Should Uterus Transplantation for Transwomen and Transmen Be Subsidized?

[PorcelinaV]

https://journalofethics.ama-assn.org/article/should-uterus-transplantation-transwomen-and-transmen-be-subsidized/2023-06

Of course we shouldn’t! I have been waiting since 2019 for endometriosis surgery. The NHS is on its knees.

Janice Turner is talking about the womb transplant in the Times today:

https://www.thetimes.co.uk/article/604951f0-4372-11ee-8b31-3c9c533abb75?shareToken=ce104693d0efe7cf35c77b570a86d521

It's a good article.

Unfortunately, no mention of an increase in risk of dementia for the donor sister.

There's a limit as to the word count, unfortunately. I trust that the donor sister was counselled on that prior to the surgery.

A lot will depend on the preservation of the blood supply to the ovaries depending on how radical the surgery was and various other matters?

It was pretty radical (not sure of the exact meaning of that term medically) because they took the uterus, it’s supporting ligaments, the cervix and the top part of the sister’s vaginal canal.

I have an older sister and I would never ask her to do that for me - at 46 might only be half way through her life and even if her ovaries survive the trauma, could face incontinence, prolapse, loss of sexual function and early onset dementia.

I realise adoption isn’t an option for all, but women with MKRH will be diagnosed as teenagers at the latest and so will have plenty of time to prepare an adoption-suitable life and wait for an available baby (unlike the many women who confirm their infertility is insurmountable in their late 30s/early 40s).

Plus the anti rejection drugs are pretty horrendous.

Stem cells/bone marrow and maybe a kidney are probably my line for living donors.

If women want to leave their uterus for transplant after death so be it, but make it an opt in extra.

Not that many women die in ways that make them suitable for organ donation* tho and I expect Big Pharma knows that, hence eyeing up transmen as a suitable source (which will no doubt coerce them into earlier surgery than they would’ve wanted left to their own devices because no one wants a used womb that has atrophied due to exogenous testosterone use).

*women are more likely to volunteer for donor registers than men and more likely to be living donors than men but we are less likely to have a traumatic brain-injury death because (on average) we are less prone to risk taking/being physically reckless.

Wow - that's not like donating a kidney, that's carving out your insides.

Oh! And I think women are less
likely to die of the cardiac events that leave donate-able organs too?

Quite!

And while it’s true that the sister didn’t intend to gestate any more children in her uterus so was ‘no longer using it’ in that sense, she presumably still had some use for a cervix and vaginal cuff (to stop her other organs prolapsing into the gap where the uterus was and poking through into her vagina, or indeed to prevent her upper vagina prolapsing into the lower vagina aka ‘vaginal vault prolapse’).

I’m probably extra sensitive to this topic (not that you’d know from my horror film post upthread!) because my mum died from a gynae cancer and I saw all the struggles she had post hysterectomy AND my child has had a living donor transplant from an anon donor in a foreign country so while I am absolutely full of gratitude for a life saving donation it was
one that is uncomfortable and inconvenient in the short term but has very few long term issues (because the donor’s body renews the donated material, although there is a 2% chance of long term complications/side effects of the donation process).

A non life saving donation that may leave the donor with 30-40 years of quality-of-life destroying complications seems like an unnecessarily imbalanced risk/reward situation to me (especially with the added complication of the potential adverse effects of anti rejection drugs on a baby).

Great article from Janice.

The donor sister is now facing a variety of lifelong complications. It's completely unacceptable imo and I don't think it is at all sisterly to expose your loved a long to these risks.

We need a massive DON'T BE KIND campaign to educate young women to prioritise THEIR OWN health. It sickens me how women are schooled to be kind and generous, offering g their eggs, their breeding services and now actual body parts that can impact their health for life.

Incidentally whilst live kidney donation is fairly well established, and of course I'd do it in a flash for my daughters or maybe other family member, it also has risks. I don't suppose they warn of the risks of medical negligence when going through the risks at pre-op assessment, but that is also one of the risks.

I think the Doctor in this case was subsequently struck off, I can't find the article I first saw about it. But the poor man who donated a kidney to his father ended up needing a kidney transplant from his sister and meanwhile the NHS has had to pay out millions in compensation.

www.ibblaw.co.uk/insights/blog/kidney-donor-makes-14m-medical-negligence-claim

Yes, there are times when being 'selfish' rather than 'kind' (like prioritising your own health) is the right thing to do.

This 'be kind' matra doesn't really use the word 'kind' in the traditional understanding of the meaning of the word anyway. It's more totilitarian and demanding in it's use.

Thanks for explaining RE the word count.

I hope that the sister was made fully aware of everything. I also hope that the doctors ensured that she fully understood everything. There is a big difference between being given all the information (and in some cases being completely overwhelmed by it) and fully understanding it, especislly if you have no medical background. I hope that no-one played down the risks, which is something that can also happen.

The claimant received £6.74m damages but there was a separate award to the wife. It certainly seems to have had an understandably huge impact on the family relationships.

https://www.dailyecho.co.uk/news/8852310.portsmouth-hospitals-nhs-trust-to-pay-patient-674m/

We need a massive DON'T BE KIND campaign to educate young women to prioritise THEIR OWN health.

I agree with this but I'd tag it as #StopTheSelfHarm because there's a point at which it ceases to be a matter of kindness and becomes self-harm.

Interesting that the recipient sister is now experiencing periods for the first time in her life. I bet that's a bit of a shock.

Especially with a 46 year old uterus!

Although tbf peri is a bit like the teenage years in terms of volume and lack of predictability.

I have to admit I am slightly surprised how much of the vagina they needed to take as well. I do wonder how that will impact the donor along with the early menopause etc.

How? What?

OK I have gone away and researched, this took place in February, I thought it was just a few days ago but that was when the paper was published.