This week’s Insight explores the ethics, impacts and outcomes of transplants. Watch “Transplant Breakthroughs” on .
Kirsty Britt, aged 30, was the first woman in Australia who received a uterus donation.
Six weeks after her operation, which was part in a clinical trial at The Royal Hospital for Women, Sydney, she is doing well and has her first period.
Michelle Hayton, Michelle’s mother, was ill.
Kristy was allowed to be conceived by her mother.
“I had a few bumps in the road,” she told Insight. “I’ve had a couple of infections but definitely getting stronger every day.”
This procedure is still experimental. It will be possible to have a child if the trial is successful. Around one in 5,000 people in the country have the rare Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome, which typically means their uterus may be small or absent.
However, uterine transplantation does not save lives and has its ethical challenges.
The trial was led by Dr Rebecca Deans, a gynaecologist.
“It’s quite a complicated procedure. And we’ve only done, in the world, less than 80,” Dr Deans told Insight.
Contrary to a standard hysterectomy that removes the uterus, the surgery for transplantation involves removing blood vessels from the uterus. This is done without any adverse effects on other organs of a living donor. It can take anywhere from eight to twelve hours.
Dr Deans says the trial has received the necessary ethics approval under Australia’s Human Research Ethics Committee’s framework to perform the procedure on six patients.
“At the moment we’ve got ethics approval to do six. And we’re going to do a combination of transplant surgeries from living and deceased donors.
Dr Deans stated that there is a five-year limit, or two live babies, that a person can have a transplanted, uterus. It is because immunosuppressing medication can cause other organs to be affected in the long-term.
After suffering a hemorhage in her uterus during her 2021 birth, Ms Bryant had to have her uterus surgically removed. She claims she has always wanted more children. She looked into surrogacy and adoption options after her hysterectomy.
It’s quite a complicated procedure. It’s a complicated process that we have done in the world less than 80 times.
Dr Rebecca Deans
“People wanted to reassure me that you still have your ovaries, you still have your eggs, you’ll be able to have biological children. But obviously, I wasn’t going to be able to carry another pregnancy,” she said.
“Carrying a baby doesn’t make me any more of a parent or a mother. But I knew that I wanted to be pregnant again and that I wanted to carry another baby.”
What ethics are there around elective transplants.
Associate Professor Mianna Lotz from Macquarie University has advised the Royal Hospital for Women about the ethical questions that the trial has raised.
One is whether transplantation that isn’t life-saving is worth the risk.
“When we shift to something like a life-enhancing or quality of life transplant, as they’re also known, the question immediately arises for people, is there a medical need for this?” Associate Professor Lotz said.
Because donors are living people, it’s important to make sure their decision is voluntary and informed about the complexity of the procedure as well as medical and psychological risks.
The process of extracting the cysts is more complex than a normal hysterectomy. Credit: Feed
“Here, we’re talking about a donor who’s healthy, who doesn’t have any medically indicated need for a 10 or 12-hour surgery, and for whom there might be impacts on bladder and those sorts of things,” Lotz said.
“But they also need to be really informed and really thinking carefully over a period of time about the potential psycho-emotional risks.”
Associate Professor Lotz said that, in addition to safety and consent questions, there are larger ethical concerns about the stigma surrounding infertility. This could lead to women and partners being pressured to have children.
However, as Associate Professor Lodz noted, even a decision that something is a medical need doesn’t settle the question of whether it should or should not be treated.
This is a healthy donor, who has no medically-indicated need for a 10- or 12-hour operation.
Associate Professor Lotz
“Some preferences and desires are so central to people’s conception of a good life and to what they perceive their identity to be, that to simply say, ‘well, that’s a mere reproductive preference that you have’, is to treat it without due respect and not accord it due significance,” she said.
“We all need to make a careful deliberation and determination of what it is we’re going to treat as a need, or as a preference and what is worth and important to divert our medical resources towards addressing.”
Ms. Hayton (54), says that the surgery was well worth it.
“Even knowing everything that I know now, would I still have done it? Yes, definitely,” she said.
“As a mother, you do anything for your children. I really knew how much Kirsty wanted to carry another baby.”
Kirsty indicated that, while she doesn’t know if she will fall pregnant again in the future, she is proud of participating in the trial.
Kirsty hopes to have a sibling through her uterus donation. Credit: Feed
“I knew I wanted to put my hand up and my hat in the ring and; hopefully, what we’ve done so far and the surgery will help other women and help the doctors and the team,” she said.
“Hopefully women out there realise that this may be an option for them one day.”
Watch “Transplant Breakthroughs” from Tuesday, 8.30pm on SBS On Demand.
