Japan medical body ponders uterus transplants to help wombless women give birth

TOKYO -- The Japanese Association of Medical Sciences has begun looking into the pros and cons of allowing uterus transplants in the country to pave the way for wombless women to get pregnant and give birth.

The association set up a 13-member panel to examine the matter on April 3. Members include experts in reproductive medicine, medical transplantations, bioethics and criminal law. The panel will discuss ethical and safety issues associated with womb transplants and release its view on the issue within two years.

The panel also plans to compare uterus transplants with surrogate deliveries, which are currently prohibited in Japan, with an eye on lifting the ban in the future.

For women who were born without a womb or had their womb removed due to a disease or other reasons to have a child, they can either adopt a child, undergo a uterus transplant operation or resort to surrogate delivery. In uterus transplants, a woman receives a womb from a donor and seeks to get pregnant after her egg fertilized in-vitro with her partner's sperm is implanted. In surrogate delivery, a third individual gives birth to a baby using an egg fertilized in-vitro. The egg can come either from the client or a third individual.

Uterus transplants have been carried out in countries including Sweden and the United States, and 14 children have been born from transplanted uteruses.

However, ethical questions remain as to whether the transplant of organs for the purpose of delivery is permissible, as compared to the transplant of hearts or livers, which are necessary to sustain human lives. It also remains unclear what effect a long-term dose of immunosuppressant would have on fetuses.

In November last year, a group of researchers at Keio University seeking to perform clinical trials on uterus transplants between relatives submitted a draft plan on such a study to the Japan Society of Obstetrics and Gynecology. As the society has yet to determine its rules on uterus transplants, any clinical trials would require approval from an in-house ethical panel at the university.

While the society had sought to draw up guidelines for ethical screenings of uterus transplants together with the Japan Society for Transplantation, the issue encompassed too wide a range of points for discussion. Therefore, the Japanese Association of Medical Sciences, which presides over all domestic medical societies, has taken up the role of examining the issue.

Under Japan's Act on Organ Transplantation, uterus donations from deceased donors, including brain-dead patients, are prohibited. The association will discuss whether the current legal arrangement is appropriate.

While many countries approve surrogate delivery, the Japan Society of Obstetrics and Gynecology prohibits domestic cases on the grounds of the burden it places on surrogate mothers and the complication of family relationships. As uterus transplants would inflict heavy physical burdens on living donors, however, there are calls for lifting the ban on surrogate deliveries in Japan.

The Japanese Association of Medical Sciences will discuss the issue carefully before compiling a report and submitting it to member societies.

In Japan, there are an estimated 50,000 to 60,000 women in their 20s or 30s who are without a womb.

(Japanese original by Norikazu Chiba, Science & Environment News Department)