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The uterus transplant patient born to the uterus raises ethical questions: vaccines

The first baby born as a result of a uterus transplant in the United States in the neonatal unit at Baylor University Medical Center in Dallas.


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The first baby born as a result of a uterus transplant in the United States in the neonatal unit at Baylor University Medical Center in Dallas.


Beautiful. Pure. Natural. Medicine at its pinnacle.

Those were the words of Dr. Giuliano Testa this week: the principal investigator of a clinical trial with ten women in progress at Baylor University Medical Center in Dallas.

He talked about the birth of a baby to a mother who had a uterus transplant last year. It is the first in the USA But in Sweden, eight babies have been born to mothers with uterine transplants.

Not everyone is celebrating though.

Dr. Testa and his colleague, Dr. Liza Johannesson, who joined the Baylor team from Sweden earlier this year, spoke with All Things Considered host of Kelly McEvers on this development. Following are excerpts from the interview, edited for their length and clarity.

Dr. Johannesson, you have given birth to many babies, can you describe how it was, seeing this baby born in Dallas?

Dr. Johannesson: It really does not matter how many babies you have delivered … This was a very special moment.

Dr. Johannesson, you've been through this in Sweden, we mentioned that eight babies were born there for mothers with transplants. How complicated is a procedure?

Dr. Johannesson: Well, it's a transplant, and it's a completely new transplant. …. I think we can compare it to a hysterectomy. When it comes to donor surgery, it is probably a bit more complicated than a simple hysterectomy. It takes approximately five hours. For the recipient, the transplant also takes around five hours as well. … Then, after you have the transplant, you will not have immediate success. First you have to know that the uterus stays with the recipient, then you have the following periods, showing that it is viable, then you have to implant the embryo, and finally you have a pregnancy and then you have to wait for the nine months before having a baby. So, the real success is a year and a half later. That is very rare in transplants.

We must mention, Dr. Testa, that some of the other women who have participated in this trial have had transplants that were not successful. What lessons did you learn from those?

Dr. Testa: Well, we learned many emotional lessons. … They trusted us to do something that was of great value to them. We could not deliver. So that was a great lesson in humility in itself. And then, all the scientific information we got, we could apply to the woman who came later, and now we are successful. So I really feel with the first ones.

We mentioned that not everyone is celebrating this. It poses some ethical questions. Is it possible with such an experimental, risky procedure to obtain the informed consent of women who desperately want to have a baby?

Dr. Testa: I doubt that the laity can have an informed consent on anything we do in medicine, if you ask me. This is even more complicated because we are going to unexplored waters. … I think we spent years studying to understand what we do and to master the things we do. And then we pretend that in ten minutes we can explain something to someone. … I do not think it's really possible.

… We try to use the simplest terms in which we can think and then we leave it to the autonomy of the patients, in this case not even the patients, these women, to make decisions. I think we really abstained, and it was really important for us, in the face of any pressure from our side but, of course, the internal pressure of this woman to have a child I believe led the whole process and her decision in the end. .

What about the risk to the baby? What possible complications should you consider?

Dr. Johannesson: So, in that sense, we know a lot. That is perhaps the only aspect of this that we really have a good knowledge of because women have been giving birth after kidney and liver transplants for many years with immunosuppressive drugs. So, we know what the effect of immunosuppressive drugs is on pregnancies, babies and recipients. And we know what immunosuppressive medications you should not take during pregnancy.

Dr. Testa, women and families have other options for having a baby: adoption, using a surrogate mother. I wonder how you think about it, about compromising scarce medical resources to solve a problem that has other solutions.

Dr. Testa: It's true, I do not have a very intelligent answer to this question. I simply understood through this process that I had completely underestimated the desire of any woman I have found so far to have her own child. I do not know if there is a price for that. I have no philosophical discussion to add. I just have to say that it was a humiliating discovery and it still moves me deeply.

Dr. Johannesson: I think it's important to also say that it does not exclude surrogacy or adoption. We are only offering this as a complementary treatment.

You are adding this to a menu of options. Which raises the question of cost: this is not a cheap procedure to carry out. At this time, as part of a clinical trial, this is paid with research funds, as I understand it. It is not clear if insurers will pay this in the future, which means that you can perfect this technique and that women can desperately want it and can not afford it.

Dr. Testa: That is absolutely true. But this is true for infertility in general in this country. … Some woman will go to extremes to have this experience. The cost of medical care is in any case extremely high for everything we do. As I said, I do not know if this is really an important question, who is going to pay and how. I doubt that insurers will ever pay for something like this.

What is the cost?

Dr. Testa: we are collecting all the data. … I suppose it's going to be a similar cost that we face today for a kidney transplant. … The stadium is, I would say around $ 200,000 to $ 250,000.

What's next? You have another mother in the trial who is pregnant?

Dr. Johannesson: Yes, we have one that is in an advanced stage of pregnancy. Then the next is your delivery. Then we have a couple of other women in different stages of the procedure, so we expect a very happy 2018.

All Things Considered Presenter Mary Louise Kelly and lead producer Andrea Hsu contributed to this report. Greta Jochem is an intern at the NPR science desk.

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