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Vyas P, Sader D, Testa G, Du J, Wall A, Johannesson L. Exploring Divergent Views: A Comparative Study of Uterus Transplantation Perceptions among Transplant and Obstetrics/Gynecology Providers. J Clin Med 2024; 13:3182. [PMID: 38892894 PMCID: PMC11172972 DOI: 10.3390/jcm13113182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/20/2024] [Accepted: 05/24/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Uterus transplantation (UTx) provides women with absolute uterine-factor infertility (AUFI) the opportunity to carry their own pregnancy and deliver a child. There are multiple ethical and medical concerns associated with UTx. Since the last survey of US provider perceptions of UTx in 2018, there have been additional reports of successful transplantations and pregnancies. This study aimed to identify the perception of UTx among providers involved in the diagnosis of AUFI and on the transplant team to help us understand knowledge gaps and determine what barriers must be overcome for UTx to be used in general clinical practice. Methods: We administered REDCap surveys to conference attendees at the 2023 American College of Obstetricians and Gynecologists (ACOG) conference and 2023 American Transplant Congress (ATC). Participants were recruited by medical student volunteers. Results: Two hundred ACOG and ATC attendees completed the survey. Medical concerns related to UTx were reported by 42% of providers from ACOG compared to 22% of providers from ATC. Overall, 76% of participants agreed that UTx should be an option for patients with congenital AUFI. Lastly, 68% of participants agreed that the procedure should be presented as an option for transgender women. Conclusions: This study further elucidates the perception of UTx among obstetricians/gynecologists and transplant physicians. We found greater support for the procedure than in previous studies. This study also demonstrates provider support for presenting this procedure as an option for transgender women.
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Affiliation(s)
- Prema Vyas
- Burnett School of Medicine, Texas Christian University, Fort Worth, TX 76109, USA
| | - Danielle Sader
- Burnett School of Medicine, Texas Christian University, Fort Worth, TX 76109, USA
| | - Giuliano Testa
- Department of Surgery, Baylor Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX 75246, USA; (G.T.); (J.D.); (A.W.)
| | - Jinyu Du
- Department of Surgery, Baylor Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX 75246, USA; (G.T.); (J.D.); (A.W.)
| | - Anji Wall
- Department of Surgery, Baylor Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX 75246, USA; (G.T.); (J.D.); (A.W.)
| | - Liza Johannesson
- Department of Surgery, Baylor Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX 75246, USA; (G.T.); (J.D.); (A.W.)
- Department of Obstetrics and Gynecology, Baylor University Medical Center, Dallas, TX 75246, USA
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Lee JY. Who should provide the uterus? The ethics of live donor recruitment for uterus transplantation. JOURNAL OF MEDICAL ETHICS 2023:jme-2023-109227. [PMID: 37640534 DOI: 10.1136/jme-2023-109227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 08/15/2023] [Indexed: 08/31/2023]
Abstract
Uterus transplantation (UTx) is an experimental surgery likely to face the issue of organ shortage. In my article, I explore how this issue might be addressed by changing the prevailing practices around live uterus donor recruitment. Currently, women with children - often the mothers of recipients - tend to be overrepresented as donors. Yet, other potentially eligible groups who may have an interest in providing their uterus - such as transgender men, or cisgender women who do not wish to gestate or to have children - tend to be excluded as potential donors. Moving forward, I recommend that donor inclusion criteria for UTx be broadened to be more inclusive of these latter groups.
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Affiliation(s)
- J Y Lee
- Department of Public Health, University of Copenhagen, Kobenhavn 1172, Denmark
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Johannesson L, Testa G, Beshara MM, da Graca B, Walter JR, Quintini C, Latif N, Hashimoto K, Richards EG, O’Neill K. Awareness and Interest in Uterus Transplantation over Time: Analysis of Those Seeking Surgical Correction for Uterine-Factor Infertility in the US. J Clin Med 2023; 12:4201. [PMID: 37445236 PMCID: PMC10342774 DOI: 10.3390/jcm12134201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/07/2023] [Accepted: 06/15/2023] [Indexed: 07/15/2023] Open
Abstract
This study describes the characteristics of women who contacted an active program performing uterus transplantation (UTx) in the US, expressing interest in becoming a uterus transplant recipient or a living donor. Basic demographic and self-reported clinical information was collected from women who contacted any of the three US UTx programs from 2015 to July 2022. The three centers received 5194 inquiries about becoming a UTx recipient during the study timeframe. Among those reporting a cause of infertility, almost all of the reports (4066/4331, 94%) were absence of a uterus, either congenitally (794/4066, 20%) or secondary to hysterectomy (3272/4066, 80%). The mean age was 34 years, and 49% (2545/5194) had at least one child at the time of application. The two centers using living donors received 2217 inquiries about becoming living donors. The mean age was 34 years, and 60% (1330/2217) had given birth to ≥1 child. While most of the UTx clinical trial evidence has focused on young women with congenital absence of the uterus, these results show interest from a much broader patient population in terms of age, cause of infertility, and parity. These results raise questions about whether and to what extent the indications and eligibility criteria for UTx should be expanded as the procedure transitions from the experimental phase to being offered as a clinical treatment.
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Affiliation(s)
- Liza Johannesson
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX 75246, USA
- Department of Obstetrics and Gynecology, Baylor University Medical Center, Dallas, TX 75246, USA
| | - Giuliano Testa
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX 75246, USA
| | - Menas M. Beshara
- TX A&M College of Medicine, Texas A&M University, Dallas, TX 75231, USA
| | - Briget da Graca
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX 75246, USA
| | - Jessica R. Walter
- Department of Obstetrics & Gynecology, Northwestern University, Chicago, IL 60611, USA
| | - Cristiano Quintini
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Nawar Latif
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA 19107, USA
| | - Koji Hashimoto
- Department of General Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH 44103, USA
| | - Elliott G. Richards
- Obstetrics and Gynecology and Women’s Health Institute, Cleveland Clinic, Cleveland, OH 44103, USA
| | - Kathleen O’Neill
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA 19107, USA
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Maraschio MA, Larcher JMS, Alcaraz A, Giordano E, Reimondez S, Luján O, Iraci M, Sereno JL, Priotto A, Domínguez O, Valle P, Abrego M, Rubio S, Lamberto C, Villada E. Uterus transplantation in a sheep model: novel surgical technique with long-term survival and uterus vitality. First case series in Argentina. JBRA Assist Reprod 2021; 25:557-562. [PMID: 34463443 PMCID: PMC8489826 DOI: 10.5935/1518-0557.20210035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To develop a sheep autologous uterus transplantation (UT) program with an innovative surgical technique and assess long term uterus vitality and animal survival. METHODS A novel surgical technique consisting of the procurement of the complete uterus and the two ovaries, back table vascular reconstruction, and subsequent implantation in the same animal, performing only two arterial and two venous anastomoses. RESULTS Four autologous transplantations were performed; anesthesia and surgery were well tolerated by all the animals without complications. Direct observation and Doppler US performed a week after UT and laparoscopy performed three months later confirmed uterus vitality. All animals were alive more than a year after transplantation. CONCLUSIONS Our study was the first to describe a novel surgical technique for sheep uterus autologous transplantation in Latin America, showing long-term survival and uterus vitality.
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Affiliation(s)
- Martín A Maraschio
- Liver, Kidney and Pancreas Transplant Program in Hospital Privado Universitario de Córdoba, Argentina
| | - José M Sad Larcher
- Department of Obstetrics and Gynecology of Hospital Privado Universitario de Córdoba, Argentina
| | - Alvaro Alcaraz
- Liver, Kidney and Pancreas Transplant Program in Hospital Privado Universitario de Córdoba, Argentina
| | - Enzo Giordano
- Liver, Kidney and Pancreas Transplant Program in Hospital Privado Universitario de Córdoba, Argentina
| | - Santiago Reimondez
- Liver, Kidney and Pancreas Transplant Program in Hospital Privado Universitario de Córdoba, Argentina
| | - Oscar Luján
- Department of Animal Clinic, Faculty of Agronomy and Veterinary, Universidad Nacional de Río Cuarto, Córdoba, Argentina
| | - Marcelo Iraci
- Department of Surgical Pathologies, Faculty of Agronomy and Veterinary, Universidad Nacional de Río Cuarto, Córdoba, Argentina
| | - José L Sereno
- Hospital Escuela of the Faculty of Agronomy and Veterinary, Universidad Nacional de Río Cuarto, Córdoba, Argentina
| | - Analía Priotto
- Department of Anesthesiology, Hospital Privado Universitario de Córdoba, Argentina
| | - Olga Domínguez
- Liver, Kidney and Pancreas Transplant Program in Hospital Privado Universitario de Córdoba, Argentina
| | - Pablo Valle
- Department of Orthopedics and Traumatology, Hospital Privado Universitario de Córdoba, Argentina
| | - Maximiliano Abrego
- Department of Obstetrics and Gynecology of Hospital Privado Universitario de Córdoba, Argentina
| | - Soledad Rubio
- Department of Plastic and Reconstructive Surgery, Hospital Privado Universitario de Córdoba, Argentina
| | | | - Eduardo Villada
- Veterinary Hospital, Universidad Católica de Córdoba, Argentina
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Uterine Transplantation: Evolving Data, Success, and Clinical Importance. J Minim Invasive Gynecol 2020; 28:502-512. [PMID: 33348011 DOI: 10.1016/j.jmig.2020.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/09/2020] [Accepted: 12/15/2020] [Indexed: 11/22/2022]
Abstract
Uterine transplantation is an evolving procedure to allow for childbearing in paitents with absolute uterine factor infertility. The objective of this study was to review the existing literature using a comprehensive PubMed literature search. A systematic medical subheadings search strategy was used with the terms "uterus transplant" and "uterine transplantation". Of the 75 full-text articles assessed for eligibility, 68 were included in the qualitative synthesis. Of these, 9 were included in the meta-analysis on living donor uterine transplant, 5 on deceased donor uterine transplant, and 6 case reports of single uterine transplants. In conclusion, uterus transplant is a nascent field undergoing a rapid rate of evolution as programs mature their data and increase the number of procedures performed. The most recent publications and advances are thus summarized in this article to capture the most up-to-date information.
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