Saturday , December 4 2021

The first child born after transplantation & # 39; donor & # 39; kadaveric donor was born



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The baby born from transplant Source: AP – Credit: Dr. Wellington Andrau

It happened in Brazil. On 15 & # 39; December 2017, a baby was born with 2,550 kilograms in & # 39; her health. Three days later, mother and daughter were at home. S & # 39; now, nothing out of the ordinary, except for decisive fact: it is the first child in the world obtained from uterus transplant & # 39; kadavuż donor and the first in Latin America after the transplant uterus.

Woman & # 39; 32 years, who had their ovaries and produced eggs but lacked the uterus due to Mayer syndrome Rokitansky-Kuster-Hauser, congenital disorder that affects one in every 4,500 women, received the organ another 45, dead due to stroke. Although the donor had reached menopause seven & # 39; years before, his uterus could & # 39; lead. The treatment effect in & # 39; in September 2016, but has just been published in the medical journal
The Lancet.

"From the medical and scientific perspective: Excellent, technologically extraordinary", says Dr. Mario Sebastiani, obstetrician and member of the Ethics Committee of the Italian Hospital, "When you transplant & # 39; uterus, you do anastomosi. [conexión de los vasos sanguineos] receiver with donated organ; is a small organ [pesa 225 gramos] and difficulties are noticeable. But the procedure also poses complex ethical points, because to accept the organ, the woman is exposed to the dangers of surgery and immunosuppression, which puts in & # 39; risk & # 39; banal infections, without a threat & # 39; death (as is the case in other transplants, except for kidney and cornea) and alternatives ".

The transplant surgery was necessary & # 39; 10 and a half hours, and high doses of & # 39; immunosuppressants to prevent rejection. Six weeks later, the receiver began menstruation. Seven & # 39; months after vaccination, doctors impjantaw embryo derived from eggs and sperm of their partner. After delivery, doctors removed the transplanted uterus to restore normal functioning of the immune system. In his work, the medical team of the Hospital of Clinics & # 39; San Pablo said that this acquisition will facilitate "the widespread adoption" of & # 39; this intervention and suggests that not only & # 39; help infertile women with & # 39; congenital diseases, but also suffered organ removal from infections or cancer.

She operation, for now, is considered experimental. The team with the highest number of & # 39; these operations is the gynecologist Swedish Mats Brännström, who in 2013 announced the birth of the first child with the living donor transplant uterus. Since then 39 have been completed, of which 11 baby b & # 39; health born, but in & # 39; this mode donors generally are mothers, sisters or close friends of the recipients, which availability & # 39; organs is very limited.

"B & # 39; kadavuż donor, one m & # 39; why should put the donor in & # 39; risk, and also reduce costs, because it prevents the hospital & # 39; one of the women", said Dani Ejzenberg, team leader of & # 39; San Pablo University who led the investigation. S & # 39; now, 10 transplants have been proven by & # 39; this mode, but without success.

However, their optimism is not shared by everyone. "It's very questionable technical achievement ethically", said Beatriz Domínguez-Gil, director of the National Transplant Organization in the newspaper El País in Spain. In 2016, the ethics committee & # 39; this organization has analyzed these proceedings and rejected them, because they create more risks than benefits. "In cases & # 39; women born without a uterus, in making this intervention, the woman's right to motherhood prevails, but in our opinion it is more important to respect the non principle a & # 39; [no hacer daño] and also what the proper use of public resources. "In Argentina, interventions & # 39; this type have not yet been registered, although the Italian Hospital assessed the possibility to launch a program.

"I came in & # 39; Gothenburg was created Society of Transplantation uterus, there were 50 or 60 doctors from around the world", says the young gynecologist Victorio Viglierchio, sent by the hospital & # 39; Buenos Aires to learn about technique.

According to the specialist, the protocol for doing this kind of & # 39; intervention is simple. It is necessary to find candidates, usually by women & # 39; genetic alteration, and find possible donor. Then you stimulate the ovaries, remove the ovoċiti, tiffriżahom, generating embryos and, eventually, making biopsies to study the chromosomes. As the donor, those who have not undergone previous sections & # 39; cesarea, who were born, and endometrial biopsies are often made to control the receptivity of the uterus to be transplanted. "After organs kataveriji eliminate certain difficulties, but requires that the technique dissipate much, because multidisciplinary team involving surgeons, gynecologists, immunological", explains Viglierchio, "when working with & # 39; living donor, the advantage is that there are more istocompatibility and mild immuno-suppression can & # 39; is made, tailored to the patient, in both cases, subsequent pregnancy is & # 39; high risk. "

Despite the conditions, there are those who believe that these procedures can benefit from a multitude of & # 39; patients and denial & # 39; transplant are similar to palitattiv not give treatment to a patient sick with & # 39; mode terminal. Those in & # 39; this group anticipate that this technique will be extended to offer solutions for women who have undergone removal of the uterus due to oncological problems, tumors or infections, and for the & # 39; now the only alternatives were surrogacy or adoption. M In the country & # 39; there is no law & # 39; subrogation, though a case in & # 39; this regard.

"In Europe are already talking about the uterine transplantation can & # 39; to be applied in the event & # 39; trans people," says Viglierchio, "technically possible, the man has the same provision & # 39; vessels in the pelvis as a woman. "

Others talk whether medical necessity or & # 39; luxury. "The uterus transplant, unlike & # 39; others, not done to save the patient's life," says Viglierchio, "the goal is to generate, sometimes mortality and morbidity are very high to justify the ultimate goal that can & # 39; sostitut.Għalhekk uterus, a & # 39; is often argued that this is an attempt to get maternity at any price, but for me all the options have pros and cons ".

"One can & # 39; say, m & # 39; there is no alternative?" Sebastian reflects, "because the woman is subject to very dangerous event to be able to manage, when there is a surrogate or adoption." Bioethical principle is justice. distributive justice Money is finite and so it is legitimate to invest so many resources in & # 39; these cases to omit other pressing public health problems? "GESTAR" m & # 39; be "maternarju". a & # 39; things that generate successes: medication, human resources, exploring neighborhoods have the effect of stimulating creativity, thinking and continue to manage borders ".

In turn, the specialist of reproductive medicine Ramiro Quintana, director of IFER, believes that it is imperative to take into account the legal and social aspects. "It is feasible, but it carries risks," he says, "in the event & # 39; subrogation, here they were out but there are fewer than a dozen children born with & # 39; this method."

The Incucai authorities have actually in Argentina m & # 39; there is no group that started this kind of & # 39; transplantation. Not included in the current technical practices and, if it starts, should be within the framework of & # 39; protocol & # 39; research. Two years ago there was a meeting with Argentina Society of Gynecology and obstetric and the Favaloro Foundation Surgeons, the Austral Hospital and Italian Hospital with the intention to develop a protocol, but it still is not done.

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