Doctors plan first womb transplant in U.S.

First came kidney, liver and heart transplants. Then a few doctors started transplanting hands. French surgeons did a face.

Now, doctors are planning the first uterine transplant in the United States.

A team based in Manhattan has begun screening women left barren by cancer, injuries or other problems who want a chance to bear their own children.

"The desire to have a child is a tremendous driving force for many women," said Giuseppe Del Priore, of the New York Downtown Hospital, who is leading the team. "We think we could help many women fulfill this very basic desire."

But the planned operation, which Del Priore and his colleagues could attempt later this year, is stirring objections among some transplant experts, fertility specialists and medical ethicists.

They question whether the procedure has been tested enough on animals and whether the benefit of being able to carry a pregnancy outweighs the risks for the woman and fetus.

"This raises a set of very difficult medical and ethical questions," said Thomas Murray, who heads the Hastings Center, a biomedical-ethics think tank in Garrison, N.Y. "I think it's very questionable."

In-vitro fertilization

After performing the complex surgery, doctors would wait, probably about three months, to make sure the organ is functioning and has been stabilized with anti-rejection drugs.

An embryo created through in-vitro fertilization (IVF) then would be placed in the womb. If all goes well, the baby would be delivered by Caesarean section to minimize any risks from labor and allow doctors to simultaneously remove the uterus, so the woman could discontinue the anti-rejection drugs.

"We are calling it a temporary transplant," Del Priore said. "This minimizes the time patients have to be on the medications, and makes it a much more reasonable risk to take to have a baby."

Eventually, women with such transplants might be able to get pregnant without IVF, said Jeanetta Stega, who is working with Del Priore.

The operation would mark a confluence of two medical specialties — transplant surgery and reproductive medicine — that frequently spark controversy.

"It is the convergence of two fields that are already embedded in large ethical disputes," said Lori Andrews, a bioethicist at the Chicago-Kent School of Law. "This represents the worst of both worlds."

Although many obstacles would have to be overcome, some wonder whether the procedure, if successful, could theoretically lead to men being able to bear children.

"If they perfect this procedure, trust me, somebody else will think it's a good idea," Murray said. "If gay marriage gets some people upset, this is going to tip a lot of people over the edge."

Del Priore and others defend the effort in women, saying the surgery will be tried only after careful vetting by independent experts.

They note that thousands of women cannot bear children because they were born with a malfunctioning uterus or their wombs were damaged by cancer, accidents, pregnancy complications or other problems. Women who want the operation are being screened to make sure they fully appreciate the risks and have seriously considered alternatives.

Many women who lack a functioning womb suffer terribly, said Del Priore, a gynecological oncologist. He described a pregnant woman who started hemorrhaging after a car accident. "Suddenly her husband is dead, her baby is dead and her uterus is gone. It's terrible suffering. I think she deserves every possibility."

Some ethicists and other experts, while expressing reservations, agreed, as long as doctors are fairly confident of success and prospective patients understand the risks.

"I think patients deserve autonomy," said Alan DeCherney, a fertility expert speaking on behalf of the American Society of Reproductive Medicine. "As long as they know all the facts, it should be their choice."

While women who have undergone other kinds of transplants have had healthy babies, it may be risky to subject developing fetuses to anti-rejection drugs and possibly an inhospitable uterus.

"You might have a viable fetus, but as it outgrows the blood supply you might end up with a compromised fetus," said John Fung, a Cleveland Clinic transplant surgeon.

Saudi Arabia

After practicing in baboons and goats, doctors in Saudi Arabia reported in 2002 that they had performed the first human uterus transplant on a 26-year-old woman whose womb had been removed six years earlier because of hemorrhaging after the birth of her first child.

The donor was a 46-year-old woman with an ovarian condition that required removal of her ovaries and uterus. Although blood clots forced surgeons to remove the organ after 99 days, doctors called the procedure a technical success.

Del Priore and his colleagues repeated the transplant in rats, pigs, rabbits and a rhesus monkey, in which they plan to try a pregnancy. They also showed that human wombs could be removed from deceased organ donors in the United States.

"I think we're ready," Del Priore said.

Hundreds of women have inquired about undergoing the transplant, including between 40 and 50 who are being screened, Del Priore and his colleagues said.

Some experts say more work should be done on animals before attempting the operation in a woman, including showing that a primate could bear offspring with a transplanted uterus.

"I think we should do more animal research before we do it in a human," said Mats Brannstrom, of Goteborg University in Sweden, who has been trying the procedure on mice, pigs and sheep.

"We have to be sure it's a safe procedure and that we know exactly how we would do it in humans. We haven't done all those experiments yet."

But even if animal surgeries showed the procedure could work, some questioned whether it is ethical to subject a woman to the risks of major surgery — and both mother and baby to powerful anti-rejection drugs — for a condition that is not life-threatening.

"This is not like a kidney transplant; it's not medically necessary to the woman's life," said Andrews, the law-school bioethicist.