Deal With It

The Race for the World's First Uterine Transplant
By Noah Evslin, Director of Medical Research

If you watch our show closely, you'll realize it's not the medical treatments that make Private Practice different than other shows on television; rather, it's the ethical debates surrounding the myriad decisions our doctors need to make every week.

In this week's episode "Deal With It", Addison and Jake jointly treat NINA HOPKINS (20s) a patient who suffers from Mayer Rokitansky Kuster Hauser Syndrome. MRKH is a rare disorder that caused Nina to be born without a uterus. Despite this problem, however, Nina is determined to both conceive and carry her own baby.

How is this going to happen? By our patient undergoing a cutting edge procedure known as a uterine transplant. In fact, this procedure is so cutting edge that it's never been successfully done on a human before. To make things even more ethically complex, the donor uterus is coming from Nina's grandmother.

This brings us to our ethical debate which revolves around promising a patient we'll do a procedure that is theoretically possible, but has never been successfully performed before. Even more specifically, the ethical debate is:

Do we do a risky, life-threatening procedure to try and fix a non life-threatening problem when there are so many other ways that a woman can become a mother?

There's also a secondary debate about Nina using her grandmother's uterus to carry a baby, but that's not the focus of this discussion.

In 2000, doctors in Saudi Arabia did the world's first uterus transplant on a 26-year-old, but it had to be removed after 99 days because of clotting issues in the associated blood vessels. A similar type of transplant is currently being planned in Sweden for some time in the near future. In addition, teams around the world, including multiple teams in America, are currently searching for viable candidates to do the procedure on.

Without question, this is something that will happen sooner rather than later. The reason doctors and researchers are so eager to perform a uterine transplant is because they think it will offer hope for women with severe womb defects or other uterus related fertility issues. Unfortunately, a uterine transplant is a very complex procedure due to the amount of blood vessels that need to be re-attached.

In Nina's case, Addison is against the procedure because she thinks the risks outweigh the rewards. Conversely, Jake thinks they should do it, because in the event they're successful, the science of fertility would be pushed forward AND make a patient very happy.

In the end they do the procedure, but there's a complication and instead of giving Nina a new uterus, Jake and Addison fight to save her life.

Did they make the right decision?