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To: Lane3 who wrote (1665)	3/7/2002 8:46:06 AM
From: Lane3	Respond to of 21057

Saudi Surgeons Perform Human Uterus Transplant By Rick Weiss Washington Post Staff Writer Thursday, March 7, 2002; Page A08 Surgeons in Saudi Arabia have performed the first human uterus transplant, an operation that many doctors had considered too technically challenging for anyone to attempt and one that some still believe is not ethically justifiable. Complications forced surgeons to remove the organ 99 days after the transplant. But doctors characterized the operation as essentially successful, and some suggested that it may not be long before women who have lost their uteruses to hysterectomy may be able to become pregnant and gestate their own children. Many women who have lost their wombs to disease or surgery and who want the unique experience of childbearing might opt for the procedure, doctors said. But the surgery is particularly in demand in Muslim countries. That's because Islamic tradition places great value on women raising children for their husbands -- through whom family lineage is traditionally traced -- yet Islamic law bans most adoptions and surrogacy arrangements. The surgery also raises ethical red flags. As with recent attempts to transplant hands, there are questions about whether patients should take on significant surgical risks to obtain a body part not essential for survival. In the case of the uterus, which enables a woman to have an experience widely recognized as profound, the balancing act of risks and benefits is especially difficult, personal and emotional. "To some individuals, childbearing is the greatest event of a lifetime," write obstetricians Louis G. Keith and Guiseppe Del Priore in an editorial accompanying the research in the March issue of the International Journal of Gynecology & Obstetrics. "To such persons, transplantation of organs of reproduction would not be considered frivolous or unnecessary, even though these organs do not sustain life." The transplant recipient was a 26-year-old Saudi woman whose uterus had been removed six years earlier because of uncontrolled bleeding after the birth of her first child. She wanted to have another baby, said lead surgeon Wafa Fageeh of the King Fahad Hospital and Research Center in Jeddah. The donor was a 46-year-old woman from Yemen with an ovarian condition that required the removal of her ovaries and her healthy uterus. The Islamic Jurisprudence Council, which interprets religious doctrine, deemed a uterine transplant acceptable as long as no eggs were transferred. A key difficulty with uterine transplantation is that the organ is fed not by a few major blood vessels but many smaller ones, each of which must be reattached with microsurgical techniques, Fageeh said. In the 1960s scientists conducted a few uterine transplants in dogs and even achieved pregnancies afterward, but little progress had been made since then. So Fageeh and her colleagues practiced on 16 baboons and two goats, perfecting vessel attachment techniques before wheeling the two women into surgical suites in April 2000. The team used extra lengths of blood vessel removed from the Saudi woman's leg to help span the distance between the vessel stumps on the uterus and those in her body. Although she was taking immune system-suppressing drugs, her body began to reject the organ after three days. But 10 days of intensive drug therapy eliminated that reaction. Doctors gave the woman hormone injections to assist her own ovaries -- which had not been removed during her hysterectomy -- and ultrasound tests showed the uterus responding with a monthly buildup of endometrial tissue. She even menstruated monthly. But after three months, just when her doctors were preparing an attempt to help her become pregnant by in vitro fertilization with her husband's sperm, tests indicated the organ was suddenly dying. When the team removed it, they found that several vessels had become blocked by clots. Despite the organ's demise, the surgery should be considered an initial success, concluded Keith -- one of the journal's editors -- and Del Priore, of Northwestern University Medical School and New York Medical Center, respectively. But some disagree. The team relied on sonograms instead of more definitive biopsy tests to prove that the uterine lining was responding normally to hormones, said Kutluk Oktay, a reproductive specialist at Cornell University's Weill Medical College in New York. Oktay also questioned the ethics of assisted reproduction in a woman taking immune system-suppressing drugs, which can increase the incidence of birth complications. "This is going to be a big problem ethically," Oktay said. "It looks to me like a risky experiment in humans. You may be risking mother and fetus." But Fageeh, who said she hopes to try another transplant soon, said recent data indicate that birth complications associated with immune system-suppressing drugs are rare and mostly minor, such as low birth weight or temporary developmental delays -- the sort of thing many women may be willing to accept in exchange for the opportunity to bear a child. "Even where surrogacy is acceptable, a woman might prefer to do this because when she carries the baby it gives a real connection," Fageeh said. "This is to be judged by the lady, not others, if she wants to take the risk." Abdulaziz Sachedina, a professor of religious studies at the University of Virginia in Charlottesville, said he could imagine a market for the procedure in some parts of the world. "In Muslim culture, when you don't have a child, society looks at you as if you carry a stigma," Sachedina said. "There is more tolerance today in Muslim educated society, but it is still a strong traditional culture and everybody wants a child in this culture." © 2002 The Washington Post Company