out during the initial phase of the evaluation process.…”

Section: Introductionmentioning

confidence: 99%

“…The majority of the donors were screened out during the initial phase of the evaluation process. 5 The main reasons for not proceeding were either that the donor did not meet the basic inclusion criteria of the trial, self-withdrawal, or comorbidities. 5 None of the donors or recipients were excluded based on the psychological evaluation (in-depth interview and standardized psychological questionnaires).…”

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confidence: 99%

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Live nondirected uterus donors: Psychological characteristics and motivation for donation

Warren

Testa

Anthony

et al. 2018

American Journal of Transplantation

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Emerging research suggests that uterus transplantation is a viable option for women without a uterus who want to become pregnant and carry a child to term. Currently, no knowledge exists regarding nondirected uterus donors. This study (NCT 02656550) explored the baseline psychological characteristics of nondirected uterus donors at a single study site. Of the 62 potential donors who underwent initial screening, 6 nondirected donors were chosen and participated in uterus donation. Participants received a comprehensive evaluation, which included clinical history and psychological assessments. The mean age of the donors was 42 years; most (83%) were white/not Hispanic, and all had a college degree. Current depression was reported by 2 participants, past depression was reported in 2 participants, and past anxiety was reported in 3 participants. Based on several different psychological measures, donors had a higher general well-being than the normative sample, and none of the participants' scores indicated psychological distress. All 6 women indicated that giving another woman an opportunity to carry her own child was a motivation for pursuing uterus donation. Further research on potential psychological motives and gains for the donor as well as long-term effects on donors is crucial for ethical practice.

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Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

Live nondirected uterus donors: Psychological characteristics and motivation for donation

Warren

Testa

Anthony

et al. 2018

American Journal of Transplantation

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“…On the other hand, little is known regarding the characteristics of women who seek UTx as a treatment for AUFI. Furthermore, only one research group so far has described the screening protocol developed within their UTx trial (9). As a consequence, currently no standardized evaluation protocols are available for the screening process (10).…”

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confidence: 99%

Screening and evaluation of potential recipients and donors for living donor uterus transplantation: results from a single-center observational study

Taran

Schöller

Rall

et al. 2019

Fertility and Sterility

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Objective: To report our experience with the screening and selection of potential recipients and living donors of our uterus transplantation (UTx) program. Design: Part of an observational program. Setting: University hospital. Patient(s): Patients with absolute uterine factor infertility (AUFI). Intervention(s): Screening by e-mail and telephone, selection during surgical consultation, and preoperative investigations according to a multistep procedure for living donation. Main Outcome Measure(s): Age, cause of AUFI, exclusion reasons, and preoperative workup. Result(s): A total of 212 potential recipients expressed interest in participation. Among the 46 potential recipients and 49 directed donors were 4 potential recipients, each with 2 directed donors. Mean (range) age of potential recipients was 29.6 (19-41) years. Of the potential recipients, 39 (84.8%) had congenital AUFI and 7 (17.3%) had acquired AUFI. Ultimately, 15 potential recipients with 16 directed donors were selected for participation, with 1 potential recipient having 2 directed donors. Mean age of included potential recipients was 28.9 (22-35) years, and mean donor age was 51.3 (37-62) years. Fourteen potential recipients (93.3%) had congenital AUFI, and one potential recipient (6.7%) had undergone hysterectomy for obstetric complications. Conclusion(s): The number of potential candidates for UTx is not inconsiderable, with congenital AUFI being the leading cause of AUFI in our cohort. However, our findings highlight that large numbers of AUFI patients need to be screened, considering our exclusion rates were >50%, owing to ABO incompatibility, unavailability of a directed donor, and self-withdrawal. Moreover, meticulous preoperative screening, including in-depth psychological assessment, is mandatory to maximize living donor safety and UTx success. (Fertil Steril Ò 2019;111:186-93. Ó2018 by American Society for Reproductive Medicine.

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“…The preoperative selection process including, amongst others, meticulous physical examinations and psychological assessments, imaging, and immunological testing, is of great importance to ensure both donor and recipient safety and the success of uterus transplantation . During uterus transplantation surgery, the vaginal vault is dissected free from the bladder and rectum and, in the case of patients with MRKHS, the uterine rudiment needs to be cleaved to reach the top of the vagina.…”

Section: Conclusion and Future Perspectivesmentioning

confidence: 99%

Neovagina creation methods and their potential impact on subsequent uterus transplantation: a review

Kölle

Taran

Rall

et al. 2019

BJOG

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Congenital uterovaginal aplasia commonly occurs in Mayer-Rokitansky-K€ uster-Hauser syndrome. Various methods of neovagina creation exist, including nonsurgical self-dilation, surgical dilation, and surgical procedures involving skin or intestinal transplants. Subsequent uterus transplantation is necessary to enable pregnancy. We review the main characteristics, advantages, and disadvantages of established neovagina creation methods and discuss their suitability regarding subsequent uterus transplantation. Suitability criteria include sufficient vaginal length, absence of previous major intra-abdominal surgery, a natural vaginal axis, and a natural vaginal epithelium. In conclusion, Vecchietti-based laparoscopically assisted neovagina creation provides ideal functional conditions for uterus transplantation. Nonsurgical self-dilation and Wharton-Sheares-George vaginoplasty may also be suitable.

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Living uterus donation and transplantation: experience of interest and screening in a single center in the United States

Cited by 45 publications

References 6 publications

Live nondirected uterus donors: Psychological characteristics and motivation for donation

Live nondirected uterus donors: Psychological characteristics and motivation for donation

Screening and evaluation of potential recipients and donors for living donor uterus transplantation: results from a single-center observational study

Neovagina creation methods and their potential impact on subsequent uterus transplantation: a review

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