Publication Surrogacy: Uterine Transplants

Starting a family is something that most men and women think about. However, it isn’t possible for everyone. Some women struggle with getting pregnant, and it takes an emotional toll on everyone in the family. Some people choose to adopt, some choose to use surrogacy, several families use in vitro fertilization, and others come to terms with not being able to get pregnant and never being able to have a baby of their own. There is an advancement in the medical field that can allow for a woman to carry her own child.

A new discovery in science has determined that women who are unable to carry a baby due to medical issues involving uterine leiomyoma, endometriosis, malignancy, or damage caused by post-partum hemorrhage or malplacentation resulting in an emergency hysterectomy, may be able to conceive with a uterus transplant.

Evidence Based Practice

There are several physiological reasons why many women cannot conceive. Uterine leiomyoma, Chronic endometritis, Asherman’s Syndrome, uterine malignancy, and complications from previous child birth resulting in hemorrhage where an emergency hysterectomy is performed, are some examples of why a woman would be infertile.

The first uterus transplant was performed in 2000 but had to be removed due to Uterine Necrosis caused by not enough blood supply and factors involving rejection. In September 2012, there were nine transplants attempted. The average age of all the donors was fifty-three years. According to Castellón, L. et al (2017), “The post-menopausal donors received cyclical hormone therapy for a few months before uterus removal until a normal menstrual pattern was achieved.

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” A thrombosis and numerous intrauterine infections occurred which resulted in two of the nine to be removed. Two years later, the first baby was born to one of the remaining seven women. As reported by Laurence B. (2012), “…the first infant was born in September, 2014. The recipient suffered from pre-eclampsia occurred at 31 weeks’ gestation and a 1775g boy was born via an emergency cesarean section. Since then, five births have been officially reported to date as of April 2017.”

Benefit The Patient

The major benefits to the patient is that she will be able to conceive her own baby in her own body, and that she will be able to have a regulated menstrual cycle. With surrogacy, the woman can feel detached from the pregnancy process. Now a mother can carry her own child. As stated by Saso S. (2016), “…forty women were interviewed and 92.7% would prefer to attempt a uterine transplant over surrogacy.” This means that most women would prefer to carry their own baby rather than go through the surrogacy programs. This new discovery allows them to do just that.

Many women in the world suffer from irregular menstrual cycles. This is can be due to a lack or overabundance of female hormones. If a patient is not menstruating properly, she is usually not ovulating properly, meaning an egg isn’t released into the fallopian tubes to be fertilized by the male sperm. A transplant would help the patient regulate her cycles by implanting a more functional uterus and ovaries. In turn, this would regulate her ovulation. Scientists are transplanting the uterus with the ovaries intact in some cases and not intact in others depending on the extent of damage of the recipient’s former uterus. The eggs, however, are removed from the donors’ ovaries and replaced with the eggs of the recipient so the patient’s child will be conceived with the mother’s genes and not the donor’s.

Impact Nursing Care

The care provided to the patient after the surgery is just like any other transplant patient. They will have immunosuppressant’s and require close monitoring for infection. During delivery, the patient will have to be monitored closer as scar tissue does form around the attachment sites. All medical personnel should be wearing gloves and washing their hands frequently. Keeping sick family members away from the mother is also important to decrease the likelihood that the mother would get sick, which in turn would make the baby sick and pose a potential threat to his or her life.

There are more than just physical problems that relate to this very sensitive time. Women suffer psychologically as well. If a patient is unable to conceive after the transplant due to rejection, or if a still born is delivered due to uterine complications, the patient and the family go through a great deal of sadness. This will impact nursing because as an RN, you will have to manage a family’s stress and deliver coping mechanisms. Referrals to a family therapist in order to sort out any unhealthy thoughts are needed from all medical team members. Therapeutic communication is highly suggested.

Legal or Ethical Issues

Nurses and other healthcare workers need to practice beneficence and non-maleficence, which means to perform the work that is beneficial to the patient and that does not intentionally harm anyone while doing so. A uterine transplant is a beneficial thing for a woman who is unable to have children, but the patient still has the risk of infection and rejection. Following these issues, psychological problems may occur. The donor may change her mind regarding the transplant process, and chose not to undergo the removal of her uterus. This is the donors right to change her mind. She would be practicing autonomy and making choices related to her own body. She can decline the procedure at any time. According to Laurence B.et al (2012), “Maternal surrogacy is prohibited in many countries, including France, Germany, Bulgaria, Croatia, Estonia, Finland, Hungary, Italy, Lithuania, Portugal, Slovakia, Australia, Holland, Spain, Sweden, and Norway, while in others there is no legislation or regulation on the matter, which often leads to conflict between the involved parties.” This means it is either illegal or there are no rules and regulations protecting the rights of both parties, making it an unapproved method of conception.

Diversity

As described by Randhawa (2016), there are also some cultures who feel as though you have to be buried with all of your own body parts when you die. So in this case, neither the recipient nor the donor would be able to participate. Transplantation from deceased donors may be discouraged by the Native American culture in this case because they believe in reincarnation, but only if you have all of your own body parts. Jehovah’s witnesses are against receiving blood and organs unless absolutely necessary, and even then, they may choose to decline. The religion believes that if you are not buried with your whole body intact, you cannot go to heaven. In conclusion, there are risks and benefits to this process, but this is an option available to families who are unable to conceive on their own. Science has come a long way in just the past five years, allowing women to conceive using a donor uterus. A uterine transplant has potential as a highly effective treatment for infertility due to problems associated with congenital or acquired uterine absences.