In a first-of-its-kind surgery in India, a team of 12 specialist doctors of Galaxy Care Laparoscopy Institute (GCLI) in Pune successfully carried out India’s first Uterine transplant on a 22-year-old woman from Solapur district of Maharashtra. The donor of the uterus was the woman’s 40-year-old mother. At the time of writing this, both were doing fine and recovering.
Globally, over 1.5 million suffer from absolute uterine infertility, a condition where the woman may have been born without a uterus or has had it removed due to disease or defect. One in 500 women are believed to suffer from this and consequently, have not been able to conceive.
Such women have two choices before them – adopt a baby or go in for a surrogacy arrangement. Doctors have been trying a third option of uterine transplant where several countries like the US, Germany, China, Saudi Arabia, Serbia, Brazil, Czech Republic and Turkey have failed in their attempts in successfully carrying out the transplant procedure and in delivering a healthy baby thereafter.
In 2012, a team of doctors in Sweden, led by Dr Mats Brännström of the University of Gothenburg, became the first to successfully carry out the first uterine transplant. He followed-up on that by delivering the first healthy baby from the same mother, in 2014. Only six such babies have been delivered till date, with two being born to the same mother.
It is in this context that the achievement of the team of Doctors in Pune, led by Dr Shailesh Puntambekar, deserves to be lauded.
The surgery itself took over nine and a half hours, as it involved connecting every artery and vein of the organ to those of the recipient, a very complex procedure. During surgery, the doctors had to maintain a close watch on the recipient for changes in body response, as the chances of rejection can be high and fatal.
In this case, the recipient is going to be kept in ICU for a week to observe how her body is reacting to the new organ, after which she will be moved to special ward and kept under observation for at least a fortnight.
If the recipient is normal thereafter and recovers on expected lines, then the process of pregnancy and delivery can begin after 12 months.
The process of uterine transplant, pregnancy and delivery of a child
The process of confirming the match and compatibility between donor and recipient is the first step and it takes several tests before acceptable level of compatibility is determined.
Once the reports confirm positive results, the doctors collect the eggs from the recipient using In Vitro Fertilization (IVF), and fertilize them with sperm from the male partner. The resulting embryo is then frozen.
Once the transplant procedure is complete and the recipient recovers on expected lines, the doctors, after a minimum period of 12 months, transfer the frozen embryo to the mother’s new uterus. The doctors continue to closely monitor the progress of the mother and the foetus till delivery.
Once the baby has been delivered successfully, the doctors remove the uterus from the mother. Retaining the uterus would force the mother to take strong immuno-suppressants for her lifetime, thereby raising the possibility of side effects or complication at a later stage.
Questions on safety
There are still unanswered questions on procedural standards and human safety, as the knowledge and practice of uterine transplant is still at a nascent stage. The problem with medical science is that unless there are trials on willing patients, medical science would not have developed, and will not in future.
However, till medical procedures are established and experiences documented, the patients who volunteer to undergo uterine transplant will continue to remain at high risk, even years later.
Questions on medical ethics
This brings us to the question of ethics on the doctor’s part in carrying out high risk procedures when there are no precedents. They face a dilemma of either allowing a patient to go childless for life or attempt at offering a solution that the patient voluntarily seeks.
The surgery in Pune on 18 May 2017 was successful and the patient is hopefully recovering on expected lines, but what if the next procedure or the one after that goes wrong? The media attention and pressure will be immense on the doctors concerned and many will have to face questions on medical ethics.
Questions on social pressure and traditions
Lastly, the question of social pressure as result of traditional beliefs must be addressed. In India, the issue of motherhood is taken for granted and any woman unable to conceive, is condemned by her own family members, and very often, shunned for life.
The pressure to deliver a child, and a male one at that, is so great that a woman is willing to undergo any risk in order to deliver a baby just to avoid the social stigma and meet family expectations. Under these circumstances, it is unfair for doctors to accept the woman’s consent as ‘informed consent’, where a woman is fully aware on the risks involved for her and the baby.
If it is a case of just having a baby, simply adopting one should be an acceptable solution or one can even explore surrogacy, but in India today, both these options are frowned upon. Leaving the woman with little choice but offer herself to be the subject of a high risk experiment.
If we lead healthy and longer lives today, it’s because of pioneering work done by doctors, scientists, technical staff, etc, all coming together to take that first step, one that no one has ever taken. Also, they would not have been able to achieve what they have, were it not for brave patients who volunteered but subsequently lost their lives in the process.
With the advent of technology, it has been possible to minimize the risk from earlier days, but questions on safety, ethics and social pressure remain open, till science and human enterprise can address these.