32011Jul

Now it’s hope for a new womb

OTTOSON

Eva Ottosson, 56, wants to donate her uterus to her daughter Sara.

Ash Hanafy

Dr Ash Hanafy will perform a uterus transplant early next year. Picture: Luke Marsden

HOW far are women prepared to go to become mothers?

We know many are willing to risk their lives and also push the boundaries of medical science.

But the question remains whether society is prepared to sit back and allow these boundaries to be continually stretched.

When I read last month about a Swedish biology teacher named Sara who wanted her mother’s womb so she could have a baby, I thought it was a step too far. Her mother, Eva Ottosson, 56, wanted to help Sara, 25, – who was born without a womb – to become a mother.

I believe there is nothing more instinctive than a mother wanting to help her child, but I did wonder if a mother’s love was clouding judgment and common sense.

When an international team announced it was preparing to attempt a womb transplant, it was understandable ethicists questioned the project.

And like the once controversial procedure of in-vitro fertilisation, it might be Australian ethicists and politicians will have to be among the first to address this because Australia again looks like it will be at the forefront of this radical transplant program.

One of the architects is Queensland-based Ash Hanafy, who believes the womb transplant has the potential to help thousands of women become pregnant.

A Melbourne woman has already asked to be considered for the program. She asked not to be named, so we will call her Sue.

Sue has a young son, but complications at his birth meant the 30-year-old had to have an emergency hysterectomy.

“We’ve looked into adoption and other options, such as surrogacy,” she said.

“This might be the way to go.”

Sue plans to ask her mother to be the donor because she has no sisters.

I asked about the risks and Sue said that would be her decision.

“I want more than anything to have another child,” she said.

But should it be Sue’s decision alone?

Ethicists argue it may not be acceptable for patients to risk major surgery when their lives are not technically in danger and that’s a valid point.

Swedish Sara doesn’t need her mother’s donated womb to save her life – the transplant is life-enriching rather than life-saving – but it underscores the medical community’s difficulty to say no to women so desperate to give birth.

And it is not about cash. The procedure may attract thousands – but not money-making millions – of women worldwide.

But what should not be overlooked is that specialists warn this is one of the most complicated surgeries in modern medicine; more difficult than transplanting a kidney or heart because of the increased risk of bleeding. There are risks to donor and recipient and the recipient will need to take immuno-suppressant drugs that can increase the risk of infections, high blood pressure and diabetes.

This type of transplant has been attempted once before – 11 years ago in Saudi Arabia – but the organ survived only three months.

The Swedish-based team believes it is better prepared for success after 10 years of research. Consultant and clinical dean of obstetrics and gynaecology at Queensland’s Griffith University, Dr Hanafy is also a member of the international research team preparing to do the transplant.

He recently published a peer-reviewed paper on uterine (womb) transplantation in the Australian and New Zealand Journal of Obstetrics and Gynaecology, coming to the conclusion the process can work. He believes the transplant is a stepping stone to the next stage – wombs grown from stem cells in laboratories. That is also being pioneered in Australia.

Dr Hanafy argues the human transplant procedure has moved on from being life-saving to a new area that is about improving the quality of life – in the past decade we have seen hand, face and larynx transplants.

At the heart of this debate is a woman who wants only to be a mother and a mother who wants only to help complete her daughter’s dreams.

Sara has Mayer Rokitanksy Kuster Hauser syndrome – which affects about one in 5000 people. It means she was born without reproductive organs.

Her mother told Britian’s Daily Mail newspaper that Sara needed her womb more than she did.

“If I’m the best donor for her, well, go on. I’ve had two daughters so it has served me well.”

Sara said: “It’s just an organ like any other organ.”

Most of us understand what drives women to go to such lengths to have a baby – but is the gift of a womb going too far? When does risk outweigh result and when is it time for doctors to say no?

I put that to Dr Hanafy. He is a softly spoken man, a father who had that day delivered three babies.

“This (surgery) carries a huge risk to improve the quality of life,” he said. “(But) for some women, having a baby is that important and it becomes about improving their quality of life.”

Dr Hanafy has been involved in the Swedish-based womb transplant project from the start.

He told me it started at the suggestion of a young Australian woman desperate to preserve her fertility.

Dr Hanafy was one of the doctors caring for 26-year-old Angela in an Adelaide hospital. The other was Mats Brannstrom.

When Angela needed a radical hysterectomy to treat cervical cancer, she asked about a womb transplant.

Dr Hanafy was then a young resident at the hospital; Dr Brannstrom was in Australia for a year to complete his studies before returning to Sweden where he is professor of obstetrics and gynaecology at Gothenburg University.

“We looked at each other and thought, why not?” Dr Hanafy said. “Angela told us she had a mother and sister who would be willing to be donors.”

Sadly, Angela lost her fight with cancer, but her legacy could be the reality of human womb transplants.

Dr Hanafy will help operate on Sara and her mother in Sweden next year.

It will be complicated microsurgery requiring the team to not only rejoin blood vessels and fix the womb in a normal position, but to also join ligaments to stop it moving.

And then it will be a 12-month wait to make sure it is not rejected by Sara before a pregnancy – through IVF – can even be attempted.

And when a pregnancy is achieved and completed, the womb will be removed http://jump4loves.com/live-girls/.

That might seem like a lot of effort to some, but to those desperate for a baby, they are, well, baby steps.