The world’s first baby has been born via a uterus transplanted from a dead donor. The baby girl was born in Brazil via caesarean section at 35 weeks and three days, and weighed around 6lbs. The transplanted uterus was removed during the caesarean section and showed no anomalies. Currently, uterus donation is only available for women with family members who are willing to donate. With live donors in short supply, doctors say the new technique might help to increase availability and give more women the option of pregnancy. The details of the first baby born following a uterus transplantation from a deceased donor were reported in a case study from Brazil, published in The Lancet. It was also the first uterine transplantation in Latin America.
Experts say the case study shows that uterus transplants from dead donors are feasible and may open access for all women with uterine infertility, without the need for live donors. But the outcomes and effects of donations from live and deceased donors are yet to be compared. The recipient of the transplant was a patient with uterine infertility. Previously, there have been 10 other uterus transplants from dead donors attempted in the United States, Czech Republic and Turkey, but this is the first to result in a live birth. The first childbirth following uterine transplantation from living donors occurred in Sweden in September 2013 and were also published in The Lancet. In total, there have been 39 procedures of the kind, resulting in 11 live births so far.
Infertility affects up to 15 per cent of couples of reproductive age. One in 500 women have uterine anomalies due to congenital anomalies, or through unexpected malformation, hysterectomy, or infection. Before the advent of uterus transplants, the only available options to have a child were adoption or surrogacy. Research leader Dr Dani Ejzenberg, of Universidade de Sao Paulo in Brazil, said: “The use of deceased donors could greatly broaden access to this treatment and our results provide proof-of-concept for a new option for women with uterine infertility. “The first uterus transplants from live donors were a medical milestone, creating the possibility of childbirth for many infertile women with access to suitable donors and the needed medical facilities.
“However, the need for a live donor is a major limitation as donors are rare, typically being willing and eligible family members or close friends. “The numbers of people willing and committed to donate organs upon their own deaths are far larger than those of live donors, offering a much wider potential donor population.”] The surgery took place in September 2016. The recipient of the uterus was a 32 year-old woman born without a uterus as a result of Mayer-Rokitansky-K ster-Hauser (MRKH) syndrome. She had one in-vitro fertilisation (IVF) cycle four months before transplant, resulting in eight fertilised eggs which were cryopreserved. The donor was 45 years old and died of subarachnoid haemorrhage, a type of stroke involving bleeding on the surface of the brain.
The uterus was removed from the donor and then transplanted into the recipient in surgery lasting more than 10 hours. The surgery involved connecting the donor uterus’ and recipient’s veins and arteries, ligaments, and vaginal canals. After surgery, the recipient stayed in intensive care for two days, then spent six days on a specialised transplant ward. She received five immunosuppression drugs, as well as antimicrobials, anti-blood clotting treatment and aspirin while in hospital. Immunosuppression was continued outside of hospital until the birth. Five months after transplantation, the uterus showed no signs of rejection, ultrasound scans showed no anomalies, and the recipient was having regular menstruation. The fertilised eggs were implanted after seven months.
The researchers said that they were able to implant the fertilised eggs into the transplant uterus much earlier than previous uterus transplants. Ten days after implantation, the recipient was confirmed to be pregnant. Non-invasive prenatal testing was done at 10 weeks, showing a normal foetus, and ultrasound scans at 12 and 20 weeks revealed no fetal anomalies. There were no issues during the recipient’s pregnancy, other than a kidney infection at 32 weeks which was treated with antibiotics in hospital.
Both the mum and baby were discharged three days after birth, with an uneventful early follow-up. The immunosuppressive therapy was suspended at the end of the hysterectomy. At the age of seven months, the baby continued to breastfeed and weighed 15lbs and 14oz (7.2 kilos). The researchers say that transplants from deceased donors might have some benefits over donations from live donors, including removing surgical risks for a live donor, and that many countries already have well-established national systems to regulate and distribute organ donations from deceased donors. The recipient and her partner received monthly psychological counselling from professionals specialised in transplants and fertility throughout before, during and after the transplant.