Doctors based at the New York Downtown Hospital, have been given the go-ahead to begin screening women to undergo the first womb transplant in the US. The procedure will involve the removal and transferral of a uterus from a dead donor to a female recipient. After waiting three months, the recipient's own IVF embryo, previously frozen, will be introduced. If the implantation and ensuing pregnancy is successful, it is planned that the child will be delivered by Caesarean section to reduce the risk of complications. The uterus would then be removed and discarded to minimize the chances of tissue rejection. The procedure has been initially approved by the New York Downtown Hospital ethics board, which will reconsider its position after the first female patient is chosen.

Dr Giuseppe Del Priore, who is leading the New York team, said, 'The desire to have a child is a tremendous driving force for many women. We think we could help many women fulfil this very basic desire', he added. Womb transplants may provide fertility solutions for women who have had their wombs removed or damaged, and for whom IVF would not otherwise be an option. If proven safe and effective, the procedure may add to the reproduction choices of women and couples, offering an alternative to surrogacy. 'I think patients deserve autonomy', said Alan De Cherney, a fertility expert speaking on behalf of the American Society of Reproductive Medicine. 'As long as they know all the facts, it should be their choice'.

The world's first human womb transplant was performed in Saudi Arabia in 2000, but was not reported until 2002. Doctors at the King Fahad Hospital and Research Center in Jeddah transplanted a healthy womb from a 46-year old living donor into a 26- year old woman who had previously undergone a hysterectomy. The recipient required ten days of intensive immunosuppressive drug therapy to prevent the donated womb from being rejected, and it was ultimately removed after 99 days because of a blood clot. Nevertheless, the team hailed the operation as a technical success. The team in New York has been testing the procedure in rats, pigs, rabbits and hope to attempt a pregnancy in a rhesus monkey. The results have shown that a womb is able to be removed from a dead donor, reducing problems associated with blood clotting.

Some commentators have criticised the announcement, highlighting safety and ethical concerns. 'It is the convergence of two fields [organ transplantation and assisted reproduction] that are already embedded in large ethical disputes', said Lori Andrews, a bioethicist at the Chicago-Kent School of Law. 'This represents the worst of both worlds'. And other experts have cast doubt on the safety of such a procedure. 'At any time during the nine months of pregnancy it could very easily reject, and if a pregnant uterus rejects you have got a serious medical problem', said Dr Sherman Silber, a US fertility expert.

Last September, doctors at Hammersmith Hospital, London, claimed they were two years away from performing the first successful womb transplantation. For now it seems the race is on.

Reproduced from BioNews with permission, a web- and email-based source of news, information and comment on assisted reproduction and human genetics, published by Progress Educational Trust.