Uterus Transplant Faces Technical, Ethical Hurdles

For some, it might seem like a dream come true. For others, it is simply another step toward an ethically disquieting "brave new world."

Little surprise, then, that one Manhattan hospital's move to perform a uterus transplant has reignited the controversy over this prospective procedure.

A team of doctors, led by Dr. Giuseppe Del Priore of New York Downtown Hospital, has begun screening candidates for the first uterus transplant in the United States.

Such an operation would conceivably offer hope to women who desire to have children but cannot because of past disease or injury. Concerns over risks of the procedure to both mother and fetus, however, outweigh these potential benefits, some say.

But while the public finds itself once again caught up in the ethical dilemma of whether such surgeries should be allowed, transplant experts say that developing the surgery into a reliable technique could take years -- if ever.

"I would certainly say that this is not in the next 10 years," says Dr. Sherman Silber, director of the St. Luke's Hospital's Infertility Clinic of St. Louis.

Another factor that could limit the likelihood that such a procedure will be adopted in the future is that a relatively simple alternative already exists -- surrogacy.

"Gestational surrogacy is a fairly accepted procedure," says Dr. Richard Paulson Director of USC Fertility in Los Angeles, Calif. "The approach of uterine transplant seems doubtful, as this would be technically difficult. It's just not that plausible.

"I am skeptical that this would have a wide application."

The procedure, however, has been attempted -- and arguably completed -- in the past.

In 2002, doctors in Saudi Arabia's King Fahad Hospital and Research Center performed the first human uterus transplant operation.

Doctors transplanted the uterus of a 46-year old woman into a 26-year-old Saudi woman whose uterus had been removed six years earlier.

The woman receiving the uterus took powerful drugs in order to prevent rejection -- a treatment that compromised her immune system. She also received hormone injections to allow the transplanted uterus to develop normally.

After 99 days, blood flow to the transplanted uterus stopped, and the organ was removed. No pregnancy had occurred while the uterus was inside the recipient. Still, surgeons counted the experience as a success.

The procedure has also been carried out in animals, including a Rhesus monkey.

Risks to Mother, Fetus, Could Heighten Controversy

Considering the nature of the procedure, it is no surprise that many find the prospect of a uterus transplant controversial or even objectionable.

However, while the public at large may object to the operation on gut principle, Silber and Paulson note other reasons for concern.

"Something shouldn't be considered unethical just because it is new and shocking," says Silber. He says he is not opposed to the transplant of reproductive organs; he has performed testicular and ovarian transplants in the past.

"But there is no real danger associated with these procedures," he says, adding that the potential risks of uterus transplant procedures render them "dead in the water, as a concept."

"Let's say that this could be done," Silber says. "If you have a rejection anytime during pregnancy, that's an intra-abdominal disaster. The uterus could be rejected while the fetus is still alive."

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