What Are Good Guidelines for Evaluating Uterus Transplantation?

Horvat, Margaret; Iltis, Ana S.

doi:10.1001/amajethics.2019.988

Cited by 9 publications

(4 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Moreover, restoration of blood flow and reoxygenation itself paradoxically further enhance the activation of innate and adaptive immune responses and cell death programs (reperfusion injury) [10]. These processes increase the likelihood of short-and long-term complications, such as delayed graft function and acute or chronic rejection [11]. Different strategies to reduce IRI, such as optimization of organ perfusion and storing conditions, or the development of drugs targeting IRI, are under investigation [12,13].…”

Section: Introductionmentioning

confidence: 99%

Melatonin and Glycine Reduce Uterus Ischemia/Reperfusion Injury in a Rat Model of Warm Ischemia

Zitkute

Kvietkauskas

Maskoliūnaitė

et al. 2021

IJMS

View full text Add to dashboard Cite

Ischemia/reperfusion injury (IRI) remains a significant problem to be solved in uterus transplantation (UTx). Melatonin and glycine have been shown to possess direct cytoprotective activities, mainly due to their antioxidative and anti-inflammatory properties. The aim of this study was to investigate the protective effects of melatonin and glycine and their combination on IRI in a rat model of warm ischemia. In this study, Sprague-Dawley rats were assigned to eight groups, including sham and IRI (n = 80). Melatonin and glycine alone or their combination were administered prior to 1 h of uterus ischemia followed by 1 h of reperfusion. Melatonin (50 mg/kg) was administered via gavage 2 h before IRI and glycine in an enriched diet for 5 days prior to intervention. Uterus IRI was estimated by histology, including immunohistochemistry, and biochemical tissue analyses. Histology revealed that uterus IRI was significantly attenuated by pretreatment with melatonin (p = 0.019) and glycine (p = 0.044) alone as well as their combination (p = 0.003). Uterus IRI led to increased myeloperoxidase expression, which was significantly reduced by melatonin (p = 0.004), glycine (p < 0.001) or their combination (p < 0.001). The decline in superoxide dismutase activity was significantly reduced in the melatonin (p = 0.027), glycine (p = 0.038) and combined treatment groups (p = 0.015) when compared to the IRI control group. In conclusion, melatonin, glycine and their combination significantly reduced oxidative stress-induced cell damage after IRI in a small animal warm ischemia model, and, therefore, clinical studies are required to evaluate the protective effects of these well-characterized substances in uterus IRI.

show abstract

Section: Introductionmentioning

confidence: 99%

Melatonin and Glycine Reduce Uterus Ischemia/Reperfusion Injury in a Rat Model of Warm Ischemia

Zitkute

Kvietkauskas

Maskoliūnaitė

et al. 2021

IJMS

View full text Add to dashboard Cite

show abstract

“…Second, UTx possesses elements of both transplantation medicine and ART. Existing ethical frameworks developed specifically for transplantation medicine or ART, therefore, do not straightforwardly map onto the ethics of UTx ( Horvat and Iltis, 2019 ). Third, the prospect of UTx underscores the potential moral or social significance not only of genetic parenthood, but also of gestational parenthood.…”

Section: Ethics Of Uterus Transplantationmentioning

confidence: 99%

“…The position of UTx as a blend of both transplantation medicine and ART is apparent in some criteria. For example, these criteria require that a recipient ‘does not exhibit frank unsuitability for motherhood’, drawing inspiration from ART ethical frameworks ( Lefkowitz et al , 2012 ; Horvat and Iltis, 2019 ). More generally, there is widespread agreement that the physical, psychological, and broader societal risks of UTx ought to be carefully identified and assessed ( O’Donovan et al , 2019 ).…”

Section: Ethics Of Uterus Transplantationmentioning

confidence: 99%

Uterus transplantation: from research, through human trials and into the future

Brännström

Racowsky

Carbonnel

et al. 2023

Human Reproduction Update

View full text Add to dashboard Cite

Women suffering from absolute uterine factor infertility (AUFI) had no hope of childbearing until clinical feasibility of uterus transplantation (UTx) was documented in 2014 with the birth of a healthy baby. This landmark accomplishment followed extensive foundational work with a wide range of animal species including higher primates. In the present review, we provide a summary of the animal research and describe the results of cases and clinical trials on UTx. Surgical advances for graft removal from live donors and transplantation to recipients are improving, with a recent trend away from laparotomy to robotic approaches, although challenges persist regarding optimum immunosuppressive therapies and tests for graft rejection. Because UTx does not involve transplantation of the Fallopian tubes, IVF is required as part of the UTx process. We provide a unique focus on the intersection between these two processes, with consideration of when oocyte retrieval should be performed, whether, and for whom, preimplantation genetic testing for aneuploidy should be used, whether oocytes or embryos should be frozen and when the first embryo transfer should be performed post-UTx. We also address the utility of an international society UTx (ISUTx) registry for assessing overall UTx success rates, complications, and live births. The long-term health outcomes of all parties involved—the uterus donor (if live donor), the recipient, her partner and any children born from the transplanted graft—are also reviewed. Unlike traditional solid organ transplantation procedures, UTx is not lifesaving, but is life-giving, although as with traditional types of transplantation, costs, and ethical considerations are inevitable. We discuss the likelihood that costs will decrease as efficiency and efficacy improve, and that ethical complexities for and against acceptability of the procedure sharpen the distinctions between genetic, gestational, and social parenthood. As more programs wish to offer the procedure, we suggest a scheme for setting up a UTx program as well as future directions of this rapidly evolving field. In our 2010 review, we described the future of clinical UTx based on development of the procedure in animal models. This Grand Theme Review offers a closing loop to this previous review of more than a decade ago. The clinical feasibility of UTx has now been proved. Advancements include widening the criteria for acceptance of donors and recipients, improving surgery, shortening time to pregnancy, and improving post-UTx management. Together, these improvements catalyze the transition of UTx from experimental into mainstream clinical practice. The procedure will then represent a realistic and accessible alternative to gestational surrogacy for the treatment of AUFI and should become part of the armamentarium of reproductive specialists worldwide.

show abstract

“…Current ethical frameworks for UTx are based largely on existing guidelines for solid organ transplantation [ 4 ]. However, UTx differs from other forms of organ transplantation in several important respects.…”

Section: Why Uterine Transplantation Poses Ethical Challengesmentioning

confidence: 99%

Ethical issues in uterine transplantation

Koplin

Kendal

2020

Korean Journal of Transplantation

View full text Add to dashboard Cite

Despite a recent surge of bioethical attention, ethical analysis of uterine transplantation is still in its early stages, and many of the key ethical issues remain underexamined and unresolved. In this paper, we briefly review some key ethical issues associated with uterine transplantation (beyond those associated with organ transplantation more generally). We structure our discussion in terms of Beauchamp and Childress’ four principles of biomedical ethics: beneficence, non-maleficence, autonomy, and justice. Our review highlights some ethical questions that require further bioethical attention before uterine transplantation can be fully embraced as a potential treatment for absolute uterine factor infertility. We close by arguing that the costs and benefits of uterine transplantation need to be considered in the context of other possible treatments for absolute uterine factor infertility and alternative methods of family creation.

show abstract

What Are Good Guidelines for Evaluating Uterus Transplantation?

Cited by 9 publications

References 13 publications

Melatonin and Glycine Reduce Uterus Ischemia/Reperfusion Injury in a Rat Model of Warm Ischemia

Melatonin and Glycine Reduce Uterus Ischemia/Reperfusion Injury in a Rat Model of Warm Ischemia

Uterus transplantation: from research, through human trials and into the future

Ethical issues in uterine transplantation

Contact Info

Product

Resources

About