According to an article published by Asahi Shimbun on Nov. 25, Keio University has applied to the health ministry for permission to carry out uterus transplants. If permission is granted, the ministry will start screening applicants for the procedure early next year, after which clinical trials will be launched. Last July, the Japan Medical Association studied the prospects for uterus transplants and agreed to permit clinical trials, which would be the first step toward actual transplant operations. The JMA’s summary stated that the transplants would be for women in their 20s and 30s diagnosed as being unable to bear children, women who were born without uteruses, and women who had undergone hysterectomies due to benign tumors. (Women who had had hysterectomies because of malignant tumors are not eligible.) As with donated eggs, transplanted uteruses can only be from blood relatives of the recipient, typically an older, pre-menopausal woman like a mother or an aunt. Anti-rejection medication is administered following the transplant procedure and menstruation is monitored for at least 6 months to determine the viability of the transplanted organ. The recipients retain their ovaries, from which eggs are harvested and fertilized. The resulting embryo is then implanted in the transplanted womb. Any baby that is subsequently brought to term is delivered via caesarian section. Since the mother must continue taking anti-rejection drugs, she is allowed a maximum of two babies. Eventually, the transplanted uterus is removed. The cost of the operation alone is estimated at ¥25 million, but as the article points out there are still many issues to be resolved before any transplant can be performed.
The first uterus transplant took place in Saudi Arabia in 2000 on a 26-year-old woman, but the uterus turned out to be not viable. After more testing on animals was carried out over the years, the first child born to a woman via a transplanted uterus was in Sweden in 2014. As of October, there have been 98 uterus transplants worldwide that produced 52 babies. The procedure to remove the uterus from the donor takes 8-10 hours and the implant operation takes about 5, so it is a large-scale surgical matter. According to an assistant professor at Keio who talked to Asahi, uterus transplants differ significantly from other transplant operations in that they are not performed to save or otherwise extend the lives of their recipients. The purpose is simply to provide women who are not able to conceive or deliver children with another option to give birth. Viable uteruses can be transplanted from either living donors or deceased donors, but initially in Japan only living donors will be allowed, though, according to the assistant professor, deceased donors are more appropriate due to any surgical complications when operating on a live donor. But because of existing Japanese transplant guidelines and laws, the JMA will need to discuss the related ethics first, and they plan to do so next year along with the Japan Gynecological Academy.
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