By, Lori Boggan
Organ transplantation, according to the U.S. Department of Health and Human Services, dates back as early as 1869 with the first skin transplant. The first kidney transplant occurred nearly one hundred years later in 1954. Organ transplantation has saved countless lives. In 2014, transplantation history was made. It was the year the first transplantation bore life.
Since 1999, a major break through in fertility has occurred. There have been multiple attempts at successful uterine transplantation between Saudi Arabia, Turkey, Sweden, and now most recently the U.S. Starting in 2014, Sweden is the first and only country to have successfully transplanted more than 9 uteruses with a total of five healthy births.
Recently I had the privilege to meet with a nurse that is a part of one of the most
phenomenal advances in fertility history. Her name is Cecilia and she has been part of the research team, The Swedish Uterus Transplantation Project, that has made history at The University of Gothenburg here in Sweden.
We met for fika in a bustling café on one of the poshest streets in Gothenburg- Linnegatan. She biked from work to meet me, a quintessential Swede. I asked her immediately if she would prefer the interview in Swedish or English. “English,” she said with the hint of an Australian accent. It turns out we had a lot in common. She lived in Australia for several years, so she understood full and well the trials and tribulations of moving abroad and working in a foreign healthcare system.
In addition to her work with the research team, Cecilia works full time as an ethical advisor for Sahlgrenska Hospital at University of Gothenburg’s Sahlgrenska Academy. Her work can one day involve the ethics of continued life support for an infant in critical condition or work with rights of refugees without formal papers.
The questions I had were bare bones just to have some foundation, but the conversation evolved exactly as I had hoped. It was a conversation of ethics, hope, and the true meaning of being a nurse:
How did you join the research team and when?
I joined the research team in 2001 when Mats (Mats Brännström, professor of Obstetrics and Gynecology at Sahlgrenska Hospital, University of Gothenburg) asked me if I was interested.
He wanted a team comprised of people from multiple disciplines (obstetricians, surgeons, nurses, psychologists, clergy, ethics). He wanted to be sure that there was an open conversation and that everyone was on board with moving forward with the research. I was hesitant in the beginning. I wasn’t sure it was right or that it could even happen and the idea of implanting someone else’s uterus seemed strange. We made a great team because of the doubt, because of the questions. It created conversation. As I sat in our first meeting with a potential group of parents, everything changed. The turning point for me was when one of the potential candidates told her story. When she was fourteen, it was discovered that she did not have a uterus. She was told that it was no big deal, she just would not be able to have children. It was at this moment for me that what we were contemplating doing felt right. It was about helping people that previously had no options.
Cecelia with Malin (the first woman in the world to conceive & deliver a baby from transplantation) & her family.
Can you briefly explain the process?
There were a total of nine women who received transplants, five became pregnant and
delivered healthy babies. There are requirements for donors and recipients. The donors the first round were all live donors-some mother to daughter even. The donor should be healthy, a non smoker, and have had a viable pregnancy among other things. The recipients are those who are either born without a uterus (Rokitansky Syndrome) or those are infertile because of a problem with the uterus (cancer, adhesions). All undergo psychological evaluations. The transplantation takes between 11-14 hours because of the delicacy of carefully removing the uterus and vessels from the recipient and joining them to the donor. The recipient takes immunosuppressant medication to decrease the risk of rejection. After a year, one embryo (from the recipient and partner) is implanted. All five babies have been delivered by Caesarean Section to reduce maternal risks with regard the implanted uterus.
What kind of follow up and how long for mom and baby?
A psychologist follows up with both the mother and father for some time after delivery. The babies are monitored for years for development and growth.
What has the reaction been?
There was the question, “is this ethical?” As we sat around and talked, no one could answer the question. I think it all comes down to whether someone has the right to give birth and to have children. I think this is something we decided long ago when we started using contraception. Another question was the cost. Who was going to pay for this? It is not up to the researchers. The research was fully funded. It is now a decision for the politicians. The age old question of why not adopt also came up. Having or adopting is such a personal choice.
What does the future of uterine transplantation look like?
In Sweden, it is now just a question of who is going to pay. Infertility is considered a disease in Sweden, which provides government funding and support for women. Sahlgrenska Hospital is ready and willing to move forward with the project. It is just a question of funding and that question is again left for the politicians.
How does it feel to be a part of history?
How many times in your life do you get to be part of something this big? I’m so happy I agreed to join even though I had my doubts. The doubts were necessary.
As Cecilia answered my final question, she became emotional. She described that moment in the operating room in anticipation of the first baby. Years of research and trial was for this very moment. I imagine all involved were overcome with emotion at this moment. It was about helping someone that until now had no chance of being a biological mother. How meaningful to be present in the biggest moment of these young families’ lives? Cecelia put it perfectly. What they did was not about making history. It was not about being remembered in science or making money. It was about helping someone that previously had no chance.
One patient. One couple. One baby. Many lives changed. This is why we in healthcare do what we do. Thank you Cecilia, Mats, and all involved for taking a leap into the unknown and making a difference in the world.
Lori Boggan, RN
Lori is a NICU Staff Nurse at Sahlgrenska University Hospital in Gothenburg, Sweden. After becoming a nurse, Lori traveled across the country to work a three-month travel contract in San Francisco, California. Nearly five years later her journey continued to Gothenburg, Sweden, where she now lives and works. She also write her own blog Neonurse athttps://neonursetravels.com/
References
http://sahlgrenska.gu.se/english/research/uterus
http://organdonor.gov/legislation/timeline.html
This is awesome to provide this for parents who have had issues but do they continue the immunosuppressive drugs during the pregnancy and if so what effects does it have on these babies?
Hi Anna 🙂 Good question. Here is what I copied from the transplant project’s website. To read in full, click the link.
“Studies have been done on women who have received kidney and liver transplants and who have taken immunosuppressants during a pregnancy. Included in the studies are 15,000–20,000 children born to mothers with organ transplants.
These studies suggest that the child can be born about one week earlier than usual, that the child may have a slightly lower birth weight than normal and that there is an increased risk of pregnancy poisoning. This is not held to be due to the patient’s immunosuppression but rather to the fact that the patient’s illness which occasioned the transplantation in the first place may have resulted in this pregnancy problem. Nothing in the studies suggest an elevated risk of fetal malformation.”
http://sahlgrenska.gu.se/english/research/uterus