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Lebanon: Mother-Daughter Uterine Transplant Raises Hope For Infertile Women

By Terrance J. Mintner | The Media Line

July 24, 2018

Cleveland Clinic surgeons in February transplanted a uterus from a deceased donor into 26-year-old Lindsey McFarland, who was born without one. Though the experimental surgery was initially thought successful, a raging infection forced removal of the organ within weeks.
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The procedure may be less valued in Israel and other countries that allow surrogacy

Lebanese doctors, working in cooperation with a Swedish team, have completed a uterus transplant for the first time in Lebanon. The rare and difficult procedure for infertile women was conducted last month at Bellevue Medical Center (BMC) in Mansourieh, located just east of Beirut.

The recipient, a Jordanian woman who suffered from uterine factor infertility, received a new uterus donated by the patient’s mother, hospital officials confirmed.

“Today, we are ensuring that Lebanon is not just a beacon among the hospitals of the Arab world,” BMC CEO Nayef Maalouf said. “Today we are putting Lebanon on the international map.”

Officials at the hospital believe the operation could help tens of thousands of women in the Middle East who are infertile as a result of an absent or non-functioning uterus.

Collaborating with Swedish medical experts, BMC in 2016 started to explore the procedure. The University of Gothenburg had already been researching the benefits and drawbacks of the transplant research since 1999, a program that ultimately resulted in the world’s first child born from a successful uterus transplant in 2014. Thus far, eight children have been born in Sweden using the method.

Randa Akouri, a Lebanese-Swedish doctor who participated in the operation, told a local newspaper on Tuesday that the transplant reflects the region’s values. “In the Middle East, the family is very important,” she stressed. “When a woman can’t become pregnant, it’s a very bad thing for her socially. Family planning is very important for a Middle Eastern woman.”

Dr. Amel Alghrani, an expert on uterus transplants at the University of Liverpool, highlighted that the procedure is particularly valuable for Muslim women, given that surrogacy is forbidden in many Islamic countries. “In Islam, surrogacy is widely regarded as haram [forbidden], and there have been fatwas issued to this effect. For women in the Middle East and especially in Muslim countries, uterus transplantation potentially represents an alternative way women unable to gestate can still achieve genetic motherhood and reproduce.”

The procedure in Lebanon was not the first attempted uterus transplant in the Middle East, but hopes are high that it might result in the first successful subsequent birth. A similar operation was conducted in Saudi Arabia in 2000, but the uterus needed to be removed shortly thereafter due to blood clotting. Another attempt occurred in Turkey in 2011, but the uterus in that case was provided by a donor with a disease, thereby precluding childbirth.

Following these failures, new safety protocols were implemented requiring that the transplanted uterus remain in the recipient’s body for about a year before the mother becomes pregnant. This is done to rule out medical rejection.

Once the new uterus appears to have been accepted by the body, the woman is impregnated through In-vitro-Fertilization (IVF). The baby is then delivered via Cesarean section—about a month before full-term—in order to minimize stress on the donated organ.

Aside from Sweden, two children in the U.S. have been born using the procedure, as well as one in Brazil and another in Serbia, according to Dr. Akouri. While the transplant in Lebanon is holding for now, doctors still need to determine if the patient can become pregnant and give birth.

Dr. Tamar Ashkenazi, Director of the Israel National Transplant Center, told The Media Line that the procedure is currently not done in Israel, though some medical centers have started sending teams abroad to learn about the technologies and surgical expertise required.

When asked about the demand for uterus transplants in Israel, Ashkenazi responded that many Israelis do not know about the procedure. “But as more and more people become aware of it and learn about the methods, costs, advantages and disadvantages, demand could grow,” she asserted.

Judy Siegel-Itzkovich, a long-time medical journalist, told The Media Line that the negatives of the operation currently outweigh the benefits, at least in Israel. “In Israel, women who are unable to get pregnant can resort to surrogacy if they desire a child and the government will help them,” she said. Nevertheless, Siegel-Itzkovich noted that the procedure might be desirable for women born without a uterus or who underwent hysterectomies after contracting uterine cancer.

Still, she continued, “the transplant is extremely tricky and not cheap,” explaining that it involves the complex fusing of blood vessels and nerves to the new muscular sac itself. “Also, the procedure requires the woman to take anti-rejection drugs afterwards, sometimes for a long time [and definitely until she is ready to get pregnant]. These drugs can be toxic and cause complications.

“These women would face another difficulty,” Siegel-Itzkovich concluded, “as the uterus must then be removed, the last and necessary step of the procedure.”

The possibility of uterine transplantation first emerged in 1918, based on the work decades earlier of Emil Knauer, an Austrian gynecologist that successfully performed an ovarian auto-transplantation in a rabbit. The procedure involved the extraction and storage of ovarian material and subsequent transplantation back into the same female rabbit. The research paved the way for uterine transplantation experiments in dogs and rats in subsequent years.

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