Uterus Transplant?

By J. Ron Eaker, M.D.

Recently, news of the first uterus transplant in the United States was blasted across the mediasphere. Doctors at The Cleveland Clinic, in a nine-hour-long surgery on a 26-year-old patient, took the uterus from a cadaver and implanted it in the young woman. The clinic says the patient adequately tolerated the procedure and is recovering well. She faces a year-long rehabilitation in which she will be required to take anti-rejection drugs.

The first question any sane person should ask about this news is…why? The spokesperson for Cleveland Clinic stated that one potential recipient capsulized her feelings by stating, “I crave that experience…I want the morning sickness, the backaches, the feet swelling. I want to feel the baby move. That is something I’ve wanted for as long as I can remember.”  While I empathize with her wishes, I find that lacking as a justification.

There are a number of issues that should be considered with any new medical procedure or device. It is becoming increasingly apparent that in medicine, as well as other technologies, that simply doing something because it can be done may not be either prudent or ethical. 

I realize that, as a clinician, ideally I would like to take cost out of any discussion surrounding medical care. However, that is impossible given today’s environment. Not a day goes by when I am not bombarded by requests (or demands) from insurance companies regarding costs of patient care. It is a fact of modern healthcare that economic concerns play a role in medical care delivery from both the physician and patient perspective. One group of economists in New York estimated that a single uterine transplant could cost well north of half a million dollars.      

Currently the procedure is considered experimental so no insurance company will even entertain the idea of coverage nor is it likely they ever will. Instantly, this then becomes the purview of the very wealthy or potentially a campaign on Kickstarter. Who pays then? We all do.

As I read the Cleveland Clinic press release I was struck by a paragraph that has seemingly slipped under the radar. They stated, “And the clinic says it intends for uterus transplants to be temporary in order to reduce long-term exposure to the medications.  After one to two healthy babies are born, the anti-rejection drugs are stopped…the transplanted uterus is either removed or allowed to disintegrate.”  

I had to read that twice, incredulous at the implication. It was stating that this multi-million dollar, nine-hour procedure was temporary. At a set time, two to three years after the initial surgery, the patient would undergo another operation to have the uterus removed! 

This illustrates the problem with this procedure. Imagine telling a heart or liver transplant patient that two years after they are getting their new liver, out it comes. I realize this is apples and oranges, but it highlights the underlying issue that this transplant is elective and not essential or life preserving. Millions of women live wonderfully fulfilled lives with or without children in spite of not having a uterus. So consider this: a woman is subjected to multiple surgeries, with no guarantee of a successful birth (as this appears as the only benchmark for success) and then undergoes another surgery to remove what was transplanted!  I’m going out on a limb here by saying maybe we can find a better utilization of resources, time and research.

Tommaso Falcone, MD, chair of the Ob/Gyn & Women’s Health Institute at Cleveland Clinic, and member of the surgical team, stated, “Uterine transplantation is the only hope for some women with no uterus.” I hope he meant that this was the only hope for women to have the pregnancy experience, because I know many adoptive parents and surrogates who would argue his point.

This debacle illustrates a bigger question looming over the healthcare horizon. As costs escalate (which they have done in spite of ObamaCare) will there be a time when care is either restricted, denied or…dare I say it…rationed? The massive baby boomer generation is aging rapidly, and unfortunately a majority is aging poorly. The costs associated with Medicare alone will potentially bankrupt the U.S. unless they are buffered. It is clear that allocating resources to such things as uterine transplants is a frivolous waste. I am in favor of everyone having access to quality health care, but we cannot get there if we don’t make some tough decisions, and why not start with the low-hanging fruit.  

The looming healthcare crisis will only be solved at the level of the individual and not by government. Choosing healthy lifestyles and eliminating corrosive habits and behaviors will empower the individual and benefit the society as a whole. The power lies within.