Professional Documents
Culture Documents
Johannesson 2017
Johannesson 2017
org
OBSTETRICS
Living uterus donation and transplantation: experience of
interest and screening in a single center in the United States
Liza Johannesson, MD, PhD; Kristin Wallis, BSN; E. Colin Koon, MD, PhD; Greg J. McKenna, MD; Tiffany Anthony, MD;
Sara G. Leffingwell, BS; Goran B. Klintmalm, MD, PhD; Robert T. Gunby Jr, MD; Giuliano Testa, MD
BACKGROUND: Little is known about attitudes toward uterus donation with a congenital uterine absence were in general younger than the
and transplantation in society and the interest of the women the treatment women in the group whose uterus had been removed (mean of 28 and 33
is aimed to assist. years, respectively). In every step of the initial screening and evaluation
OBJECTIVE: This study examined the interest of recipients and living process, there were donor and recipient candidates that chose not to
donors in our uterus transplantation program; it describes the screening continue the process. The reasons for self-withdrawal after expressing
protocol we developed and the results of the screening and reports de- interest were not returning phone calls or e-mails (17 donors and 76
mographic data and characteristics of screened candidates. recipients); after initial phone screening, no longer interested (1 donor
STUDY DESIGN: Initial screening and evaluation included physical and 9 recipients); in step 1, health history questionnaire not returned after
examinations by a gynecologist and a transplant surgeon; psychological 1 reminder (10 donors and 9 recipients); step 2, not right in their current
evaluation; imaging (x-ray, computed tomography, ultrasound); blood life situation (2 donors and 2 recipients), and in step 3, chose another way
tests; immunological testing; viral, bacterial, and fungal testing; drug to achieve motherhood (1 recipient). Most donor and recipient candidates
screen; hormonal testing; Papanicolau smear; urinalysis; and electro- (52% and 78%, respectively) could be screened out (because of self-
cardiogram. For selected recipients, the process also included in vitro withdrawal or transplant team’s decision) during the noninvasive and
fertilization. cost-efficient initial screening.
RESULTS: A total of 351 women contacted our department with in- CONCLUSION: Our initial experience shows a great interest in
terest in participating in uterus transplantation; 272 were potential re- participating in a trial of uterus transplantation by both potential recipients
cipients and 79 were potential donors. Among these women, 179 and donors. It is the first study to show interest in nondirected donation. A
potential recipients and 62 potential donors continued the evaluation after sufficient but thoughtful screening process of living donors and recipients
the initial telephone screening. The mean age of the donor candidates is essential and should aim both to assure donor/recipient safety and to
was 40 years; all had completed their own family, and 80% were provide good quality grafts.
nondirected. Most recipient candidates (92%) had an anatomical lack of
the uterus, and of these, 36% had a congenital malformation. The women Key words: donor, infertility, interest, recipient, uterus transplantation
FIGURE
Results of initial screening and evaluation process for candidates
Results of the initial screening and evaluation process for candidates of uterus donation and transplantation, showing causes for not continuing evaluation
for both donors and recipients. Administrative reasons included insurance/financial issues or the candidate or spouse being unable to relocate.
BMI, body mass index; HPV, human papillomavirus; HSV, herpes simplex virus; STD, sexually transmitted disease.
Johannesson et al. Uterus transplantation interest. Am J Obstet Gynecol 2017.
expensive. Hence, one of the greatest 3. Flyckt RL, Farrell RM, Perni UC, Tzakis AG, 7. Arian SE, Flyckt RL, Farrell RM, Falcone T,
challenges is to recognize patient char- Falcone T. Deceased donor uterine trans- Tzakis AG. Characterizing women with interest
plantation: innovation and adaptation. Obstet in uterine transplant clinical trials in the United
acteristics and examinations that would Gynecol 2016;128:837-42. States: who seeks information on this experi-
identify unsuitable candidates as early in 4. Rodrigue JR, Tomich D, Fleishman A, mental treatment? Am J Obstet Gynecol
the process as possible. n Glazier AK. Vascularized composite allograft 2017;216:190-1.
(VCA) donation and transplantation: a survey of
Acknowledgment public attitudes in the United States. Am J Author and article information
Transplant 2017;17:2687-95. From the Annette C. and Harold C. Simmons Transplant
This observational study had a trial registration
5. Saso S, Clarke A, Bracewell-Milnes T, et al. Institute (Drs Johannesson, McKenna, Anthony, Klint-
number of NCT02656550.
Survey of perceptions of health care pro- malm, and Testa), Baylor Research Institute (Ms Wallis
fessionals in the United Kingdom toward and Ms Leffingwell), and Department of Obstetrics and
References uterine transplant. Prog Transplant 2015;25: Gynecology (Drs Koon and Gunby), Baylor University
1. Brannstrom M, Johannesson L, Bokstrom H, 56-63. Medical Center, Dallas, TX.
et al. Livebirth after uterus transplantation. Lan- 6. Kisu I, Banno K, Soeda E, et al. Survey of Received Aug. 22, 2017; revised Nov. 7, 2017;
cet 2015;385:607-16. attitudes toward uterus transplantation accepted Nov. 29, 2017.
2. Sieunarine K, Zakaria FB, Boyle DC, et al. among Japanese women of reproductive The authors report no conflict of interest.
Possibilities for fertility restoration: a new surgical age: a cross-sectional study. PLoS One Corresponding author: Liza Johannesson, MD, PhD.
technique. Int Surg 2005;90:249-56. 2016;11:e0156179. liza.johannesson@BSWHealth.org