A surgeon in New York has been given the go-ahead to carry out a womb transplant. The procedure has been tried once before in humans in Saudi Arabia in 2000, but the organ had to be removed after 100 days when a blood clot formed in the connecting blood vessels. Now, Dr Giuseppe Del Priore has received approval to carry out the procedure by the review board of New York Downtown Hospital. Del Priore recently carried out an apparently successful transplant on a rhesus monkey although the organ was only monitored for a short time and the animal did not become pregnant. Thousands of women lack a functioning uterus through genetic conditions, fibroids or through pregnancy-related problems. Dr Del Priore is said to have donors and recipients lined up for the new procedure.
Other experts are concerned that more extensive work needs to be done on uterine transplants in primates before the procedure should be attempted in women. Transplants from unrelated donors need to be accompanied by strong drugs to suppress the immune response to the alien material; it is not known what effect these drugs would have on a developing fetus. Further complications are envisaged due to the complex blood vessels that supply the uterus and the dramatic growth that occurs in pregnancy. Del Priore argues that other procedures have been carried out without prior testing in primate systems, such as the recent face transplant that took place in France. Professor Mats Brannstrom of Gothenburg University carried out the first womb transplant that led to a successful pregnancy in mice. Brannstrom believes that further work needs to be done to optimise the technique before beginning to work on humans. His team are developing the possibility of live donor transplants in order that a close genetic match could be found; this would reduce the need for immune suppressants.
Del Priore believes that by transferring more original blood vessels with the donated uterus and by using cadaveric tissue the problems with blood clots could be minimised. Using a dead donor whose heart is still beating would allow higher doses of anti-clotting drugs to be used when the organ is removed. Currently women without a functional uterus can only have children using a combination of IVF technology and surrogacy to carry the child. Speaking to the magazine New Scientist, Del Priore said that 'if a person walked in tomorrow and requested a uterine transplant, I am cautiously optimistic that we could be successful'.