Photo/Illutration The report issued by a committee under the Japanese Association of Medical Sciences approving uterus transplants (Kazuya Goto)

A Japanese Association of Medical Sciences committee released a report on July 14 clearing the way for uterus transplants, a rare procedure that faces obstacles. 

“I was concerned at first about finding an answer because the issue is very complicated and sensitive," Masamitsu Iino, a vice president of the association who headed the committee looking into uterus transplants, said at a news conference that day. "The views of committee members were at odds with each other at times, but we managed to conduct constructive discussions.”

The biggest issue facing the committee was that the transplant objective would be to allow the woman to give birth.

That differs greatly from other transplants in which the main objective is to save the recipient’s life. In addition, committee members had to consider allowing a transplant operation that held major health risks for both the donor and recipient.

According to a report, there have been 85 cases of uterus transplants in 16 nations overseas as of March and 40 have led to the delivery of a baby.

In many of those cases, an in-vitro fertilized embryo is placed in the transplanted uterus. But the uterus is removed after childbirth because of the need to continue using immunosuppressant agents to prevent the body from rejecting the transplanted organ.

In Japan, there are an estimated 60,000 to 70,000 women between the ages of 20 and 50 who were born without uteruses or have had their uteruses surgically removed due to tumors or other causes.

Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a condition in which the woman’s vagina and uterus are underdeveloped or absent. About one in 4,500 women are said to have the syndrome.

Although there have so far been no uterus transplants in Japan, a team of researchers at Keio University is planning to conduct clinical research involving women with MRKH syndrome.

There are also legal hurdles that have to be cleared.

Japan’s organ transplant law does not include uteruses as an organ that can be removed for transplantation from a brain-dead individual.

For that reason, the report allowed for transplants from live donors in only a very few cases to conduct clinical research.

The report also called for revising the organ transplant law to allow for uterus transplants from brain-dead women.

But even if the law was revised, organ donations from brain-dead individuals are still not widespread in Japan, meaning it would be almost impossible to plan for a uterus transplant operation.

Experts were divided in their views about the latest report.

Nobuhiko Suganuma, a professor of reproductive medicine at Nagoya University of Arts and Sciences who heads the Japan Society for Uterus Transplantation, said providing an alternative for women who want to give birth was a positive development.

But Yukiko Saito, an associate professor of medical ethics at Kitasato University, raised concerns about approving an available technology just because there may be people who want to utilize it.

“Unless a conclusion based on principles to serve as a foundation is reached, there will be no rationale for deciding in the future which people and which type of organ transplants should be allowed,” Saito said. “That would lead to further concerns about an ever-expanding range of possibilities for organ transplants.”

(This article was compiled from reports by Kai Ichino, Mirei Jinguji, Kazuya Goto and Akiyoshi Abe.)

Related News