Department of Gynaecology, Obstetrics and Urology, Sapienza University of Rome, Rome, Italy.
Int J Gynaecol Obstet. 2013 Nov;123(2):173-7. doi: 10.1016/j.ijgo.2013.05.010. Epub 2013 Jul 31.
Transplanting a uterus has unique characteristics, since a successful outcome is represented only by the birth of a viable healthy child. For this reason, critical issues in this type of transplantation differ profoundly from those of other solid organs and, beside a functioning uterus, involve 3 additional steps. First, at the time of implantation, the quality of embryo is tested by specialized decidual cells surrounding the implanting embryo; such testing is aimed at allowing the development of a normal embryo. Second, from early gestation onward, blood supply to the uterus increases from 45 to 750mL per minute. Vascular anastomoses should support such a marked increase in blood flow. Third, full transformation of spiral arterioles in the placental bed is required to direct 75% of the uterine blood flow to the intervillous space. Unfortunately, no suitable animal model is available for experimentation. Three overarching ethical issues must be considered. Should organ transplant be conducted when it is not absolutely necessary as a life-saving or quality-of-life-saving measure? To what extent should medicine delimit its potential in spite of societal desires? Should society demand from medicine the application of whichever technology can be developed and, if so, to what extent?
移植子宫具有独特的特点，因为成功的结果仅表现为健康婴儿的存活分娩。出于这个原因，这种类型的移植中的关键问题与其他实体器官的问题有很大的不同，除了功能正常的子宫外，还涉及 3 个额外的步骤。首先，在胚胎着床时，着床胚胎周围的专门蜕膜细胞会检测胚胎的质量；这种检测旨在允许正常胚胎的发育。其次，从妊娠早期开始，子宫的血液供应每分钟从 45 毫升增加到 750 毫升。血管吻合术应支持如此明显的血流量增加。第三，胎盘床的螺旋小动脉需要完全转化，以便将 75%的子宫血流导向绒毛间隙。遗憾的是，目前尚无合适的动物模型可供实验。有三个需要考虑的总体伦理问题。是否应该进行器官移植，即使它不是绝对必要的救命或提高生活质量的措施？医学应该在多大程度上限制其潜力，尽管社会有这种愿望？社会是否应该要求医学应用可以开发的任何技术，如果是这样，应该在多大程度上应用？
