Peters H E, Juffermans L J M, Lambalk C B, Dekker J J M L, Fernhout T, Groenman F A, de Groot C J M, Hoksbergen A W J, Huirne J A F, de Leeuw R A, van Mello N M, Nederhoed J H, Schats R, Verhoeven M O, Hehenkamp W J K
Department of Obstetrics & Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands.
Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands.
Hum Reprod Open. 2020 Feb 28;2020(2):hoz032. doi: 10.1093/hropen/hoz032. eCollection 2020.
Is it feasible to perform uterus transplantations (UTx) in a tertiary centre in the Netherlands?
Considering all ethical principles, surgical risks and financial aspects, we have concluded that at this time, it is not feasible to establish the UTx procedure at our hospital.
UTx is a promising treatment for absolute uterine factor infertility. It is currently being investigated within several clinical trials worldwide and has resulted in the live birth of 19 children so far. Most UTx procedures are performed in women with the Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, a congenital disorder characterized by absence of the uterus. In the Netherlands, the only possible option for these women for having children is adoption or surrogacy.
We performed a feasibility study to search for ethical, medical and financial support for performing UTx at the Amsterdam UMC, location VUmc.
PARTICIPANTS/MATERIALS SETTING METHODS: For this feasibility study, we created a special interest group, including gynaecologists, transplant surgeons, researchers and a financial advisor. Also, in collaboration with the patients' association for women with MRKH, a questionnaire study was performed to research the decision-making in possible recipients. In this paper, we present an overview of current practices and literature on UTx and discuss the results of our feasibility study.
A high level of interest from the possible recipients became apparent from our questionnaire amongst women with MRKH. The majority (64.8%) positively considered UTx with a live donor, with 69.6% having a potential donor available. However, this 'non-life-saving transplantation' requires careful balancing of risks and benefits. The UTx procedure includes two complex surgeries and unknown consequences for the unborn child. The costs for one UTx are calculated to be around €100 000 and will not be compensated by medical insurance. The Clinical Ethics Committee places great emphasis on the principle of non-maleficence and the 'fair distribution of health services'.
In the Netherlands, alternatives for having children are available and future collaboration with experienced foreign clinics that offer the procedure is a possibility not yet investigated.
The final assessment of this feasibility study is that that there are not enough grounds to support this procedure at our hospital at this point in time. We will closely follow the developments and will re-evaluate the feasibility in the future.
STUDY FUNDING/COMPETING INTERESTS: This feasibility study was funded by the VU Medical Center (Innovation grant 2017). No conflicts of interest have been reported relevant to the subject of all authors.
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在荷兰的一家三级医疗中心进行子宫移植（UTx）是否可行？
综合考虑所有伦理原则、手术风险和财务方面，我们得出结论，目前在我院开展子宫移植手术是不可行的。
子宫移植是治疗绝对子宫因素不孕症的一种有前景的方法。目前全球正在进行多项临床试验，到目前为止已经有19名儿童通过子宫移植存活出生。大多数子宫移植手术是在患有 Mayer-Rokitansky-Küster-Hauser（MRKH）综合征的女性中进行的，这是一种以子宫缺失为特征的先天性疾病。在荷兰，这些女性生育孩子的唯一可能选择是领养或代孕。
研究设计、规模、持续时间：我们进行了一项可行性研究，以寻求在阿姆斯特丹大学医学中心（VUmc院区）开展子宫移植的伦理、医学和财务支持。
参与者/材料、环境、方法：在这项可行性研究中，我们成立了一个特别兴趣小组，成员包括妇科医生、移植外科医生、研究人员和一名财务顾问。此外，我们与MRKH综合征女性患者协会合作，进行了一项问卷调查研究，以了解潜在受者的决策过程。在本文中，我们概述了当前子宫移植的实践和文献，并讨论了我们可行性研究的结果。
我们对MRKH综合征女性患者的问卷调查显示，潜在受者对此表现出了高度兴趣。大多数（64.8%）女性积极考虑活体供体子宫移植，其中69.6%有潜在供体。然而，这种“非挽救生命的移植”需要仔细权衡风险和益处。子宫移植手术包括两个复杂的手术，且对未出生婴儿的影响尚不清楚。据计算，一次子宫移植的费用约为10万欧元，医疗保险不予报销。临床伦理委员会非常重视不伤害原则和“医疗服务的公平分配”。
局限性、谨慎的理由：在荷兰，有其他生育方式可供选择，并且未来与提供该手术的经验丰富的国外诊所合作的可能性尚未得到研究。
这项可行性研究的最终评估是，目前我院没有足够的理由支持开展该手术。我们将密切关注进展情况，并在未来重新评估其可行性。
研究资金/利益冲突：这项可行性研究由VU医学中心资助（2017年创新基金）。所有作者均未报告与该主题相关的利益冲突。
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