It is estimated there are 15,000 women a year in Britain who suffer UFI. Given that the U.S. population is approximately five times that of Britain, there would be approximately 75,000 women in the U.S. in any given year who cannot become pregnant either because they are born without a womb or their wombs have been destroyed by fibroids/cancer treatment or are rendered non-functional because of disease.
2.
The congenital absence of a uterus and vagina is known as the Rokitansky-Kuster-Hauser syndrome. Before uterine transplantation can be attempted in a woman with Rokitansky syndrome a vagina should be constructed, ideally, in early adulthood. The special attention to arterial and venous angiography to plan anastomosis sites for uterine grafting would be especially critical in uterine recipients with Rokitansky syndrome due to typical vascular anomalies.
3.
Requisites for women hoping for natural conception within UT are well-functioning fallopian tubes and ovaries with oocytes.
4.
The salient features of the Del Priore model have been explained in the following media reports: Antony Blackburn-Starza, “New York Surgeons Announce Plans for Womb Transplant,” BioNews 392 (January 22-28, 2007); Heidi Nicholl, “New York Doctors Given Go-Ahead to Attempt Womb Transplants,” BioNews 384 (November 7-13, 2006); Julie Wheldon, “New York Doctor Given Go-Ahead for World's First Womb Transplant,” http://www.dailymail.co.uk/pages/live/articles/news/news.html; Marilynn Marchione, “Uterus Transplant May Enable Pregnancy,” Washington Post, January 15, 2007, http://www.washingtonpost.com/wp-dyn/content/article/2007/01/15; Associated Press, “Hospital Plans to Offer Uterus Transplant,” January 15, 2007, http://www.msnbc.msn.com/id/16637583.
5.
BrännströmMats, WranningCaiza Almen, and El-AkouriRanda Racho, “Transplantation of the Uterus,”Molecular and Cellular Endocrinology202 (2003): 177–184.
6.
FageehW.“Transplantation of the Human Uterus,”Int. J. Gynaecol. Obstet.76.3 (2002): 245–251. These clinical researchers practiced first on baboons and goats before attempting human UT. Rob Stein, “First U.S. Uterus Transplant Planned,” Washington Post, January 15, 2007, http://www.washingtonpost.com/wp-dyn/content/article/2007/01/14.
7.
Fageeh reported that they successfully treated an episode of acute rejection on the ninth day after the uterus transplant with antithymocytic globulin. The uterine graft also responded well to combined estrogen-progesterone therapy with two episodes of withdrawal bleeding after cessation of the hormone therapy indicating good blood perfusion and viability of the uterosalpingeal graft. Fageeh, et al., “Transplantation of the human uterus,” 248.
8.
As the abstract of Fageeh's case report article explains: The blood clot (acute vascular occlusion) “appeared to be caused by an inadequate uterine structure support, which led to probable tension, torsion, or kinking of the connected vascular uterine grafts.” Ibid, 245.
9.
Marchione, “Uterus Transplant May Enable,”1.
10.
Stein, “First U.S. Uterus,”3.
11.
BrännströmMats“Transplantation of the Uterus,”Molecular and Cellular Endocrinology202 (2003): 178–81.
12.
The last two characteristics of what I have called the Brännström model of UT are less those of the researcher and more of my own extrapolation based on its unique goal of using live rather than cadaveric donors. Brännström, like Del Priore, stipulates that the uterine recipient must have a “satisfactory ovarian reserve” so she “can undergo IVF treatment with good chances of achieving fertilization.” However, since he hopes to use a live donor/relative who could be a close tissue match, there would definitely be less risks for the recipient from immunosuppressants. With less risk from exposure to these drugs, there would also be the possibility for the uterine recipient and her husband to take whatever time needed to achieve a pregnancy naturally, thereby escaping the moral and physical dangers of the expedient baby-making of IVF and ET. And, finally, with less risk from anti-rejection drugs, there would be less need to remove the uterine graft and to suppress the recipient's procreative capacity. Furthermore, if the graft could be retained without medical complications up to and including the first gestation, the uterine recipient may be able to achieve pregnancy more than once. I am painfully aware, however, that the second and third characteristic phases of what I have called the Brännström approach, while theoretically plausible, will only be able to be practically implemented after the entire UT procedure is optimized. It is also possible that natural conception and permanency of the graft will never be viable options for women contemplating UT. Nonetheless, I would insist that, before UT would conform to the dignity of life, procreation and bodily integrity, a woman who has identified a uterine graft that is genetically friendly must also be able to opt for natural conception and permanency of the graft.
13.
I have also applied these principles in a comparative study of the medical-moral effectiveness of IVF and NaProTechnology in treating infertility. Cf. FurtonEdward J., ed. Live the Truth: The Moral Legacy of John Paul II in Catholic Health Care (Philadelphia: National Catholic Bioethics Center, 2006), 203–231.
14.
Congregation for the Doctrine of the Faith, (Donum Vitae) The Gift of Life: In struction on Respect for Human Life in Its Origin and on the Dignity of Procreation (Boston: National Catholic Bioethics Center, n.d.), intro., n. 5.
15.
Marchione, “Uterus Transplant May Enable,”2.
16.
BrännströmTransplantation of the Uterus.182.
17.
AltchekAlbert“Uterus Transplantation,”The Mount Sinai Journal of Medicine70 (2003): 160.
As Thomas H. Murray, director of the Hastings Center put it: “If they perfect this procedure [UT], trust me, somebody else will think it's a good idea [men bearing children]…. If gay marriage gets some people upset, this is going to tip a lot of people over the edge.” Stein, “First U.S. Uterus,” 3.
Catholic Medical Quarterly, quoting address of John Paul II to the First International Congress of the Society for Organ Sharing, June 20, 1991.
27.
In an editorial, Del Priore and co-author, Louis G. Keith, opine that, although uterine transplantation does not affect the life of the recipient, it certainly affects the “the ability of the recipient to reproduce. To some individuals, childbearing is the greatest event of a lifetime. To such persons, transplantation of organs of reproduction would not be considered frivolous or unnecessary, even though these organs do not sustain life.” International Journal of Gynecology & Obstetrics76 (2002): 243–244.
The reperfusion process, insuring that the recipient's blood flows through the veins and arteries of the grafted uterus, provides a physiological confirmation of the fact that the grafted uterus becomes a part of the embodied person of the uterine recipient.
30.
Benedict AshleyO.P.Justice in the Church (Washington, D.C.: The Catholic University of America Press, 1996), esp. ch. III, “Men and Hierarchy,” 67-130; and ch. IV, “Women and Worship,” 131-163.
31.
AshleyBenedict, and O'RourkeKevin D.Health Care Ethics: A Theological Analysis, 4th ed. (Washington, D.C.: Georgetown University Press, 1996): 219–223.
32.
If surgery is used to remove or damage a part of the body when the continued functioning of that body part does not present a threat to the whole body, such surgery constitutes mutilation. Applied to the surgical removal of a uterus (hysterectomy): If the uterus is removed (even for the good goal of donating it to a woman without a womb) without the organ presenting any threat from to the woman's bodily health or life, the hysterectomy is directly sterilizing or mutilation.
33.
Cadaveric donation of cornea, on the other hand, is morally acceptable and has proven to be a medical success. Cullen, “Organ Donation,” 3.
34.
Altchek, “Uterus Transplantation,”160.
35.
George Agich underscores the point that, because human UT is investigative transplantation, it must be undertaken responsibly. Besides adequate preparatory research, the success of experimental transplantation largely depends on “the skill or experience—the ‘field strength’ of the team performing the procedure.” “Extension of Organ Transplantation: Some Ethical Considerations,”The Mount Sinai Journal of Medicine.70 (2003): 146.
36.
Associated Press, “Hospital Plans to Offer,”3.
37.
Brännström, “Transplantation of the Uterus,”183.
38.
Altchek lists the following known risks involved with UT: those “associated with anesthesia, surgery, graft rejection and antirejection medication, susceptibility to infection, and increased long-term possibilities of diabetes, hypertension, and neoplasm, as well as risks of in vitro fertilization, should that be necessary.” “Uterus Transplantation,”157.
39.
Stein, “First U.S. Uterus,”1.
40.
“First U.S. Uterus,”, 2. As of this writing, Del Priore's lab told me that their published report of UT in a rhesus monkey is in its final edition and will be published soon.
41.
Consider Altchek's description of the unique internal circulation system of the uterus and the challenge it presents for uterine reanastomosis: “while each kidney most often has a single, separate artery and vein, the uterus has a symmetrical circulation from a lateral uterine artery on each side, resulting from the embryonic fusion of the paired bilateral Müllerian duct to form a single uterus. In addition, the interior of the uterus has multiple anastomosing arcuate horizontal arteries connecting each uterine artery running in both anterior and posterior walls…. Furthermore, the arterioles of the uterus have extensive anastomoses with those of the adjacent vagina, which receives branches from the lateral hypogastric or uterine arteries. Thus nature has endowed the pear-sized uterus with an extraordinarily abundant arterial circulation which prepares the uterus for random placentation either in the anterior or posterior wall and permits nourishment to the fetus.” And then there is the really difficult problem of a successful UT graft—reanastomosing the venous circulation of the uterus. “Veins run with arteries but are more numerous, and they are narrower, thin walled, and delicate. Anatomists have never paid much attention to them except to indicate an extensive, continuous, dense plexus of veins involving the uterus, parametrium, vagina, bladder, tubes and ovaries.” “Uterine Transplantation,” 158.
42.
Fageeh, et al. advise future transplant teams attempting human UT to learn how to properly secure the grafted uterus in place to prevent the thrombosis that proved to be the nemesis of their first attempt: “Strong fixation of the transplanted uterus to the anterior abdominal wall and the sacral promontory is required, as the uterus lacks the support of the uterosacral ligaments and could develop slow progressive or acute prolapse with consecutive thrombosis, infarction, and loss of the uterus.” “Transplantation of the Human Uterus,”251.
43.
Associated Press, “Hospital Plans to Offer,” 1; Marchione, “Uterus Transplants May Allow,” 1.
44.
Altchek, “Uterus Transplantation,” 157, 160; Brännstrom“Transplantation of the Uterus,”181, 182.
45.
Racho El-AkouriR., KurlbergG., and BrannstromM.“Successful Uterine Transplantation in the Mouse: Pregnancy and Postnatal Development of Offspring,”Hum Reprod.18 (2003): 2018–2023.
46.
WranningCiaza Almén“Auto-Transplantation of the Uterus in the Domestic Pig (Sus scrofa): Surgical Technique and Early Reperfusion Events,”J. Obstet. Gynaecol. Res.32 (2006): 359; Mckenna, “Uterus Transplant,” 1.
47.
A risk for uterine transplantation or any other medical procedure has two defining characteristics: the level of probability and the extent of damage. Further research with UT will help to identify known risks by means of a risk percentage or statistical frequency. And, of course, a very probable risk could be easily tolerated if it brought only a small amount of damage. However, a risk that causes a high level of damage, even though highly improbable, brings more concern and requires more caution. Expanded research efforts in UT, especially in respect to risks to the woman receiving the graft and any baby conceived subsequently, would help to clarify the probability issue and, ultimately, whether the level of probability and the extent of damage are ethically acceptable. Pontifical Academy for Life, “Xenotransplantation,” 11.
48.
Brännström“Transplantation of the Uterus,”181.
49.
Marchione“Uterus transplants,”2.
50.
“Uterus transplants,”, 3.
51.
Brännström“Transplantation of the Uterus,”182; Stein, “First U.S. Uterus,” 1.
