Allow uterus transplant for the unmarried too: Pune doctors

PUNE: The success of the country's and Asia's first two uterine transplants carried out in Pune last month have predictably seen many more women queuing up for the operation. At last count, 156 women from India and abroad had expressed their wish to undergo the surgery.

The city surgeons who performed the transplants are, however, in a dilemma as half these women are unmarried and hence ineligible for the operation. The prevailing protocol prevents surgeons from operating on unmarried women as the basic purpose of a womb transplant is reproduction.

These women aged 18 to 30, who are either without uteruses or have dysfunctional ones, have heartbreaking stories to tell of the absence of monthly menses, marred marriage prospects and an inferiority complex. City surgeons who performed the country's first two uterine transplants last month say they will raise the issue of unmarried women not being allowed to undergo uterine transplants.

Many of these women suffer from an inferiority complex, shun social networks and cut themselves off from friends. They tend to further alienate themselves after their younger siblings get married.

Oncosurgeon Shailesh Puntambekar, who performed the two transplants with 11 other surgeons, said, “The issue must be addressed with compassion. These women, many of them from highly educated families, now see great hope in having their own children.“

A 28-year-old woman from Mumbai wanting to undergo the surgery said her mother was willing to donate her own uterus. “I am in a steady relationship but my boyfriend and his family want the transplant to precede the marriage,“ she said. A doctor from Bhopal, who has been in a live-in with her colleague, is also eager for the transplant but faces opposition from his family.

A married woman from Chandigarh was served a divorce notice by her husband when he learnt she could not have children due to a dysfunctional uterus.“However, he is ready to accept me if I go in for the transplant.My family is more than willing to get it done,“ she said.

The surgeons' hands are, however, tied by the Montreal Criteria -a set of ethical guidelines formulated internationally -which bars them from performing uterine transplants on unmarried women.

“The main purpose of such a transplant is not the menstruation problem; it is to help women produce children.Therefore, only married women are allowed to undergo the surgery. Besides, the life span of a transplanted uterus has been set at five years or till the purpose of childbirth is served. After that, the uterus should be removed so that the woman does not have to take anti-rejection drugs (immunosuppressants). Imagine a situation where an unmarried woman either fails to find a match or have a child within five years of the transplant?“ Puntambekar said.

Dr Soumya Swaminathan, head of the Indian Council of Medical Research (ICMR), said uterine transplants for unmarried women would set off a dangerous trend in a country where health consciousness and literacy is already low. “ A uterine transplant is an extreme procedure that is not well accepted globally.

Ethically, the hospital shouldn't offer it to anyone without a serious anatomical anomaly. There should be serious attempts at convincing the family to opt for other safer options, including adoption,“ she said.

(With inputs from Sumitra Debroy)