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提供者对子宫移植的知识与支持:对多学科团队成员的调查

Provider Knowledge and Support of Uterus Transplantation: Surveying Multidisciplinary Team Members.

作者信息

Riggan Kirsten A, Khan Zaraq, Langstraat Carrie L, Allyse Megan A

机构信息

Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN.

Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN.

出版信息

Mayo Clin Proc Innov Qual Outcomes. 2020 Feb 17;4(2):150-158. doi: 10.1016/j.mayocpiqo.2019.11.001. eCollection 2020 Apr.

DOI:10.1016/j.mayocpiqo.2019.11.001
PMID:32280925
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7140015/
Abstract

OBJECTIVE

To determine relevant provider opinions on uterus transplantation (UTx).

PATIENTS AND METHODS

We invited 1933 providers in obstetrics and gynecology, transplant surgery, transplant medicine, internal medicine, and family medicine at a large, integrated health care system to complete an online survey containing a series of questions on their attitudes about the ethics and clinical utility of UTx. The survey was open from June 4, 2018, through July 2, 2018. We received 449 responses overall (23.2% response rate).

RESULTS

Of 433 physicians who responded, 195 (45.0%) believe that UTx is ethically justified, and just over a third (160 of 446 [35.9%]) would introduce the possibility of UTx to a patient with absolute uterine factor infertility (AUFI). Respondents indicated the risks to donor, recipient, and child carried the most weight in their ethical evaluation and were most supportive of UTx in a patient with congenital uterine absence (334 of 743 [45.0%]; participants were allowed to choose more than one answer). A majority stated that a living or cadaveric donor would be an acceptable donor source (238 of 395 [60.3%]).

CONCLUSION

Provider support for UTx is qualified by safety concerns and its expansion to patient populations other than women with AUFI. This survey suggests that most providers limit their support of UTx to patients with the most demonstrated clinical need, childless women with AUFI.

摘要

目的

确定医疗服务提供者对子宫移植(UTx)的相关意见。

患者与方法

我们邀请了一家大型综合医疗保健系统中妇产科、移植外科、移植医学、内科和家庭医学领域的1933名医疗服务提供者完成一项在线调查,该调查包含一系列关于他们对子宫移植的伦理和临床实用性态度的问题。调查于2018年6月4日至2018年7月2日开放。我们共收到449份回复(回复率为23.2%)。

结果

在433名回复的医生中,195名(45.0%)认为子宫移植在伦理上是合理的,略超过三分之一(446名中的160名[35.9%])会向绝对子宫因素不孕症(AUFI)患者介绍子宫移植的可能性。受访者表示,在伦理评估中,供体、受体和胎儿所面临的风险最为重要,并且最支持为先天性子宫缺失患者进行子宫移植(743名中的334名[45.0%];参与者可选择多个答案)。大多数人表示,活体或尸体供体将是可接受的供体来源(395名中的238名[60.3%])。

结论

医疗服务提供者对子宫移植的支持受到安全问题以及将其扩展到除绝对子宫因素不孕症女性之外的患者群体的限制。这项调查表明,大多数医疗服务提供者将他们对子宫移植的支持限制在临床需求最明确的患者,即无子女的绝对子宫因素不孕症女性。

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本文引用的文献

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Fertil Steril. 2019 Jul;112(1):3-10. doi: 10.1016/j.fertnstert.2019.05.030.
2
Livebirth after uterus transplantation from a deceased donor in a recipient with uterine infertility.因子宫性不孕行同种异体子宫移植术后活产 1 例
Lancet. 2019 Dec 22;392(10165):2697-2704. doi: 10.1016/S0140-6736(18)31766-5. Epub 2018 Dec 4.
3
American Society for Reproductive Medicine position statement on uterus transplantation: a committee opinion.美国生殖医学学会关于子宫移植的立场声明:委员会意见。
Fertil Steril. 2018 Sep;110(4):605-610. doi: 10.1016/j.fertnstert.2018.06.017.
4
"Whole Again": Why Are Penile Transplants Less Controversial Than Uterine?《再度完整》:为何阴茎移植比子宫移植争议更小?
Am J Bioeth. 2018 Jul;18(7):34-35. doi: 10.1080/15265161.2018.1478044.
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