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For the first time in Belgium, a child has been born following a uterus transplant. To date, 65 children have been born in this way around the world. This small number is due to the difficulty of finding uterus donors. Ghent University Hospital, which carried out the transplant, hopes that in the future it can use living donors.
The procedure began in 2018, when the uterus of a brain-dead donor was transplanted into a woman suffering from Mayer-Rokitansky-Küster-Hauser syndrome. This syndrome is characterised by the total or partial absence of a vagina and an underdeveloped or non-existent uterus. To achieve pregnancy in these conditions, embryos were conceived by in vitro fertilisation prior to the transplant and subsequently re-implanted once doctors had established that the transplanted uterus had not been rejected.
While the couple can testify to the psychological difficulties encountered during this procedure, there are also serious bioethical issues associated with this technique, which are highlighted in this EIB article: Uterus transplants: what ethical view? They concern both the health of the recipient and that of the child, whose future health risks cannot be ruled out.
Other bioethical issues are also being raised by the shortage of donors.
The difficulty of finding brain-dead donors has led researchers at the Ghent Hospital to consider a new type of donor, living donors. These donors are still very rare, since removing the uterus for transplantation involves removing the blood vessels in the pelvic wall without damaging the nerves around them. While this technique makes it possible to plan the surgery and select potential donors in advance, it remains highly complex and carries real health risks for the donors.
Researchers are therefore interested in another donor profile. These are women suffering from serious brain damage but who are not necessarily brain dead, and for whom the decision to stop treatment has been taken by the doctors and the family, due to a lack of satisfactory quality of life. In this case, death is caused by the cessation of life-sustaining treatment, which results in the cessation of circulation (Maastricht III). This category makes it possible to widen the pool of donors in a context of shortage. However, the procedure may give rise to a conflict for doctors or their families between the desire to save lives and the decision to stop the treatment of the potential donor patient. In the case of uterus transplants, this procedure would be all the more problematic as this organ is not vital (see EIB dossier on organ donation).