WEBVTT - A Womb of Oneâs Own? 0:00:03.240 --> 0:00:05.960 I was yearning for something so deep that I felt 0:00:05.960 --> 0:00:08.959 like it was impossible to get to. I just felt 0:00:09.000 --> 0:00:12.080 like I was in kind of like a hole that 0:00:12.119 --> 0:00:15.239 I couldn't get out of because I was ready to 0:00:15.280 --> 0:00:17.520 start a family and I wanted to be able to 0:00:18.200 --> 0:00:19.320 have our own babies. 0:00:20.600 --> 0:00:23.319 In twenty fifteen, Jen Dingle went through a period of 0:00:23.360 --> 0:00:26.799 intense depression. She was ready to start a family with 0:00:26.840 --> 0:00:30.360 her husband, and she wanted the experience of being pregnant, 0:00:31.120 --> 0:00:34.120 but she was grieving the fact that that could never happen. 0:00:34.880 --> 0:00:37.360 Being a mom and having my own kids has always 0:00:37.400 --> 0:00:39.600 been a dream, but I knew that it wasn't it 0:00:39.640 --> 0:00:40.839 wouldn't be possible for me. 0:00:41.720 --> 0:00:45.680 Jen has a rare congenital disorder called Maya Rokitanski Cousta 0:00:45.680 --> 0:00:49.760 Houser syndrome m r K eight for short. She was 0:00:49.800 --> 0:00:53.680 born with ovaries but no cervix or uterus. She first 0:00:53.760 --> 0:00:57.280 became aware of her diagnosis when she was fourteen, but 0:00:57.360 --> 0:00:59.680 Jen says at the time she had trouble wrapping her 0:00:59.680 --> 0:01:01.480 head around what it all meant. 0:01:02.440 --> 0:01:05.839 It was sad, but at the same time, being fourteen, 0:01:05.920 --> 0:01:08.800 you're not really thinking about carrying. 0:01:08.360 --> 0:01:09.240 Your own child. 0:01:09.480 --> 0:01:13.199 And also, I feel like at that age, you don't 0:01:13.360 --> 0:01:17.440 really fully understand how your body works all the way. 0:01:17.520 --> 0:01:20.200 And so for me, whenever I got that news, I 0:01:20.360 --> 0:01:23.399 actually thought to myself, well, maybe my uterus just hasn't 0:01:23.440 --> 0:01:27.119 grown in, and maybe my uterus will just miraculously grow 0:01:27.160 --> 0:01:31.080 in by itself. And so at that age, I think 0:01:31.160 --> 0:01:34.800 I didn't really realize what it really truly meant for me. 0:01:35.840 --> 0:01:39.000 When Jen got older, I married her husband. They started 0:01:39.040 --> 0:01:42.119 looking into their options for how to have a biological child. 0:01:43.000 --> 0:01:45.920 A fertility doctor told them that their only option was 0:01:45.959 --> 0:01:50.240 to create embryos using in vitro fertilization and then find 0:01:50.240 --> 0:01:54.000 a gestational carrier to give birth to the baby, But 0:01:54.120 --> 0:01:57.640 the couple wasn't sure they could afford it. Gestational carriers 0:01:57.640 --> 0:02:01.760 can be prohibitively expensive. Anyway, it still wasn't what Jen 0:02:01.920 --> 0:02:06.880 really wanted. Then one day, the fertility doctor made an 0:02:06.960 --> 0:02:09.760 offhand comment that changed the course of Jen's life. 0:02:10.560 --> 0:02:13.919 She said, I remember hearing something about a uterus transplant 0:02:14.000 --> 0:02:17.280 happening somewhere overseas, And she said, but I would never 0:02:17.360 --> 0:02:20.280 count on that happening here in the States, because it's way, 0:02:20.320 --> 0:02:21.800 way too risky. 0:02:22.040 --> 0:02:25.679 But to Jen, a uterus transplant sounded like the perfect 0:02:25.680 --> 0:02:29.240 solution to her problem, despite whatever risks her doctor may 0:02:29.240 --> 0:02:32.840 have been referring to. When she got home from the appointment, 0:02:32.960 --> 0:02:37.320 Jen immediately began searching uterus transplants online. She found the 0:02:37.320 --> 0:02:40.360 transplant center that the doctor had mentioned. It was in 0:02:40.440 --> 0:02:43.239 the UK, but when she reached out to the center, 0:02:43.600 --> 0:02:45.960 she found out that they weren't ready to offer them 0:02:46.000 --> 0:02:49.920 to patients. Yet she continued to feel caught in a 0:02:50.000 --> 0:02:53.240 dark depression. She opened up to her mom when she 0:02:53.320 --> 0:02:55.520 was back home in Dallas, Texas for a visit. 0:02:56.680 --> 0:02:59.640 And I remember sitting down talking with my mom and 0:02:59.680 --> 0:03:03.640 just to her, you know, I've just been sad lately. 0:03:03.880 --> 0:03:05.680 I want to be able to start a family, but 0:03:05.760 --> 0:03:08.919 surrogacy is just way too expensive and I don't know 0:03:09.080 --> 0:03:12.040 if it's even going to be possible. And that's when 0:03:12.080 --> 0:03:14.040 she's like, you're going to become a mom. I know, 0:03:14.160 --> 0:03:16.920 I feel it in my heart. You will become a mom. 0:03:17.240 --> 0:03:20.919 And that's nice for her to tell me, but it's 0:03:20.960 --> 0:03:23.320 just hard to believe those things when you've been told 0:03:23.360 --> 0:03:24.760 that it's like impossible. 0:03:25.720 --> 0:03:28.680 Jen didn't bring up utrius transplants with her mom that day. 0:03:29.320 --> 0:03:32.520 It seemed like too much of a distant possibility. But 0:03:32.639 --> 0:03:35.920 then a week after that conversation, she got a call 0:03:36.000 --> 0:03:36.640 from her mom. 0:03:37.160 --> 0:03:39.240 She's like, you are never going to believe what I've 0:03:39.240 --> 0:03:41.760 seen on the news. I'm like what, And she said, 0:03:41.880 --> 0:03:45.280 Baylor in Dallas is going to be doing a uterus 0:03:45.360 --> 0:03:48.760 transplant trial for ten women like you who were either 0:03:48.880 --> 0:03:52.040 born without a uterus or who lost their uterus due 0:03:52.080 --> 0:03:54.880 to cancer or something like that. I'm like, I gotta go, 0:03:55.040 --> 0:03:57.360 I gotta go. I didn't even let her finish telling 0:03:57.400 --> 0:03:58.880 me what all it was about. 0:04:01.560 --> 0:04:04.880 I'm Lauren Aurora Hutchinson. I'm the director of the Idea's 0:04:04.920 --> 0:04:09.040 Lab at the Johns Hopkins Berman Institute of Bioethics. On 0:04:09.160 --> 0:04:14.480 today's episode Uterus transplants, The first one that resulted in 0:04:14.520 --> 0:04:17.640 a healthy baby being born was performed in Sweden in 0:04:17.720 --> 0:04:22.200 twenty thirteen. Since then, over one hundred uterous transplants have 0:04:22.279 --> 0:04:25.599 taken place, and over a third of those were performed 0:04:25.640 --> 0:04:30.760 in the US. Uterus transplants can offer a life changing 0:04:30.760 --> 0:04:35.440 opportunity to individuals with certain types of infertility, but they 0:04:35.480 --> 0:04:39.240 do come with risk, and they will cost a lot 0:04:39.240 --> 0:04:42.760 of money, and there are other ways to build a family. 0:04:44.080 --> 0:04:47.279 What are the ethics of performing an organ transplant in 0:04:47.400 --> 0:04:50.800 order to have a baby. Is it okay to transplant 0:04:50.920 --> 0:04:55.200 organs that aren't life saving? From pushing industries and the 0:04:55.279 --> 0:04:59.720 Johns Hopkins Berman Institute of Bioethics, This is playing god. 0:05:07.440 --> 0:05:10.520 Jen couldn't believe her luck. Of all the hospitals in 0:05:10.560 --> 0:05:12.760 the world that could have been starting up a uterus 0:05:12.839 --> 0:05:18.000 transplant program, it was Baylor University Medical Center, practically in 0:05:18.080 --> 0:05:24.040 her old backyard. Jen rushed to apply the application, laid 0:05:24.080 --> 0:05:28.160 out the risk factors and requirements. After the transplant, recipients 0:05:28.160 --> 0:05:32.000 would have to go on immunosuppressants and be extremely careful 0:05:32.080 --> 0:05:35.440 not to spend time around someone who was sick, and 0:05:35.880 --> 0:05:39.320 the transplant center emphasized that the procedure was not a 0:05:39.400 --> 0:05:43.640 guarantee of a pregnancy. The first three times Baylor had 0:05:43.680 --> 0:05:47.960 attempted the transplant so far it hadn't worked. All three 0:05:48.120 --> 0:05:51.560 uterresses had to be removed because of an insufficient blood flough. 0:05:52.839 --> 0:05:55.680 That made Jen a bit nervous, but she was undeterred. 0:05:58.000 --> 0:06:01.800 I felt like this was my chance, Like this is 0:06:01.880 --> 0:06:04.440 a once in a lifetime opportunity. 0:06:04.880 --> 0:06:08.600 After a few months of waiting, Jen's application was approved. 0:06:08.960 --> 0:06:12.279 After years of dreaming, about carrying her own child. She 0:06:12.400 --> 0:06:16.360 felt like she might actually have a shot. Doctors explained 0:06:16.400 --> 0:06:18.560 that the first step was to begin the search for 0:06:18.600 --> 0:06:21.800 a living donor. The doctors at Baylor told Jen they 0:06:21.839 --> 0:06:24.839 had to put out a call for anonymous, altruistic donors, 0:06:25.600 --> 0:06:28.400 people who were willing to donate their uterus to a 0:06:28.480 --> 0:06:33.400 complete stranger. Jen also asked her family members and friends, 0:06:33.640 --> 0:06:36.400 but for various reasons, none of them were in a 0:06:36.440 --> 0:06:40.600 position to donate. While she was waiting for the clinic 0:06:40.640 --> 0:06:44.320 to identify a compatible donor, Jen and her husband flew 0:06:44.400 --> 0:06:47.520 back to Texas to do a round of IVF. They 0:06:47.560 --> 0:06:51.320 got five embryos. A month later, the clinic told Jen 0:06:51.520 --> 0:06:55.520 they'd found a donor and she was a match. For 0:06:55.600 --> 0:06:58.679 privacy reasons, the hospital couldn't share much about the woman, 0:06:59.240 --> 0:07:01.320 just that she was from the area and had four 0:07:01.400 --> 0:07:05.000 kids herself, but the hospital did allow the two women 0:07:05.080 --> 0:07:07.080 to exchange cards through their nurses. 0:07:08.320 --> 0:07:10.920 I felt like I had so much to tell her, 0:07:12.040 --> 0:07:16.720 and a pen and a card just wasn't enough. It 0:07:16.800 --> 0:07:19.840 was just very selfless for someone a stranger to do 0:07:19.880 --> 0:07:23.840 something like that for someone that they don't know, And 0:07:23.880 --> 0:07:27.040 I just couldn't think her enough, and her family for 0:07:27.160 --> 0:07:30.040 letting her go under the knife or somebody. They have 0:07:30.160 --> 0:07:32.600 no blue who they're doing it for. 0:07:33.600 --> 0:07:36.320 The transplant took place just a few weeks later. 0:07:38.520 --> 0:07:42.080 After they woke me up from the surgery. I remember 0:07:42.120 --> 0:07:45.120 them rolling me to ICU, and that was whenever I 0:07:45.200 --> 0:07:48.000 first opened my eyes, and I just remember laying there 0:07:48.080 --> 0:07:51.320 and watching the lights above me as we're walking down 0:07:51.360 --> 0:07:53.920 the hallway, and the first thing I said. 0:07:53.840 --> 0:07:55.120 Was do I have a uterus? 0:07:55.400 --> 0:07:57.640 And the nurse who was pushing me look down and 0:07:58.080 --> 0:08:00.440 they smiled and they're like, you have a uter And 0:08:00.480 --> 0:08:03.840 I just remember feeling so happy and putting my hands 0:08:03.840 --> 0:08:04.560 on my stomach. 0:08:05.360 --> 0:08:08.960 The surgery seemed to have gone well, but one month later, 0:08:09.240 --> 0:08:12.720 Jen noticed that she was having some spotting. She called 0:08:12.720 --> 0:08:16.000 her doctor, who asked her to describe the bleeding. 0:08:16.080 --> 0:08:18.240 And she's like, you know, I think you're starting your 0:08:18.320 --> 0:08:21.240 very first period, and I was like, really. 0:08:22.320 --> 0:08:25.720 At age twenty seven, Jen had gotten her period for 0:08:25.760 --> 0:08:30.320 the first time. The surgery had worked. Six months after 0:08:30.360 --> 0:08:33.320 the transplant, Jen went to the fertility clinic to have 0:08:33.400 --> 0:08:37.640 one of her frozen embryos transferred into a new uterus. 0:08:38.000 --> 0:08:43.360 After having the embryo transfer, I just I didn't want 0:08:43.400 --> 0:08:45.240 to move. I kind of just wanted to stay in 0:08:45.280 --> 0:08:48.120 one spot until we got the word to know if 0:08:48.120 --> 0:08:48.880 it had worked. 0:08:48.880 --> 0:08:50.479 I just I was so cautious. 0:08:51.760 --> 0:08:54.520 Nine days later, she went in for testing to see 0:08:54.520 --> 0:08:56.040 if the embryo had implanted. 0:08:56.520 --> 0:08:57.040 It had. 0:08:57.880 --> 0:09:03.920 Jen was pregnant, and I just, I can't believe like that. 0:09:04.120 --> 0:09:08.040 That's something that I had always dreamed about, and it happened. 0:09:08.160 --> 0:09:08.760 It worked. 0:09:10.280 --> 0:09:13.600 Her pregnancy went smoothly, and the experience of carrying a 0:09:13.679 --> 0:09:16.280 child was everything Jen had hoped it would be. 0:09:16.920 --> 0:09:20.920 I had an amazing experience being pregnant. I loved being 0:09:20.960 --> 0:09:23.960 able to look at my belly grow and feel the 0:09:24.000 --> 0:09:26.720 baby move and things like that. 0:09:27.520 --> 0:09:30.680 In February twenty eighteen, more than three years after she 0:09:30.760 --> 0:09:35.280 had first started learning about uterus transplants, Jen gave birth 0:09:35.320 --> 0:09:38.920 to a healthy daughter, Jea, in a planned C section. 0:09:39.520 --> 0:09:42.720 But Jen's story doesn't end there. Two years after she 0:09:42.800 --> 0:09:46.559 had her daughter, Jia, in February twenty twenty, Jen gave 0:09:46.600 --> 0:09:50.440 birth to a second baby, girl, Jade, That made Jen 0:09:50.520 --> 0:09:53.280 the first woman in the US to have two children 0:09:53.360 --> 0:09:57.880 with the transplanted uterus. The same day, Jade was born 0:09:58.160 --> 0:10:01.640 at the recommendation of her medical team, gens uterus was 0:10:01.679 --> 0:10:06.760 surgically removed, but by then it had changed her life forever. 0:10:08.160 --> 0:10:12.480 Despite the obvious upsides of uterus transplants, the procedure has 0:10:12.520 --> 0:10:16.800 still raised a number of tricky ethical issues. Doctor Ruth 0:10:16.840 --> 0:10:20.640 Ferrel is an obgyn and bioethicist who has been at 0:10:20.640 --> 0:10:24.880 the forefront of these issues. She's Vice Chair of Research 0:10:25.000 --> 0:10:28.720 for the Obgyn and Women's Health Institute. As a Cleveland 0:10:28.800 --> 0:10:32.880 clinic where the first ever us uterus transplant happened in 0:10:32.920 --> 0:10:37.320 twenty sixteen, Ruth led the ethics discussions leading up to 0:10:37.360 --> 0:10:41.439 that successful transplant. She helped to explain why people might 0:10:41.520 --> 0:10:45.400 choose a uterus transplant that is invasive and expensive over 0:10:45.480 --> 0:10:48.760 other options like adopting or using a gestational carrier. 0:10:51.840 --> 0:10:54.360 There are other approaches to have families, and they are 0:10:54.520 --> 0:10:58.200 very important and valid ways to build families. Yet for 0:10:58.240 --> 0:11:03.040 some individuals, either because of local legal regulations or cultural 0:11:03.200 --> 0:11:08.559 or religious policies or practices, that gestational surrogacy or adoption 0:11:08.679 --> 0:11:13.040 are not permitted or accessible, So uterine transplant is another option. 0:11:14.320 --> 0:11:18.520 The prestigious starts with the donated uters becoming available, and 0:11:18.600 --> 0:11:20.079 that can happen in two ways. 0:11:21.400 --> 0:11:26.160 One is a living donor model, where individual will make 0:11:26.200 --> 0:11:28.600 the choice to have the uters removed and then give 0:11:28.640 --> 0:11:31.839 it to another individual who's considering uterine transplant. The other 0:11:31.880 --> 0:11:33.440 approach is a deceased donor model. 0:11:34.040 --> 0:11:37.720 There are several ethical issues to consider in the donation process, 0:11:38.320 --> 0:11:41.400 regardless of whether it is a living or deceased donor. 0:11:41.760 --> 0:11:43.960 With respect to living donors, we think about what maybe 0:11:44.000 --> 0:11:47.000 the factors to deciding to donate their uterus, how do 0:11:47.040 --> 0:11:51.280 we ensure those decisions are made voluntarily and using informed consent. 0:11:51.920 --> 0:11:54.920 Or an individual who has deceased and as donate their organs, 0:11:55.000 --> 0:11:56.560 we also have to think about what they would have 0:11:56.640 --> 0:12:00.200 wanted and seeking permission and authorization from their families if 0:12:00.200 --> 0:12:02.240 the uterus is used in this way. 0:12:03.040 --> 0:12:06.760 Unlike deceased donors, living donors take some degree of risk 0:12:07.040 --> 0:12:11.280 to their health. Like any invasive surgery, there's the potential 0:12:11.320 --> 0:12:13.800 for donors to get an infection or lose a lot 0:12:13.880 --> 0:12:16.800 of blood, and that also has to be taken into 0:12:16.880 --> 0:12:20.680 consideration in an ethical analysis of uterist transplants. 0:12:21.360 --> 0:12:24.080 When you donate your uterus as a living donor, it's 0:12:24.160 --> 0:12:27.960 more than just a standard hysterectomy. The reason why is 0:12:28.480 --> 0:12:31.079 when you remove the uterus for a transplant reason, you're 0:12:31.120 --> 0:12:33.440 trying to also get a lot of the tissue next 0:12:33.440 --> 0:12:35.720 to it getting some of the blood vessels because that's 0:12:35.720 --> 0:12:39.480 important for having a good connection in the recipient. When 0:12:39.480 --> 0:12:41.440 you get more tissue, there can be some injury to 0:12:41.480 --> 0:12:43.520 the organs in the pelvis, and that can either lead 0:12:43.559 --> 0:12:45.640 to a short term or long term complication. 0:12:46.600 --> 0:12:49.920 Sometimes the donors are family members of the recipient, a 0:12:49.920 --> 0:12:54.119 sibling or even a mother That can also raise questions. 0:12:54.720 --> 0:12:58.440 There may be factors such as pressure, coersion, someone's sense 0:12:58.520 --> 0:13:01.720 of duty or obligation help a family member or a relative, 0:13:02.360 --> 0:13:03.960 So we need to think about those and do as 0:13:04.040 --> 0:13:06.480 much as we can ahead of time to ensure that 0:13:06.880 --> 0:13:10.760 all parties are informed of what the procedure entails and 0:13:10.800 --> 0:13:15.880 to reduce any potential influence of coercion or bias in 0:13:15.960 --> 0:13:19.040 that and the centers that are undergoing these studies or 0:13:19.360 --> 0:13:23.440 taking on these procedures do a very meticulous job of 0:13:24.760 --> 0:13:26.800 informed consent for all members of the group. 0:13:27.760 --> 0:13:30.800 There's a growing demand for this procedure, which allows someone 0:13:30.840 --> 0:13:33.360 to carry their own child who would otherwise not be 0:13:33.440 --> 0:13:38.000 able to. Right now, uterus transplants are mainly available through 0:13:38.080 --> 0:13:42.840 research programs one day when they do become available more widely, 0:13:43.559 --> 0:13:46.560 getting one maybe out of reach for most of those 0:13:46.760 --> 0:13:51.240 who need or want one. Many people already face limited 0:13:51.280 --> 0:13:55.280 access to fertility treatments because few are covered by insurance, 0:13:55.640 --> 0:13:58.600 which raises questions of who exactly will be able to 0:13:58.640 --> 0:13:59.880 afford this surgery. 0:14:01.200 --> 0:14:05.640 Part of the core of this is identifying that infertility 0:14:05.760 --> 0:14:08.360 is a condition, is a disease for which there should 0:14:08.360 --> 0:14:10.760 be coverage. Also, how to all play it all depend 0:14:10.840 --> 0:14:12.719 upon the country and what kind of insurance they have, 0:14:12.760 --> 0:14:16.240 whether it's a or nationalized healthcare system or system like 0:14:16.280 --> 0:14:19.520 here in the US, And so there's still many unknowns 0:14:19.560 --> 0:14:22.560 about how much this will cost and how will be 0:14:22.600 --> 0:14:26.400 paid for. So that's something which is still being studied, 0:14:26.760 --> 0:14:28.800 but it's a core part of doing research and you 0:14:28.880 --> 0:14:33.800 doing transplant understanding how we can ensure that equity issues 0:14:34.120 --> 0:14:35.640 are not perpetuated. 0:14:36.920 --> 0:14:39.600 Coming up, I'll speak with the person who knows more 0:14:39.640 --> 0:14:43.720 about uterus transplants than perhaps anyone in the world. She 0:14:43.880 --> 0:14:47.000 headed up the team that gave Jen her transplant, and 0:14:47.040 --> 0:14:49.520 she was right there in the room when Jen had 0:14:49.520 --> 0:14:53.200 her children. She and her colleagues are already at work 0:14:53.240 --> 0:14:56.280 on the next surgical breakthrough in uterrous transplants. 0:14:56.960 --> 0:15:02.160 There is no clear, you know, medical reason why transgender 0:15:02.160 --> 0:15:04.880 females couldn't undergo a uterus transplant. 0:15:05.760 --> 0:15:14.880 That's after the break Lisa Johannson is a medical director 0:15:14.960 --> 0:15:19.400 a uteris transplant at Baylor University Medical Center in Dallas, Texas. 0:15:20.040 --> 0:15:24.080 She's been working on utros transplants for fifteen years. It 0:15:24.120 --> 0:15:26.520 all started for Lisa when she was a resident in 0:15:26.560 --> 0:15:31.479 gynecology and obstetrics in Sweden. One of her professors suggested 0:15:31.520 --> 0:15:34.720 she join his lab and make uterus transplants the focus 0:15:34.760 --> 0:15:35.520 of her PhD. 0:15:36.400 --> 0:15:39.880 First, I thought he was absolutely insane. I had never 0:15:39.920 --> 0:15:42.600 heard about it and it was completely new to me 0:15:42.800 --> 0:15:45.840 the concept. But as I kind of learned more about it, 0:15:45.960 --> 0:15:49.920 I decided that this was something exciting and we started 0:15:49.920 --> 0:15:56.000 them performing the rodent surgeries and then pig models, sheep models, 0:15:56.040 --> 0:15:58.560 and then as the last kind of step before we 0:15:58.560 --> 0:16:03.120 could do humans, did baboon studies as well. So when 0:16:03.160 --> 0:16:06.440 I presented my thesis this was back in twenty twelve, 0:16:07.440 --> 0:16:09.920 a couple of months after that we started with the 0:16:09.920 --> 0:16:12.640 first human trial of uterus transplant in the world. 0:16:13.560 --> 0:16:18.040 Wow, very pioneering. So could you tell me what your 0:16:18.080 --> 0:16:21.400 favorite part of specializing in this area is now. 0:16:21.400 --> 0:16:24.720 My favorite part is that we now actually can sit 0:16:24.800 --> 0:16:28.920 down with patients that are they lost their uterus, are 0:16:28.960 --> 0:16:32.080 they're born without uters, and we can actually tell them 0:16:32.280 --> 0:16:35.720 that there is options for you. You can go through surrogacy, 0:16:35.800 --> 0:16:38.040 you can go through adoption, but there's also an option 0:16:38.200 --> 0:16:42.040 to actually treat the diagnosis you have and you can 0:16:42.120 --> 0:16:45.800 experience gestation and childbirth. And I never thought that we 0:16:45.800 --> 0:16:48.280 were going to be able to say that to our patients. 0:16:48.520 --> 0:16:51.080 Wow, that's incredible to have seen that right from the 0:16:51.120 --> 0:16:53.640 process of operating on animals and then go through to 0:16:53.680 --> 0:16:56.200 be able to tell someone that they could have a 0:16:56.240 --> 0:17:00.480 baby in that way. That's amazing. So where were you 0:17:00.560 --> 0:17:02.040 then when Jen gave birth? 0:17:02.240 --> 0:17:06.000 I was right there delivering the baby, So I think 0:17:06.040 --> 0:17:08.880 all of our team members were in that delivery room, 0:17:09.040 --> 0:17:12.080 and you know, just being there for her, for her family, 0:17:12.600 --> 0:17:13.320 it's worth it. 0:17:13.440 --> 0:17:16.960 Right there, that must have been a powerful moment. So, 0:17:17.040 --> 0:17:19.760 going back to when you got started with uterus transplants, 0:17:20.000 --> 0:17:22.840 what types of ethical questions were you and other researchers 0:17:22.840 --> 0:17:23.840 considering back then? 0:17:24.400 --> 0:17:27.439 The ethics around this has changed a lot. So in 0:17:27.520 --> 0:17:31.120 the beginning when we did this in animals, the ethics 0:17:31.200 --> 0:17:35.119 was very much focused on is this doable, this procedure, 0:17:35.600 --> 0:17:37.440 is it worth it? Why are we doing it? Because 0:17:37.440 --> 0:17:40.199 there are other options we will always get compared with 0:17:40.760 --> 0:17:45.520 surrogacy and adoption. But then when we started having offspring 0:17:45.600 --> 0:17:48.040 from the animal research and when we started having babies 0:17:48.400 --> 0:17:52.760 from the human trials, the ethics kind of changed. We 0:17:52.840 --> 0:17:56.639 more came into ethics around who should we do this for, 0:17:57.040 --> 0:17:59.760 how should we do this procedure to minimize the risk 0:17:59.800 --> 0:18:03.920 for the recipients. Which donors should we use? Is it's 0:18:04.119 --> 0:18:07.080 okay to use living donors for this transplant that is 0:18:07.080 --> 0:18:11.440 not life necessary and it's only a quality of life enhancing. 0:18:11.880 --> 0:18:15.359 So the ethical field has been very interesting to follow, 0:18:15.760 --> 0:18:18.679 but it's evolving as we of all the surgical field. 0:18:19.400 --> 0:18:21.960 Yeah, So one thing that surprised me about Gen's story 0:18:22.280 --> 0:18:24.800 was that after she had her second baby, her uterus 0:18:24.920 --> 0:18:29.080 was removed. Why is this transplant only kept temporarily rather 0:18:29.119 --> 0:18:30.440 than leaving it in place. 0:18:31.280 --> 0:18:34.679 At the moment the recipient of uterus will have to 0:18:34.720 --> 0:18:39.640 take umnisuppressive medications that goes for all solid organs, and 0:18:39.680 --> 0:18:42.600 as of now, these medications if you take them for 0:18:42.640 --> 0:18:46.159 many many years, they might have adverse effects on your 0:18:46.240 --> 0:18:50.040 kidneys and on other organ systems in the body, So 0:18:50.080 --> 0:18:53.760 we try to minimize the time that these healthy individuals 0:18:53.880 --> 0:18:56.560 need to be on a minu suppressive treatment. So that's 0:18:56.600 --> 0:18:59.920 why we usually say about five six years is enough. 0:19:00.480 --> 0:19:03.240 During that time, we give them possibility of having one 0:19:03.359 --> 0:19:06.960 to maybe three children, and then we actually take the 0:19:07.080 --> 0:19:07.720 utress out. 0:19:08.600 --> 0:19:12.919 Huh. That's interesting because if the uterus can be taken 0:19:13.040 --> 0:19:16.640 back after it's fulfilled its purpose, I could see how 0:19:16.680 --> 0:19:21.040 a surgeon might feel more ethically comfortable performing that transplant, 0:19:21.200 --> 0:19:23.480 which is not about saving a life, if they know 0:19:23.560 --> 0:19:26.240 that the side effects are more short term because the 0:19:26.359 --> 0:19:30.199 uterus can be removed again. But then how do physicians 0:19:30.280 --> 0:19:33.560 weigh their idea of when a surgery is worth it 0:19:33.720 --> 0:19:36.080 versus when a patient thinks it's worth it. 0:19:36.880 --> 0:19:39.960 Yeah, so I think you know, as a surgeon, one 0:19:40.000 --> 0:19:45.760 of our main tasks is to not inflict harm, not 0:19:46.040 --> 0:19:49.680 injure the patients we're dealing with, So it's not up 0:19:49.960 --> 0:19:52.200 to me to decide, you know, how much does a 0:19:52.400 --> 0:19:56.639 uterus in a person's life, how much quality of life 0:19:56.680 --> 0:19:59.280 does that enhance? You know, having a uterress. I can 0:19:59.359 --> 0:20:01.879 never say that because that's only up to the person 0:20:02.040 --> 0:20:05.480 who wants sat utris and to evaluate how much it 0:20:05.520 --> 0:20:09.640 means to them. But for me, I can never make 0:20:09.720 --> 0:20:13.359 myself inflict harm on anyone, So I know that immune 0:20:13.359 --> 0:20:17.439 suppression will not be in that person's best interest, and 0:20:17.480 --> 0:20:21.600 I have to lean towards what can I do to 0:20:21.640 --> 0:20:25.200 develop better drugs, what can I do to think outside 0:20:25.240 --> 0:20:29.040 of the box to help these patients. But it's a 0:20:29.160 --> 0:20:32.440 very very tricky feel because I can understand why that 0:20:32.480 --> 0:20:37.280 would be important, but I have responsibility not to inflict 0:20:37.720 --> 0:20:39.160 harm on patients as well. 0:20:40.359 --> 0:20:43.119 And could you speak a bit more about how candidates 0:20:43.119 --> 0:20:47.359 are evaluated or prioritized, so who's first on the list 0:20:47.400 --> 0:20:51.439 for a transplant and how do you assess needs and eligibility. 0:20:51.720 --> 0:20:55.040 So there's a tremendous need for this procedure, so we've 0:20:55.040 --> 0:20:57.560 been quite surprised when we look at the numbers. So 0:20:57.600 --> 0:21:01.240 we actually did a little study with Baylor and with 0:21:01.359 --> 0:21:04.199 Cleveland Clinic and with University of Pennsylvania, which had been 0:21:04.240 --> 0:21:06.600 the three centers in the US that was mostly active 0:21:06.640 --> 0:21:10.160 in utross transplant in the beginning, and during these five 0:21:10.280 --> 0:21:12.399 years or six years that we have been open for 0:21:12.520 --> 0:21:15.359 US transplant we have had more than five thousand women 0:21:15.400 --> 0:21:19.200 applying for having a utress transplant, and we have only 0:21:19.240 --> 0:21:22.439 transplanted thirty nine, so you can imagine how many we 0:21:22.560 --> 0:21:25.480 have had to say no to. From the beginning, it's 0:21:25.520 --> 0:21:30.320 been first come, first basis. They contact us, we have 0:21:30.400 --> 0:21:33.360 a basic kind of health questionnaire first to make sure 0:21:33.400 --> 0:21:35.960 that they are healthy, to make sure that they are 0:21:36.280 --> 0:21:39.600 right age, and then we have them in for evaluation. 0:21:40.200 --> 0:21:44.040 And then after we have cleared these individuals for transplant, 0:21:44.359 --> 0:21:47.600 we start looking for an eligible donor for them, and 0:21:47.720 --> 0:21:50.000 most cases in the US so far has actually been 0:21:50.040 --> 0:21:51.080 living donors. 0:21:51.520 --> 0:21:54.320 And what would happen if a patient had their children 0:21:54.480 --> 0:21:57.119 and then they said to you, I feel like this 0:21:57.280 --> 0:21:59.640 uterus is part of my body now and I don't 0:21:59.680 --> 0:22:00.760 want to have it removed. 0:22:01.359 --> 0:22:05.639 Yeah, So so far, these are highly selected patients that 0:22:05.720 --> 0:22:09.639 have been very compliant with the medical team. And we 0:22:09.720 --> 0:22:12.080 always say to the patients that we consider them to 0:22:12.119 --> 0:22:15.760 be part of the team. So we usually have conversations 0:22:15.760 --> 0:22:19.080 with them. If they have a different, you know, opinion 0:22:19.119 --> 0:22:21.840 than we do, we try to come to a common ground. 0:22:22.440 --> 0:22:24.280 But of course it's going to happen at some point 0:22:24.320 --> 0:22:26.520 that the patient is definitely don't want to give up 0:22:26.520 --> 0:22:29.639 their uters and the reason for that is that univerus 0:22:29.680 --> 0:22:31.800 oppression is not where we want it to be at 0:22:31.840 --> 0:22:36.200 the moment. It can potentially damage your life and your 0:22:36.320 --> 0:22:39.520 organs if you have it for too long. And we can't, 0:22:39.560 --> 0:22:41.959 of course force them to give up their uterus, but 0:22:42.000 --> 0:22:45.120 we can try to explain to them why we think 0:22:45.240 --> 0:22:48.439 like we do. And usually people come to terms with 0:22:48.520 --> 0:22:52.600 that because if they have given births, they also realize 0:22:52.600 --> 0:22:54.840 that they need to be there for that child for 0:22:55.280 --> 0:22:58.040 the child's lifetime, right, so they do want to be 0:22:58.119 --> 0:23:01.000 in good health, and if something is is damaging their 0:23:01.000 --> 0:23:04.760 health liking inn suppression potentially can do, they are quite 0:23:04.760 --> 0:23:05.840 willing to get rid of that. 0:23:06.320 --> 0:23:08.679 And if someone had their uterus removed because of a 0:23:08.720 --> 0:23:12.480 health condition like cancer or fibroids, but they felt that 0:23:12.560 --> 0:23:14.600