It’s easy to be negative. Given that the return in clinical outcomes relative to cost is too often poor for any clinical innovation (e.g., robotic surgery, home uterine monitoring, bone marrow transplants for breast cancer, etc.), it is a reasonable bet anything new in medicine is lemon. Innovation and technology within health care account for significant portions of per capita growth in health spending among Americans over the last 50 years. In some cases this spending has resulted in real improvements in health outcomes but this is not the case in many settings. So what about spending to transplant a uterus?
Uterine transplant is not new. The procedure has been done in animals, has even resulted in live births among humans, and is not conceptually complicated. A donor uterus including the cervix is sutured to the top of the vagina, and the blood supply is hooked up. Since there is no nervous input into the transplant, it will not contract in any sort of coordinated way and delivery of any fetus must be via cesarean section. Similarly, fetal movements will not be felt in the same way. Any “experience” of pregnancy from a transplanted uterus is thus not totally natural (note the recent patient who underwent uterus transplantation at The Cleveland Clinic said “experiencing” pregnancy was an important reason behind her decision to pursue this surgery).
The reason to perform a uterine transplant is most easy to understand in those settings where a woman is born without a uterus (although in these cases they should have ovaries). Getting pregnant with a transplanted uterus requires in vitro fertilization. The organ recipient will have to take anti-rejection drugs, and when pregnancy is no longer desired, the uterus should be removed to avoid prolonged exposure to these drugs. None of this is an ordinary part of the pregnancy experience to say nothing of the implications for the fetus.
