FRIDAY, March 8, 2002 (HealthDayNews) -- The announcement that Saudi doctors performed the world's first uterine transplant has some American experts questioning its true success and wondering whether it's right to give someone a new organ that, although life-giving, isn't lifesaving.
Dr. Jonathan Bromberg, a transplant specialist at Mount Sinai School of Medicine in New York City, had this reaction when he read about the advance yesterday: "I just rolled my eyes."
Why, Bromberg thought, would the Saudi doctors have performed the procedure in a woman when there's so little evidence that it could work even in animals? "It's still very experimental and very much science fiction," he said.
Bromberg said he's also concerned that the dangers of transplants outweigh the reward in the case of wombs. Major surgery can be deadly, and the immune-suppressing drugs used to protect the new organ have significant rates
of serious complications, including certain cancers.
"You've got to differentiate between livesaving procedures and lifestyle procedures," Bromberg said. "As important as pregnancy is, getting a new uterus is not like getting a kidney or a heart or a lung. It's not even close."
The transplant, performed in Jidda, Saudi Arabia in April 2000, held for 99 days before it had to be removed after a blood clot in a feeder vessel began starving the organ. The patient was 26 at the time of the surgery, but 20 when she lost her uterus
after a Caesarean section that bled badly. She had to take powerful immune-suppressing drugs to keep the graft, which she received from a 46-year-old woman who'd undergone a hysterectomy.
The surgeons reported their feat in the March issue of the International Journal of Gynecology and Obstetrics.
The Saudi doctors considered the operation confirmation of the "surgical technical feasibility and safety" of the womb transplant, and called the short- and mid-term outcomes "acceptable."
However, Dr. Kutluk Oktay, a fertility researcher at Cornell University's Weill Medical College in New York City, said he's not convinced. "They really didn't show any conclusive evidence that it really worked," Oktay said.
Although the Saudi doctors reported that the woman had two menstrual periods after hormone treatments were stopped, the bleeding could have been a result of her surgery, Oktay said. "She had a major procedure down there. It could
have been bleeding from anything."
If the operation demonstrates that womb grafts are technically possible, at least in the short run, Bromberg said the procedure has too many question marks to be a realistic operation.
For starters, the uterus is fed by so many small blood vessels that it's difficult to know which are vital and which don't need to be attached. The organ, he added, is also "exquisitely hormonally sensitive," adding yet unknown complexity to keeping the graft healthy.
The issue of immune suppression can probably be overcome, Bromberg suggested, at least as far as allowing women to conceive in a donated womb. Doses of the drugs start high after the operation and are scaled back gradually as the
body proves it won't reject the foreign organ. The powerful drugs don't seem to increase the risk of birth defects or developmental delays, Bromberg said, though there have been no good studies to prove it.
Canadian scientists reported earlier this year in the journal Teratology that kidney transplant patients who became pregnant while receiving immune-suppressing therapy had a much higher than normal rate of stillbirths and preemie deliveries. Their babies were also more likely to be underweight at birth.
Should the donor uterus avoid rejection, it's far from certain it could ever support a pregnancy, Bromberg said. The organ will be marred by scar tissue that might increase the chances of rupture as it grows, if it in fact grows
properly.
Even healthy women have immune responses to the developing fetus, whose cells are half foreign. But in a transplanted womb that's already suspect, the addition of a pregnancy might be too much for the immune system to tolerate.
On the other hand, Bromberg added, it's possible that the fetus might mollify the body's defenses. The trouble, he said, is that no one knows the answers to these questions.
Considering the chances for harm not only to the young women who would undergo a womb transplant, but to the pregnancies they might then carry, Oktay said the matter is clear: "Ethically, it wouldn't make sense to take all this risk."
What To Do: To learn more about organ transplants, visit TransWeb or the United Network for Organ Sharing
. For more on organ donation, try the U.S.
Department of Health and Human Services.
