Annette C. and Harold C. Simmons Transplant Institute

Wall, A., Lee, G.H., Maldonado, J. and Magnus, D. (2020). “Genetic disease and intellectual disability as contraindications to transplant listing in the United States: A survey of heart, kidney, liver, and lung transplant programs.” Pediatr Transplant Sep 30;e13837. [Epub ahead of print.]. e13837.

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Discrimination based on disability is prohibited in organ transplantation, yet studies suggest it continues in listing practices for intellectual disability and genetic diseases. It is not known if this differs between adult and pediatric programs, or by organ type. We performed an online, forced-choice survey of psychosocial listing criteria for adult and pediatric heart, kidney, liver, and lung transplant programs in the United States. Of 650 programs contacted, 343 (52.8%) submitted complete. A minority of programs had formal listing guidelines for any condition considered (Down Syndrome, Duchenne Muscular Dystrophy, Becker Muscular Dystrophy, DiGeorge Syndrome, and Wolf Hirschhorn Syndrome; and mild [IQ < 70] and severe [IQ < 35] intellectual disability), although a majority had encountered most. Pediatric programs were significantly (P < .02) more lenient in the level of contraindication to listing for all genetic conditions considered except Duchenne Muscular Dystrophy, and for mild and severe intellectual disability. Level of contraindication differed significantly by organ type (heart, lung, liver, and kidney) for Duchenne Muscular dystrophy (P = <.001), Becker Muscular Dystrophy (P < .001), DiGeorge Syndrome (P < .001), Wolf-Hirschhorn syndrome (P = .0012), and severe intellectual disability (P < .001). There is significant variation among transplant programs in availability of guidelines for as well as listing practices regarding genetic diseases and intellectual disability, differing by both adult vs pediatric program, and organ type. Programs with absolute contraindications to listing for specific genetic diseases or intellectual disability should reframe their approach, ensuring individualized assessments and avoiding elimination of patients based on membership in a particular group.

Fallahzadeh, M. A. and J. F. Trotter (2020). “An Experiment of Nature: HBV-naive Recipients Receiving Liver Grafts With HBV Core Antibody-positive Donors Without Antiviral Prophylaxis.” Transplantation 104(8): e245-e246.

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Transplantation of livers from donors who are hepatitis B core antibody (HBcAb) positive and hepatitis B surface antigen (HBsAg) negative is a standard practice occurring in about 5% of the US liver transplants (LTs).1,2 Current guidelines recommend lifelong oral antiviral prophylaxis to prevent viral reactivation reported in up to 78% of untreated recipients.1,3 We report a series of HBsAg-negative LT recipients who received an organ from HBcAb-positive donors without receiving antiviral prophylaxis through an administrative error. [No abstract; excerpt from article].

Testa, G., G. J. McKenna, J. Bayer, A. Wall, H. Fernandez, E. Martinez, A. Gupta, R. Ruiz, N. Onaca, R. T. Gunby, A. R. Gregg, M. Olausson, E. C. Koon and L. Johannesson (2020). “The Evolution of Transplantation From Saving Lives to Fertility Treatment: DUETS (Dallas UtErus Transplant Study).” Ann Surg Jul 9. [Epub ahead of print.].

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OBJECTIVE: We report the results of the first 20 uterus transplants performed in our institution. SUMMARY BACKGROUND DATA: Uterus transplantation (UTx) aims at giving women affected by absolute uterine-factor infertility the possibility of carrying their own pregnancy. UTx has evolved from experimental to an established surgical procedure. METHODS: The Dallas Uterus Transplant Study (DUETS) program started in 2016. The uterus was transplanted in orthotopic position with vascular anastomoses to the external iliac vessels and removed when 1 or 2 live births were achieved. Immunosuppression lasted only for the duration of the uterus graft. RESULTS: Twenty women, median age 29.7 years, enrolled in the study, with 10 in phase 1 and 10 in phase 2. All but 2 recipients had a congenital absence of the uterus. Eighteen recipients received uteri from living donors and 2 from deceased donors. In phase 1, 50% of recipients had a technically successful uterus transplant, compared to 90% in phase 2. Four recipients with a technical success in phase 1 have delivered 1 or 2 babies, and the fifth recipient with a technical success is >30 weeks pregnant. In phase 2, 2 recipients have delivered healthy babies and 5 are pregnant. CONCLUSIONS: UTx is a unique type of transplant; whose only true success is a healthy child birth. Based on results presented here, involving refinement of the surgical technique and donor selection process, UTx is now an established solution for absolute uterine-factor infertility.

Testa, G., L. Johannesson and A. E. Wall (2020). “Considering Uterus Transplantation for a Same-Sex Couple: A Case Study.” J Clin Ethics 31(2): 154-157.

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A woman with congenital absence of a uterus applied for participation in a clinical trial for uterus transplantation. She was married to a woman who had the potential to carry a child without the need for aggressive medical intervention. Thus, the question arose regarding whether the infertile partner should be considered for uterus transplantation. In this article we discuss the ethical issues with uterus transplantation for a member of a same-sex couple, whose partner could carry a pregnancy. We review the medical criteria for uterus transplantation, discuss the additional options for parenthood in same-sex couples, examine how to determine if this meets the criteria of just distribution of uterus grafts, and ultimately argue that the value of gestation is at the level of the individual rather than the couple.

Roth, A. E., I. R. Marino, O. Ekwenna, T. B. Dunn, S. R. Paloyo, M. Tan, R. Correa-Rotter, C. S. Kuhr, C. L. Marsh, J. Ortiz, G. Testa, P. Sindhwani, D. L. Segev, J. Rogers, J. D. Punch, R. C. Forbes, M. A. Zimmerman, M. J. Ellis, A. Rege, L. Basagoitia, K. D. Krawiec and M. A. Rees (2020). “Global Kidney Exchange Should Expand Wisely.” Transpl Int May 20. [Epub ahead of print].

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We read with great interest and appreciation the careful consideration and analysis by Ambagtsheer et al. of the most critical ethical objections to Global Kidney Exchange (GKE). Ambagtsheer et al. conclude that implementation of GKE is a means to increase access to transplantation ethically and effectively.(1,2) These conclusions by their European Society of Transplantation (ESOT) committee on Ethical, Legal and Psychological Aspects of Transplantation (ELPAT) represent a step forward toward a greater understanding and an open, honest debate about GKE.