Womb transplant – A milestone
The news is about 22 year old young lady in Turkey who successfully had a womb transplanted which then allowed her to be pregnant. She was born without a womb but her type of transplant-surgery might also be suitable for women who had to have hysterectomy for various reasons including cancer of the womb. It is indeed a milestone in terms of surgical achievement and we join the world in offering congratulations to the woman as well as the surgical team. Whether this surgery will become as popular as the kidney transplant or heart, lung transplant is another matter because practicalities will be the deciding factor.
Other transplant operations and the difficulties in thoseThe world of transplant has come from the most simple ones such as corneal transplant which has brought back eye sight to millions of people around the world. Kidney transplants are quite common so are liver transplant and more recently, the heart-lung double transplant. Medically these surgeries were huge milestones because apart from being technically more difficult, but also a life is at stake – these patients would be otherwise dead if the transplant failed. Besides, the availability of suitable donors is always a problem, especially in some of these operations. In comparison uterine transplant does not pose comparable problems.
Will uterine transplant get big ?Uterus transfer will probably way down the list if you grade transplant operations in terms of technical difficulties. Acquiring donor for a uterus will be a hundred times easier than getting a kidney. Most women who have completed their families are potentially candidates for donation of their womb. Hysterectomy- is a common operation after all. The technical challenge of putting a uterus in place and connecting its arteries is in many ways, one dimensional – in kidney transplantation there is not just the vascular connection but also the duct connection that takes away the urine to the bladder. In that sense a uterine transplant should have been one of the earlier transplants that surgeons should have tried. The reason these transplants didn’t happen earlier is probably the same reason why they will not be done in their thousands in the coming years – there are alternative ways of bypassing the needs for uterus in a woman. Surrogacy is probably the simplest option.
The small print in a uterine transplant.
Any transplanted organ will demand vigorous regime of immuno-suppression most of which are drugs with serious side effects. This make the recipient susceptible to infection, cramp their lifestyle in a big way and in general act as a put-off in itself. The cost of such a complex surgery followed by that of anti immune suppressants would in many ways match that of surrogacy.
But then the price you pay for that is even more than the first lot of operation and strong medicines. The recipient needs a further surgery to remove the donor uterus after its job is complete to avoid further treatment with immunosuppresants or further risk of infections. If you add the need for a Caesarean section after a successful transplant we now have this young lady effectively going through at least three operations to get one baby. The pragmatic couples will find that very complex solution to a problem that had simpler answer – surrogacy.
So why uterine transplant ?
Apart from technical achievement for the treating surgeon there is one great joy for the patient that is indescribable. Making baby is not just a technical job like making a television or a car. The sense of being a complete woman is perhaps to have the experience of being able to conceive and grow the baby in the womb, suffer all the physiological problems that mums suffer and go through the whole process of labour culminating in the ultimate achievement of being a mum. Using a surrogate mum has cut the process short in many ways and the mum with the recipient uterus will always feel a little bit more “complete” in their experience of motherhood.
Whilst every such medical success is to be lauded and everyone involved in these results are heartiest congratulations, I think the solution for women without uterus is to find ways of making surrogacy more easily available.
Making surrogacy easier is the pragmatic answer to the problem
After the introduction of commercial surrogacy in India more recently there has been a political backlash and the surrogacy laws now stipulate that the commissioning couple would have to be heterosexual and not just that, married for two years or more. It is an outmoded thought process that has put at risk a solution that would have been of great help to so many couples in the world at the same time as benefiting commercial surrogate mums.