Concerns Associated with Uterus Transplantation in Japan

Kisu, Iori; Banno, Kouji; Matoba, Yusuke; Aoki, Daisuke

doi:10.2302/kjm.2020-0014-le

Cited by 4 publications

(5 citation statements)

References 11 publications

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“…Besides, although surrogate conception is possible abroad, many ethical and social issues have been observed. Nevertheless, some techniques, such as uterine transplantation, are under study [24]. It is hoped that future medical advances or changes in ethical and social attitudes toward reproductive medicine will lead to the favorable consideration of these methods.…”

Section: Discussionmentioning

confidence: 99%

Case Series of Mayer–Rokitansky–Küster–Hauser Syndrome: Analysis of 17 Cases

Miyake¹,

Kobayashi²,

Imaeda³

et al. 2023

Clin. Exp. Obstet. Gynecol.

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Background:The Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a rare disorder characterized by congenital vaginal defects and uterine traces. Because of its rarity, standardized management for MRKH syndrome is unavailable. This study reviewed the management of the patients with MRKH syndrome in our institution. Methods: Using medical records, we retrospectively reviewed the surgical techniques, outcomes, postoperative management methods, and outpatient follow-up of 17 patients with MRKH syndrome in Keio University Hospital. Results: Of the 14 patients who requested vaginoplasty, 12 underwent surgery with Davydov's modified procedure after the Frank method, and it took 17 months to 34 months (median two years) for the vaginal cavity to enlarge by 5-6 cm. The Frank method is a non-surgical dilation with instrumental stretching of the vaginal vestibular mucosa. Davydov's procedure is a surgical vaginoplasty in which the vesicoureteral space is coated by the peritoneum. Although one patient lost 3800 mL of bleeding from the plexus vein and four needed to remove the prosthesis under anesthesia about one month after surgery, all patients achieved anatomic success with a vaginal cavity length of 6 cm or more and could have sexual intercourse with their sexual partners. However, two patients interrupted their preoperative hospital visits, and three were lost to follow-up postoperatively. Two of the three patients who did not accept vaginoplasty presented myoma at uterine trace and underwent myomectomy. Another one was scheduled for surgery through psychological support. Conclusions: Davydov's modified procedure is effective, and dilating the vaginal cavity adequately using the Frank method before surgery is needed to ensure sufficient vaginal length with less perineum. During the operation, attention is required to care for the plexus vein. Comprehensive psychological support, providing appropriate information to the patient for mental maturity, and planning surgery according to their life stages are essential for successful treatment.

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Section: Discussionmentioning

confidence: 99%

Case Series of Mayer–Rokitansky–Küster–Hauser Syndrome: Analysis of 17 Cases

Miyake¹,

Kobayashi²,

Imaeda³

et al. 2023

Clin. Exp. Obstet. Gynecol.

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“…As previously reported, the major ethical and social concerns related to UTx in Japan are the risks for donors, comparisons with surrogacy, and opposition to non-vital organ transplantation. 41 There are no risks associated with deceased donors, which is clearly an advantage compared to living donors. 9,13 However, in Japan, organ transplantations from living donors greatly outnumber those from deceased donors.…”

Section: Ethical/social Concerns Associated With Utx In Japanmentioning

confidence: 99%

“…Ethically, UTx is more likely to be acceptable than surrogacy in Japan because children born to a surrogate mother may not experience maternal behavior that fully respects the child's welfare. 41 Organ transplantation is an essential means of saving lives, whereas UTx is a procedure to improve the QOL of UFI patients rather than to provide a chance for survival. Therefore, some opposing opinions exist; for example, the notion that organ transplantation should not be conducted solely for the improvement of QOL because complications occasionally lead to death.…”

Section: Ethical/social Concerns Associated With Utx In Japanmentioning

confidence: 99%

Keio Uterus Transplantation Research: From Basic Research toward Future Clinical Application

et al. 2022

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Uterus transplantation (UTx) is now a potential option to allow women with uterine factor infertility to give birth. However, UTx is still at an experimental stage, and basic animal studies, including in nonhuman primates, are needed for the accumulation of data prior to clinical application. Considering that UTx may provide new hope to Japanese women, we launched UTx research in 2009 and have since accumulated a large archive of results in the UTx research field. Furthermore, we have carried out various activities aimed at the implementation of clinical applications of UTx in Japan while clarifying the ethical and social issues involved. Currently, the clinical application of UTx in Japan is just around the corner, and it is expected that UTx research will develop further in the future. Herein, we summarize our basic experiences using non-human primates and our activities with the goal of future clinical applications.

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“…Some commentators, however, argue that “UTx is still in its infancy” (Chmel et al 2019 ), noting that it remains an experimental procedure (Brännström, Kvarnström, and Dahm-Kähler 2020a , b , c ; Brännström 2019 ), and as such, should be governed by the existing ethical frameworks for surgical innovation (SI) (Farrell et al 2020 ; Flyckt et al 2018 ). Growing interest in the development of UTx in countries with established organ transplant systems, such as Spain, Australia, Japan, and the Netherlands raises important questions regarding the ethical implications of new UTx trials and programmes (Bruno and Arora 2020 ; Kisu et al 2021 ; Carmona et al 2021 ; Peters et al 2020 ). The recognition of UTx as a surgically innovative procedure has significant implications for countries and clinician-researchers when designing and implementing UTx trials.…”

Section: Introductionmentioning

confidence: 99%

Uterus Transplantation as a Surgical Innovation

et al. 2023

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Uterus transplantation (UTx) research has been introduced in several countries, with trials in Sweden and the United States producing successful outcomes. The growing interest in developing UTx trials in other countries, such as Spain, the Netherlands, Japan, and Australia, raises important questions regarding the ethics of surgical innovation research in the field of UTx. This paper examines the current state of UTx in the context of the surgical innovation paradigm and IDEAL framework and discusses the ethical challenges faced by those considering the introduction of new trials. We argue that UTx remains an experimental procedure at a relatively early stage of the IDEAL framework, especially in the context of de novo trials, where protocols are likely to deviate from those used previously and where researchers are likely to have limited experience of UTx. We conclude that countries considering the introduction of UTx trials should build on the strengths of the reported outcomes to consolidate the evidence base and shed light on the uncertainties of the procedure. Authorities responsible for the ethical governance of UTx trials are advised to draw on the ethical framework used in the oversight of surgical innovation.

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Concerns Associated with Uterus Transplantation in Japan

Cited by 4 publications

References 11 publications

Case Series of Mayer–Rokitansky–Küster–Hauser Syndrome: Analysis of 17 Cases

Case Series of Mayer–Rokitansky–Küster–Hauser Syndrome: Analysis of 17 Cases

Keio Uterus Transplantation Research: From Basic Research toward Future Clinical Application

Uterus Transplantation as a Surgical Innovation

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