For the first time even two women in Germany have brought healthy children after they were transplanted a donated uterus. In charge of this pioneering work, the Tübingen gynecologist Sara Brucker, who accompanied this very special Caesarean section at the city's University Hospital in March and in May 2019 was. She and her team had successfully transplanted in October 2016 for the first time a uterus.
When is a uterus transplantation indicated?
There are young women who possess functioning ovaries but lack the uterus. Reasons for this can be an emergency or cancer surgery or there is a congenital malformation before that can go so far that the uterus from birth was completely absent. A very special malformation of this kind is the Müllerian agenesis, where the two women mentioned above suffered. Her breasts, ovaries, clitoris and labia are indeed trained normally, but the vagina has forgotten nature with them.
This rare genital malformation is, after all, before one out of 4,500 girls. All in all, this makes in Germany alone each year from up to 80 such cases. When the girls affected grow up, they can not get a child of their own, since surrogacy is banned in this country.
The two patients, one of which is reported here were at the time of the uterus transplantation 22 or 23 years old. Both were initially created a vagina during the teenage years. In both cases it was the mothers who have their daughters donated her uterus. So a complex procedure lasts about twelve hours with just the removal is particularly complicated. This is due to the many, located deep in the pelvis vessels supplying the uterus. They expose without getting hurt, is an extremely delicate work.
The sensation is perfect
Only six weeks after the operation was ever clear that both transplanted organs were actually functional. The young women got her period for the first time in life. A year later, they sat the women their own fertilized eggs one at a suitable location. In March 2019 it finally happened: A healthy child was born. Following her mother's request, this sensation was not immediately disclosed to the public.
Still, this a successful, umfängliches, medical project of scientific value was. After all, it has more than 40 experts, including leading figures from Sweden, participated in 18 departments. So far Tübingen can be proud of three successful uterus transplants, although one of these women has brought a child into the world. A fourth transplant failed because the uterus did not fit.
That this type of transplant is successful feasible so healthy children are born with a transplanted womb to the world, the Swedish gynecologist Mats Brännström in 2014 had already been established. Also in this case the uterus from a living donor came. Uterine transplants, there is now the world about 40 in number, which allow more than ten births are connected. Last year a woman in South America gave birth to a healthy child with the particularity that the uterus even came from a deceased donor.
Who should pay?
The two current Tübingen cases, the health of the patients were asked to pay the cost is not yet precisely quantified. Alfred Königsrainer is the medical director of the Department of Transplant Surgery. He estimates the cost per procedure still below 50,000 euros. The exploration of the costs associated with the preparation of financial support by the health insurance the way, was an important aspect in this research project.
Xavier Rogiers, director of the transplant center at the University Hospital of Ghent in Belgium, advocates that the uterus transplantation must not only be an option for the rich and must be therefore already covered by health insurance. He stressed in the same breath that the risk to the living donor is not zero. This must be weighed in each individual case with the quite limited chance of the recipient, to get a healthy child of their own. Against this (ethical) background, the questions may be like rolled up again by surrogacy.
Pros and cons of uterus transplantation from an ethical perspective
Claudia Bozzaro belongs to the Institute for Ethics and History of Medicine at the Albert-Ludwigs-University of Freiburg. She keeps this transplant for non-proportional, precisely because to a healthy donor has to undergo an extremely invasive procedure above him, one more hour operation, which has absolutely no health benefits for them. It does not go so about saving the recipient's life. Against this background, the ethical legitimacy of these living donation more than questionable.
Urban Wiesing is the director of the Institute for Ethics and History of Medicine at the University of Tuebingen. He argues that it is a very central point in their life for most women to have children of their own. This was the women concerned have never possible, causing untold suffering indeed. So also belong a uterus transplant in the genuine task field of medicine, namely to help the suffering, sick people.
Xavier Rogiers from the Transplant Center of the University Hospital Ghent focuses attention more on the advantages and disadvantages of alternative options for these women, especially on the issues of adoption and surrogacy, and no longer criticizes the modern ban on surrogacy in Germany.