The what, when and how of India's first set of womb transplants

IllustrationRavi JadhavAfter failing to carry a baby to full term three times the one thing I knew was that I wanted a baby and I wanted it to be mine only says a 26yearold patient from Punes Galaxy Care Laparoscopy Institute GCLI The patient whose identity cannot be disclosed is set to receive a womb transplant at the hospital in whats slated to be the countrys first set of uterine swaps In a telephonic interview conducted via Dr Kajal Parikh a fellow in minimal access gynaecological surgery at the hospital the patient says she got married seven years ago In 2011 the couple got ready to welcome their first child but she died within five minutes of birth She suffered two miscarriages later Then some doctors advised me to consider a womb transplant My husband and I wanted our own baby so we gave the option a serious thoughtDr Shailesh Puntambekar the hospitals medical director says the patient suffers from Asherman syndrome a rare condition in which a scar tissue develops in the uterus making childbearing difficult She along with two others is set to receive a uterus transplant donated by their respective mothers The hospital says Dr Puntambekar an onco surgeon who developed a laparoscopic radical hysterectomy for cancer of the cervix known world over as the Pune Technique received permission from the state government a few weeks ago for the procedures which are likely to be conducted next month While a third patient has also been identified for the procedure Dr Puntambekar says the plan is yet to be finalised She is a longterm survivor of the cancer of the uterus We will wait till a week after the first set of transplants he addsDr Shailesh PuntambekarBeen in the worksWhat does it take to get a licence from the states directorate of health services for a procedure that has been conducted 11 times with only seven ending in successful pregnancies Infrastructure expertise and preparation In total the number of experts on board at the hospital extends to 20 As far as prep goes Dr Puntambekar says it began three years ago much before they had their first patientThe 53yearold doctor who has performed surgeries in live surgical workshops across India as well as in Germany England and France says that he and his team of surgical doctors have been to Tubingen University in Germany where they performed surgeries on cadavers an option not available to them in India Dr Puntambekar along with two others from the team also met and presented his work to Mats Brannstrom at Sahlgrenska University in Sweden who has been credited with conducting the first successful uterine transplant Aside from extensive research into the case studies Dr Puntambekar also worked on his knowledge of human anatomyWhat will happen on DdayExplaining what the procedure involves Dr Parikh says that the uterus is supplied blood by one uterine artery and two uterine veins These lie deep in the pelvis and the first step is to separate the vessels from the neighbouring structure and clip them at origin and then extract the organ so that theres minimal damage to the vessels she saysEven as the organ is being extracted from the donor when the team of doctors know that the procedure is nearing the end which will be about three hours from the start surgery will begin on the recipient Once the organ is extracted it will be flushed out so that the donors blood is removed and it will also be checked for leaks This should take an hour Once thats done the organ will be sutured into the recipients body The entire procedure should take about eight hoursTwo days for the opAsked why the success rate of the procedure isnt high Dr Parekh says that often pregnancies dont result because the uterus that is being donated belongs to a deceased donor when a patient dies the first organs to be extracted are the lungs liver kidney etc by the time the uterus is extracted blood has already clotted in vessels Results are better with a live donor who is in a healthy condition A menopausal uterus or a donor with a comorbidity such as diabetes or hypertension will also have a lower chance of success she addsGetting the patient readyHowever Dr Puntambekar does clarify that every patient will not qualify for a womb transplant Aside from meeting the medical criteria the patient should be below 35 years of age while the donor mother sister or maternal aunt should be less than 55 the donor should have had a child of her own there are other assessments The couple should have been married for at least five years and should be committed he saysAnother important aspect is getting the donor ready The couple that we spoke to told us The donor is going to be my mother There was absolutely no problem in asking her if she would donate her uterus It seemed only natural that I ask her She agreed almost immediatelySpeaking from the hospital the mother 48 says I am happy to allow my daughter to experience the joy of motherhood as I have When she asked me I felt no trepidation although I was curious how the surgery would happenDr Parekh adds counsellors play an important role in cases of womb transfer However here the family was so strongminded that we had to only focus on the mother and daughter being physically fit for the operationThe couple said Now in fact we cannot wait enough for the day the operation is over and done with We were certain that this is going to be our child or no child A mothers greatest gift is her child but in this case a mothers greatest gift is also enabling her child to have a child of her own