2024-04-12 14:15:43
Experiments on uterus transplants are increasing in number Inde and in the United States, but also in Europe and particularly in France. Presented as an alternative to GPA, which remains illegal in our country as in others, for women suffering from uterine sterility, these trials raise numerous ethical questions, especially since in the current state of knowledge, we prefers to harvest uteruses to transplant into living donors.
One in five thousand little girls are affected by Mayer-Rokitansky-Küster-Hauser syndrome (MRKH syndrome), meaning they are born with a total or partial absence of the uterus and sometimes the vagina. Although she has normal tubes and ovaries, she will not be able to carry a child once she becomes an adult. The same goes for women who have had to undergo a hysterectomy for medical reasons.
To enable women suffering from uterine infertility to become mothers, the French National Academy of Medicine recommended, in a decision of June 23, 2015that the research program be continued “strictly supervised”, “for any innovation in organ transplantation and medically assisted procreation”. Of which act. The research continues to this day.
Uterus transplantation, an experimental protocol.
As of 2015, the institution emphasizes that uterus graft transplantation is still “at the experimental stage” and that it is necessary that information “ clear and detailed, taking into account the disadvantages and risks of uterine transplantation, be issued to living donors and recipients who will participate in these research programs. “.
This is still true in 2024.
French research favors living donors, uterus transplants taken from brain-dead donors having ended in failure in almost all attempts.
There are around a hundred successful uterus transplants worldwide, a little less than half of which have resulted in the birth of a child.
In France, three babies were born thanks to such a transplant, in 2019, 2022 and 2023, at the Foch hospital in Suresnes where Professor Jean-Marc Ayoubi, head of the gynecology-obstetrics and reproductive medicine department establishment, directs a research protocol in this area. The living donors were all a family member (mother or sister) of the recipient.
Major risks of complications.
Before giving its blessing for such research programs, the National Academy of Medicine takes the precaution, in its June 2015 report, of emphasizing the significant risks incurred by the donor and the recipient, and the dangers of immunosuppressive treatment, necessary to avoid rejection, both for the mother and for the child.
The institution emphasizes the ethical problems posed by this dangerous transplant procedure, even though living without a uterus does not pose any particular health problem other than infertility, which can certainly be experienced painfully, but ultimately is not lethal.
Uterus transplant “stands out from all other transplants. First, because it is not vital, notes the academy, Its objective is not to ensure the survival of the patient as in a heart or liver transplant; it does not facilitate survival as in kidney transplantation; it does not improve life like a hand or face transplant.”
An ethical objection noted by Professor Jean-Marc Ayoubi himself, in a December 2021 article.
“Altruistic living organ donation is always controversial and even more so for a transplant that is not vital, the major problem being that the donor surgery is much more extensive than a simple hysterectomy with risks of major complications”explains the doctor.
But in 2015, faced with all these ethical obstacles, the Academy of Medicine concluded that uterus transplantation “brings to women a feeling of reparation for an injustice of nature and above all it allows them to give life”.
Of the “uncertainties regarding the medium and long-term future of children born in these very particular conditions”
In its report, the National Academy of Medicine also says “concerned by the uncertainties regarding the medium and long term future of children born in these very particular conditions”. Indeed, the consequences for the child of the immunosuppressive treatment undergone by the mother are poorly understood in the long term and “the risk of the appearance of pathology (blood disease, cancer) cannot be formally excluded”, note the academicians.
They are also concerned about the psychological issues of such infertility treatment, both for the donor, for the recipient and for the child.
But finally, they notice that it is more and more difficult to adopt a child on the one hand, and that, on the other hand, “as court decisions concerning GPA accumulate, the question of the respective advantages and disadvantages of uterine transplantation and GPA will undoubtedly arise. »
They therefore believe that “uterine transplantation would have several advantages, not the least of which would be, if not to dry up the shameless trade in ‘wombs for rent’ and the enslavement of women, at least to reduce its formidable development. »
Although insisting on the difficulty of finding organs, the academicians at no time consider the hypothesis that a “shameless trade” in uteruses could develop.
Even though they write that “ in our modern societies, the desire to have children has become so compelling that some women are ready to do anything to become a mother. »
Female transsexuals, a future breeding ground for uteruses?
On the other hand, members of the Academy of Medicine have raised, since 2015, the possibility of using harvested uteruses “among female transsexuals wishing to become men (FtM), and accepting the altruistic use of their uterus, a hypothesis explored and verified by psychiatrists at Foch Hospital”.
Beyond the new pool of uteruses that female transsexuals could offer, academicians explain that the youth of the donors would be an asset which would make it possible to “reduce the risks of obstetric complications”.
The Suresnes hospital supports candidates for gender transition, and uterus transplant researchers have proposed that the possibility of organ donation be extended to transitioners.
But this possibility has been rejected until now by the various ethical and legislative authorities, for fear that hysterectomies are encouraged for scientific interest and because the removal of a uterus for transplant purposes is more dangerous than a transplant. simple hysterectomy.
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