Women and their partners want the chance to have a biologically related child.
Many people in Australia have accessed support and resources since the introduction of IVF in 1978.
The opportunity has been out of reach for some women due to the lack of a uterus. Those with a congenital condition and those who had a hysterectomy are included.
These women have only two options for having children. It is hard to access both.
There is a change in that due to uterus transplants. uterus transplants are going to be done in Australia.
There are ethical concerns that need to be addressed before it can become a mainstream treatment.
In a uterus transplant, a uterus is removed from a suitable donor and put into a recipient.
Once the uterus is functioning normally, an embryo is transferred into the woman's uterus using hormones.
The baby is delivered via cesarean section after successful fertilization.
A uterus transplant pregnant woman may not be able to feel her baby. Women who don't have a uterus will not be able to give birth vaginally.
The uterus recipient is required to take medication to prevent rejection of the donor organ. The drugs are safe for pregnant women.
The safety of the woman and fetus is monitored throughout the pregnancy.
Up to two healthy babies or five years after the transplant, whichever is first, will be protected from immune suppression.
The uterus is removed in order to stop the immunosuppression.
Infections, reduced blood cell count, and suppression of bone marrow growth are some of the risks associated with immunosuppression. There are increased risks with time.
The term "ephemeral" transplant refers to a temporary transplant intended to enable reproduction. It's medically and ethically different from other transplants.
In the 70s, scientists began to develop uterus transplants in animals. The first attempts in humans were made in 2000 and 2011.
The world's first human trials were started in Sweden by Professor Brannstrom and his team. The first baby of the year was a healthy one.
More than 40 healthy live births have been achieved due to at least 80 uterus transplant procedures performed in more than 25 countries.
The live birth rate from a uterus that is functioning successfully after a transplant is estimated to be over 80%.
Two trials in Australia have been approved and will begin in the next 18 months.
A mother donating to her daughter is one of the reasons why most uterus transplants use altruistic living donors.
Four live births have been reported with uteruses from dead donors.
Standard family consent methods are used for providing uteruses from dead donors. They could be provided in the future through organ donor registration processes.
Only pre-menopausal women can be uterus donors, and living donors need to have had a successful baby. This may not need to be a requirement for deceased donors in order to enable younger donors and increase the availability of uteruses for transplantation.
Only one of the two approved Australian trials will perform live and dead donor uterus transplants. The other will trial only living donors.
While uterus transplantation is still in the research phase, there will be limited participation in these trials.
The main surgical risks for recipients are organ rejection, infections, and blood clot or thrombosis, as well as risks arising from the surgery duration, which is an average of 5 hours.
The risks have been minimized through close monitoring and early intervention using blood thinners.
The most common risks for living donors are urinary tract injuries and infections.
The ethical and psychological risks are there as well. Potential donors may feel pressured to donate to a family member if the transplant doesn't go well or they may experience guilt if the transplant doesn't go well.
Appropriate counseling and support can help reduce these risks. They cannot be completely eliminated.
Less surgical time and less demand on medical resources and personnel are the benefits of dying donor transplantation.
Deceased donors may be less fraught with ethical problems. There is no risk to the brain dead donor, who must have been declared brain dead and be suitable for multi- organ donation. They can only have their organs procured with their consent.
There is a shortage of organ donors in Australia. Existing donation registries and consent processes can be used to find dead donors.
It's important to compare the outcomes of living and dead donation in the same way. This will determine if uterus donation can become a mainstream clinical practice.
Evidence shows that deceased donations may yield better results for recipients. Better blood flow for the uterus and possibly greater success in transplants and pregnancies can be achieved by using dead donor organs.
There are good reasons for Australian uterus transplant research with both dead and living donors.
Mianna Lotz is an associate professor of philosophy and chair of the faculty of arts human research ethics committee.
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