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Taherkhani, S. (2023). Differences between living and deceased donation in human uterus transplantation: A narrative review. International Journal of Reproductive BioMedicine (IJRM), 21(3), 193–204. https://doi.org/10.18502/ijrm.v21i3.13195
https://doi.org/10.18502/ijrm.v21i3.13195
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Sakineh Taherkhani
Sakineh Taherkhani
School of Medicine, Arak University of Medical Sciences, Arak, Iran.
Published Date
- Apr 11, 2023
Differences between living and deceased donation in human uterus transplantation: A narrative review
Abstract
The decision to use a living or deceased donor to perform uterus transplantation (UTx) is an evaluation of benefit and harm and is based on the medical team’s choices. The current study determines the differences between living and deceased donation in human UTx according to determinant factors in choosing the donor type. For this review study, the PubMed database was searched without time, language, and location limitations up to May 2022. From 113 identified articles, 45 papers were included in the study for review. According to the results, in comparison to living donation, the biggest advantage of deceased donation is the lack of surgical and or psychological risks for the donor. In contrast, a comprehensive pre-transplantation medical assessment is less possible in deceased donation, and preplanned surgery cannot be realized. According to published peer-reviewed clinical trials on UTx, the graft failure rates in living and deceased donor UTx are 21% and 36%, respectively. Supposing all recipients who did not have graft failure underwent embryo transfer, live birth rates in living and deceased donor UTx procedures are almost 63% and 71%, respectively. Currently, considering the occurrence of live births from both donations, particularly from nulliparous deceased donors, increased demand for UTx in the near future, shortage of uterus grafts, and lack of sufficient data for a comprehensive comparison between the 2 types of donation, the use of both donations still seems necessary and rational.
Key words: Living donors, Deceased donors, Brain death donors, Uterus transplantation, Absolute uterine factor infertility, Review.
References
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[2] Peters HE, Juffermans LJM, Lambalk CB, Dekker JJML, Fernhout T, Groenman FA, et al. Feasibility study for performing uterus transplantation in the Netherlands. Hum Reprod Open 2020; 2020: hoz032.
[3] Brannstrom M, Enskog A, Kvarnstrom N, Ayoubi JM, Dahm- Kahler P. Global results of human uterus transplantation and strategies for pre-transplantation screening of donors. Fertil Steril 2019; 112: 3–10.
[4] Lavoue V, Vigneau C, Duros S, Boudjema K, Leveque J, Piver P, et al. Which donor for uterus transplants: Brain-dead donor or living donor? A systematic review. Transplantation 2017; 101: 267–273.
[5] Taherkhani S. [Uterus transplantation from the perspective of bioethical principles: A review study]. Iran J Obstet Gynecol Infertil 2021; 23: 76–98. (In Persian)
[6] Bruno B, Arora KS. Ethical implications of donor type for uterus transplantation: Why we should remain wary of using living donors. Yale J Biol Med 2020; 93: 587–592.
[7] Jones BP, Ranaei-Zamani N, Vali S, Williams N, Saso S, Thum MY, et al. Options for acquiring motherhood in absolute uterine factor infertility; adoption, surrogacy and uterine transplantation. Obstet Gynaecol 2021; 23: 138– 147.
[8] Kvarnstrom N, Enskog A, Dahm-Kahler P, Brannstrom M. Live versus deceased donor in uterus transplantation. Fertil Steril 2019; 112: 24–27.
[9] Fageeh W, Raffa H, Jabbad H, Marzouki A. Transplantation of the human uterus. Int J Gynecol Obstet 2002; 76: 245– 251.
[10] O’Donovan L, Williams NJ, Wilkinson S. Ethical and policy issues raised by uterus transplants. Br Med Bull 2019; 131: 19–28.
[11] Flyckt RL, Farrell RM, Perni UC, Tzakis AG, Falcone T. Deceased donor uterine transplantation: Innovation and adaptation. Obstet Gynecol 2016; 128: 837–842.
[12] Dickens BM. Legal and ethical issues of uterus transplantation. Int J Gynaecol Obstet 2016; 133: 125–128.
[13] Williams N. Should deceased donation be morally preferred in uterine transplantation trials? Bioethics 2016; 30: 415–424.
[14] Williams NJ. Deceased donation in uterus transplantation trials: Novelty, consent, and surrogate decision making. Am J Bioeth 2018; 18: 18–20.
[15] Brannstrom M, Johannesson L, Bokstrom H, Kvarnstrom N, Molne J, Dahm-Kahler P, et al. Livebirth after uterus transplantation. Lancet 2015; 385: 607–616.
[16] Ejzenberg D, Andraus W, Mendes LRBC, Ducatti L, Song A, Tanigawa R, et al. Livebirth after uterus transplantation from a deceased donor in a recipient with uterine infertility. Lancet 2018; 392: 2697–2704.
[17] Kisu I, Banno K, Matoba Y, Aoki D. Uterus transplantation: Advantages and disadvantages of a deceased donor. Arch Gynecol Obstet 2019; 299: 1213–1214.
[18] Favre-Inhofer A, Rafii A, Carbonnel M, Revaux A, Ayoubi JM. Uterine transplantation: Review in human research. J Gynecol Obstet Hum Reprod 2018; 47: 213–221.
[19] Akar ME, Ozkan O, Aydinuraz B, Dirican K, Cincik M, Mendilcioglu I, et al. Clinical pregnancy after uterus transplantation. Fertil Steril 2013; 100: 1358–1363.
[20] Ozkan O, Ozkan O, Dogan NU, Bahceci M, Mendilcioglu I, Boynukalin K, et al. Birth of a healthy baby 9 years after a surgically successful deceased donor uterus transplant. Ann Surg 2022; 275: 825–832.
[21] Brannstrom M, Bokstrom H, Dahm-Kahler P, Diaz-Garcia C, Ekberg J, Enskog A, et al. One uterus bridging three generations: First live birth after mother-to-daughter uterus transplantation. Fertil Steril 2016; 106: 261–266.
[22] Brannstrom M, Johannesson L, Dahm-Kähler P, Enskog A, Mölne J, Kvarnström N, et al. First clinical uterus transplantation trial: A six-month report. Fertil Steril 2014; 101: 1228–1236.
[23] Broecker V, Brannstrom M, Ekberg J, Dahm-Kahler P, Molne J. Uterus transplantation: Histological findings in explants at elective hysterectomy. Am J Transplant 2021; 21: 798–808.
[24] Huang Y, Ding X, Chen B, Zhang G, Li A, Hua W, et al. Report of the first live birth after uterus transplantation in People’s Republic of China. Fertil Steril 2020; 114: 1108– 1115.
[25] Wei L, Xue T, Tao K-S, Zhang G, Zhao G-Y, Yu SQ, et al. Modified human uterus transplantation using ovarian veins for venous drainage: The first report of surgically successful robotic-assisted uterus procurement and follow-up for 12 months. Fertil Steril 2017; 108: 346– 356.
[26] Flyckt R, Kotlyar A, Arian S, Eghtesad B, Falcone T, Tzakis A. Deceased donor uterine transplantation. Fertil Steril 2017; 107: e13.
[27] Puntambekar S, Puntambekar S, Telang M, Kulkarni P, Date S, Panse M, et al. Novel anastomotic technique for uterine transplant using utero-ovarian veins for venous drainage and internal iliac arteries for perfusion in two laparoscopically harvested uteri. J Minim Invasive Gynecol 2019; 26: 628–635.
[28] Puntambekar S, Telang M, Kulkarni P, Puntambekar S, Jadhav S, Panse M, et al. Laparoscopic-assisted uterus retrieval from live organ donors for uterine transplant: Our experience of two patients. J Minim Invasive Gynecol 2018; 25: 622–631.
[29] Flyckt R, Falcone T, Quintini C, Perni U, Eghtesad B, Richards EG, et al. First birth from a deceased donor uterus in the United States: From severe graft rejection to successful cesarean delivery. Am J Obstet Gynecol 2020; 223: 143–151.
[30] Brucker SY, Strowitzki T, Taran F-A, Rall K, Scholler D, Hoopmann M, et al. Living-donor uterus transplantation: Pre-, intra-, and postoperative parameters relevant to surgical success, pregnancy, and obstetrics with live births. J Clin Med 2020; 9: 2485.
[31] Brannstrom M, Dahm-Kahler P, Ekberg J, Akouri R, Groth K, Enskog A, et al. Outcome of recipient surgery and 6- month follow-up of the Swedish live donor robotic uterus transplantation trial. J Clin Med 2020; 9: 2338.
[32] Brannstrom M, Dahm-Kahler P, Kvarnstrom N, Akouri R, Rova K, Olausson M, et al. Live birth after robotic-assisted live donor uterus transplantation. Acta Obstet Gynecol Scand 2020; 99: 1222–1229.
[33] Johannesson L, Testa G, Putman JM, McKenna GJ, Koon EC, York JR, et al. Twelve live births after uterus transplantation in the dallas utErus transplant study. Obstet Gynecol 2021; 137: 241–249.
[34] Testa G, McKenna GJ, Bayer J, Wall A, Fernandez H, Martinez E, et al. The evolution of transplantation from saving lives to fertility treatment: DUETS (Dallas uterus transplant study). Ann Surg 2020; 272: 411–417.
[35] Fronek J, Kristek J, Chlupac J, Janousek L, Olausson M. Human uterus transplantation from living and deceased donors: The interim results of the first 10 cases of the Czech trial. J Clin Med 2021; 10: 586.
[36] Carmona F, Rius M, Díaz-Feijoo B, Musquera M, Tort J, Alcaraz A. Uterine transplantation. First viable case in Southern Europe. Med Clin (Barc) 2021; 156: 297–300.
[37] Vieira MA, Souza C, Nobrega L, Reis R, Andrade C, Schmidt R, et al. Uterine transplantation with robotassisted uterus retrieval from living donor: First case in Brazil. J Minim Invasive Gynecol 2021; 28: 1817.
[38] Kisu I, Kato Y, Obara H, Matsubara K, Matoba Y, Banno K, et al. Emerging problems in uterus transplantation. BJOG 2018; 125: 1352–1356.
[39] Testa G, Koon EC, Johannesson L. Living donor uterus transplant and surrogacy: Ethical analysis according to the principle of equipoise. Am J Transplant 2017; 17: 912–916.
[40] Kisu I, Mihara M, Banno K, Umene K, Araki J, Hara H, et al. Risks for donors in uterus transplantation. Reprod Sci 2013; 20: 1406–1415.
[41] Flyckt R, Farrell RM, Falcone T. Advancing the science of uterine transplantation: Minimizing living donor risk on a path to surgical innovation. J Minim Invasive Gynecol 2019; 26: 577–579.
[42] Liu Y, Zhang Y, Ding Y, Chen G, Zhang X, Wang Y, et al. Clinical applications of uterus transplantation in China: Issues to take into consideration. J Obstet Gynaecol Res 2020; 46: 357–368.
[43] Farrell RM, Falcone T. Uterine transplant: New medical and ethical considerations. Lancet 2015; 385: 581–582.
[44] Kumnig M, Jowsey-Gregoire SG. Key psychosocial challenges in vascularized composite allotransplantation. World J Transplant 2016; 6: 91–102.
[45] Gomel V. Uterine transplantation. Climacteric 2019; 22: 117–121.
[46] Hammond-Browning N. UK criteria for uterus transplantation: A review. BJOG 2019; 126: 1320–1326.
[47] Johannesson L, Dahm-Kahler P, Eklind S, Brannstrom M. The future of human uterus transplantation. Women’s Health 2014; 10: 455–467.
[48] Kisu I, Banno K, Mihara M, Suganuma N, Aoki D. Current status of uterus transplantation in primates and issues for clinical application. Fertil Steril 2013; 100: 280–294.
[49] Lefkowitz A, Edwards M, Balayla J. The montreal criteria for the ethical feasibility of uterine transplantation. Transpl Int 2012; 25: 439–447.
[50] Guntram L, Williams NJ. Positioning uterus transplantation as a ’more ethical’ alternative to surrogacy: Exploring symmetries between uterus transplantation and surrogacy through analysis of a Swedish government white paper. Bioethics 2018; 32: 509–518.
[51] Testa G, Johannesson L. The ethical challenges of uterus transplantation. Curr Opin Organ Transplant 2017; 22: 593–597.
[52] Hammond-Browning N, Yao SL. Deceased donation uterus transplantation: A review. Transplantology 2021; 2: 140– 148.
[53] Bruno B, Arora KS. Uterus transplantation: The ethics of using deceased versus living donors. Am J Bioeth 2018; 18: 6–15.
[54] Brucker SY, Brannstrom M, Taran F-A, Nadalin S, Konigsrainer A, Rall K, et al. Selecting living donors for uterus transplantation: Lessons learned from two transplantations resulting in menstrual functionality and another attempt, aborted after organ retrieval. Arch Gynecol Obstet 2018; 297: 675–684.
[55] Matoba Y, Kisu I, Banno K, Aoki D. Operative and clinical outcomes of minimally invasive living-donor surgery on uterus transplantation: A literature review. J Clin Med 2021; 10: 349.
[56] Taherkhani S. [Ethical considerations in domestic violence related researches]. J Med Ethics 2016; 10: 141–175. (In Persian)
[57] Ozkan O, Akar ME, Ozkan O, Erdogan O, Hadimioglu N, Yilmaz M, et al. Preliminary results of the first human uterus transplantation from a multiorgan donor. Fertil Steril 2013; 99: 470–476.
[58] Dion L, Santin G, Nyangoh Timoh K, Boudjema K, Jacquot Thierry L, Gauthier T, et al. Procurement of uterus in a deceased donor multi-organ donation national program in France: A scarce resource for uterus transplantation? J Clin Med 2022; 11: 730.
[59] Chmel R, Pastor Z, Novackova M, Matecha J, Cekal M, Fronek J. Clinical pregnancy after deceased donor uterus transplantation: Lessons learned and future perspectives. J Obstet Gynaecol Res 2019; 45: 1458–1465.
[60] Tardieu A, Dion L, Lavoue V, Chazelas P, Marquet P, Piver P, et al. The key role of warm and cold ischemia in uterus transplantation: A review. J Clin Med 2019; 8: 760.
[61] Ngaage LM, Ike S, Elegbede A, Vercler CJ, Gebran S, Liang F, et al. The changing paradigm of ethics in uterus transplantation: A systematic review. Transpl Int 2020; 33: 260–269.
[62] Jones BP, Saso S, Quiroga I, Yazbek J, Smith JR. Re: UK criteria for uterus transplantation: A review. BJOG 2019; 126: 1507–1508.
[2] Peters HE, Juffermans LJM, Lambalk CB, Dekker JJML, Fernhout T, Groenman FA, et al. Feasibility study for performing uterus transplantation in the Netherlands. Hum Reprod Open 2020; 2020: hoz032.
[3] Brannstrom M, Enskog A, Kvarnstrom N, Ayoubi JM, Dahm- Kahler P. Global results of human uterus transplantation and strategies for pre-transplantation screening of donors. Fertil Steril 2019; 112: 3–10.
[4] Lavoue V, Vigneau C, Duros S, Boudjema K, Leveque J, Piver P, et al. Which donor for uterus transplants: Brain-dead donor or living donor? A systematic review. Transplantation 2017; 101: 267–273.
[5] Taherkhani S. [Uterus transplantation from the perspective of bioethical principles: A review study]. Iran J Obstet Gynecol Infertil 2021; 23: 76–98. (In Persian)
[6] Bruno B, Arora KS. Ethical implications of donor type for uterus transplantation: Why we should remain wary of using living donors. Yale J Biol Med 2020; 93: 587–592.
[7] Jones BP, Ranaei-Zamani N, Vali S, Williams N, Saso S, Thum MY, et al. Options for acquiring motherhood in absolute uterine factor infertility; adoption, surrogacy and uterine transplantation. Obstet Gynaecol 2021; 23: 138– 147.
[8] Kvarnstrom N, Enskog A, Dahm-Kahler P, Brannstrom M. Live versus deceased donor in uterus transplantation. Fertil Steril 2019; 112: 24–27.
[9] Fageeh W, Raffa H, Jabbad H, Marzouki A. Transplantation of the human uterus. Int J Gynecol Obstet 2002; 76: 245– 251.
[10] O’Donovan L, Williams NJ, Wilkinson S. Ethical and policy issues raised by uterus transplants. Br Med Bull 2019; 131: 19–28.
[11] Flyckt RL, Farrell RM, Perni UC, Tzakis AG, Falcone T. Deceased donor uterine transplantation: Innovation and adaptation. Obstet Gynecol 2016; 128: 837–842.
[12] Dickens BM. Legal and ethical issues of uterus transplantation. Int J Gynaecol Obstet 2016; 133: 125–128.
[13] Williams N. Should deceased donation be morally preferred in uterine transplantation trials? Bioethics 2016; 30: 415–424.
[14] Williams NJ. Deceased donation in uterus transplantation trials: Novelty, consent, and surrogate decision making. Am J Bioeth 2018; 18: 18–20.
[15] Brannstrom M, Johannesson L, Bokstrom H, Kvarnstrom N, Molne J, Dahm-Kahler P, et al. Livebirth after uterus transplantation. Lancet 2015; 385: 607–616.
[16] Ejzenberg D, Andraus W, Mendes LRBC, Ducatti L, Song A, Tanigawa R, et al. Livebirth after uterus transplantation from a deceased donor in a recipient with uterine infertility. Lancet 2018; 392: 2697–2704.
[17] Kisu I, Banno K, Matoba Y, Aoki D. Uterus transplantation: Advantages and disadvantages of a deceased donor. Arch Gynecol Obstet 2019; 299: 1213–1214.
[18] Favre-Inhofer A, Rafii A, Carbonnel M, Revaux A, Ayoubi JM. Uterine transplantation: Review in human research. J Gynecol Obstet Hum Reprod 2018; 47: 213–221.
[19] Akar ME, Ozkan O, Aydinuraz B, Dirican K, Cincik M, Mendilcioglu I, et al. Clinical pregnancy after uterus transplantation. Fertil Steril 2013; 100: 1358–1363.
[20] Ozkan O, Ozkan O, Dogan NU, Bahceci M, Mendilcioglu I, Boynukalin K, et al. Birth of a healthy baby 9 years after a surgically successful deceased donor uterus transplant. Ann Surg 2022; 275: 825–832.
[21] Brannstrom M, Bokstrom H, Dahm-Kahler P, Diaz-Garcia C, Ekberg J, Enskog A, et al. One uterus bridging three generations: First live birth after mother-to-daughter uterus transplantation. Fertil Steril 2016; 106: 261–266.
[22] Brannstrom M, Johannesson L, Dahm-Kähler P, Enskog A, Mölne J, Kvarnström N, et al. First clinical uterus transplantation trial: A six-month report. Fertil Steril 2014; 101: 1228–1236.
[23] Broecker V, Brannstrom M, Ekberg J, Dahm-Kahler P, Molne J. Uterus transplantation: Histological findings in explants at elective hysterectomy. Am J Transplant 2021; 21: 798–808.
[24] Huang Y, Ding X, Chen B, Zhang G, Li A, Hua W, et al. Report of the first live birth after uterus transplantation in People’s Republic of China. Fertil Steril 2020; 114: 1108– 1115.
[25] Wei L, Xue T, Tao K-S, Zhang G, Zhao G-Y, Yu SQ, et al. Modified human uterus transplantation using ovarian veins for venous drainage: The first report of surgically successful robotic-assisted uterus procurement and follow-up for 12 months. Fertil Steril 2017; 108: 346– 356.
[26] Flyckt R, Kotlyar A, Arian S, Eghtesad B, Falcone T, Tzakis A. Deceased donor uterine transplantation. Fertil Steril 2017; 107: e13.
[27] Puntambekar S, Puntambekar S, Telang M, Kulkarni P, Date S, Panse M, et al. Novel anastomotic technique for uterine transplant using utero-ovarian veins for venous drainage and internal iliac arteries for perfusion in two laparoscopically harvested uteri. J Minim Invasive Gynecol 2019; 26: 628–635.
[28] Puntambekar S, Telang M, Kulkarni P, Puntambekar S, Jadhav S, Panse M, et al. Laparoscopic-assisted uterus retrieval from live organ donors for uterine transplant: Our experience of two patients. J Minim Invasive Gynecol 2018; 25: 622–631.
[29] Flyckt R, Falcone T, Quintini C, Perni U, Eghtesad B, Richards EG, et al. First birth from a deceased donor uterus in the United States: From severe graft rejection to successful cesarean delivery. Am J Obstet Gynecol 2020; 223: 143–151.
[30] Brucker SY, Strowitzki T, Taran F-A, Rall K, Scholler D, Hoopmann M, et al. Living-donor uterus transplantation: Pre-, intra-, and postoperative parameters relevant to surgical success, pregnancy, and obstetrics with live births. J Clin Med 2020; 9: 2485.
[31] Brannstrom M, Dahm-Kahler P, Ekberg J, Akouri R, Groth K, Enskog A, et al. Outcome of recipient surgery and 6- month follow-up of the Swedish live donor robotic uterus transplantation trial. J Clin Med 2020; 9: 2338.
[32] Brannstrom M, Dahm-Kahler P, Kvarnstrom N, Akouri R, Rova K, Olausson M, et al. Live birth after robotic-assisted live donor uterus transplantation. Acta Obstet Gynecol Scand 2020; 99: 1222–1229.
[33] Johannesson L, Testa G, Putman JM, McKenna GJ, Koon EC, York JR, et al. Twelve live births after uterus transplantation in the dallas utErus transplant study. Obstet Gynecol 2021; 137: 241–249.
[34] Testa G, McKenna GJ, Bayer J, Wall A, Fernandez H, Martinez E, et al. The evolution of transplantation from saving lives to fertility treatment: DUETS (Dallas uterus transplant study). Ann Surg 2020; 272: 411–417.
[35] Fronek J, Kristek J, Chlupac J, Janousek L, Olausson M. Human uterus transplantation from living and deceased donors: The interim results of the first 10 cases of the Czech trial. J Clin Med 2021; 10: 586.
[36] Carmona F, Rius M, Díaz-Feijoo B, Musquera M, Tort J, Alcaraz A. Uterine transplantation. First viable case in Southern Europe. Med Clin (Barc) 2021; 156: 297–300.
[37] Vieira MA, Souza C, Nobrega L, Reis R, Andrade C, Schmidt R, et al. Uterine transplantation with robotassisted uterus retrieval from living donor: First case in Brazil. J Minim Invasive Gynecol 2021; 28: 1817.
[38] Kisu I, Kato Y, Obara H, Matsubara K, Matoba Y, Banno K, et al. Emerging problems in uterus transplantation. BJOG 2018; 125: 1352–1356.
[39] Testa G, Koon EC, Johannesson L. Living donor uterus transplant and surrogacy: Ethical analysis according to the principle of equipoise. Am J Transplant 2017; 17: 912–916.
[40] Kisu I, Mihara M, Banno K, Umene K, Araki J, Hara H, et al. Risks for donors in uterus transplantation. Reprod Sci 2013; 20: 1406–1415.
[41] Flyckt R, Farrell RM, Falcone T. Advancing the science of uterine transplantation: Minimizing living donor risk on a path to surgical innovation. J Minim Invasive Gynecol 2019; 26: 577–579.
[42] Liu Y, Zhang Y, Ding Y, Chen G, Zhang X, Wang Y, et al. Clinical applications of uterus transplantation in China: Issues to take into consideration. J Obstet Gynaecol Res 2020; 46: 357–368.
[43] Farrell RM, Falcone T. Uterine transplant: New medical and ethical considerations. Lancet 2015; 385: 581–582.
[44] Kumnig M, Jowsey-Gregoire SG. Key psychosocial challenges in vascularized composite allotransplantation. World J Transplant 2016; 6: 91–102.
[45] Gomel V. Uterine transplantation. Climacteric 2019; 22: 117–121.
[46] Hammond-Browning N. UK criteria for uterus transplantation: A review. BJOG 2019; 126: 1320–1326.
[47] Johannesson L, Dahm-Kahler P, Eklind S, Brannstrom M. The future of human uterus transplantation. Women’s Health 2014; 10: 455–467.
[48] Kisu I, Banno K, Mihara M, Suganuma N, Aoki D. Current status of uterus transplantation in primates and issues for clinical application. Fertil Steril 2013; 100: 280–294.
[49] Lefkowitz A, Edwards M, Balayla J. The montreal criteria for the ethical feasibility of uterine transplantation. Transpl Int 2012; 25: 439–447.
[50] Guntram L, Williams NJ. Positioning uterus transplantation as a ’more ethical’ alternative to surrogacy: Exploring symmetries between uterus transplantation and surrogacy through analysis of a Swedish government white paper. Bioethics 2018; 32: 509–518.
[51] Testa G, Johannesson L. The ethical challenges of uterus transplantation. Curr Opin Organ Transplant 2017; 22: 593–597.
[52] Hammond-Browning N, Yao SL. Deceased donation uterus transplantation: A review. Transplantology 2021; 2: 140– 148.
[53] Bruno B, Arora KS. Uterus transplantation: The ethics of using deceased versus living donors. Am J Bioeth 2018; 18: 6–15.
[54] Brucker SY, Brannstrom M, Taran F-A, Nadalin S, Konigsrainer A, Rall K, et al. Selecting living donors for uterus transplantation: Lessons learned from two transplantations resulting in menstrual functionality and another attempt, aborted after organ retrieval. Arch Gynecol Obstet 2018; 297: 675–684.
[55] Matoba Y, Kisu I, Banno K, Aoki D. Operative and clinical outcomes of minimally invasive living-donor surgery on uterus transplantation: A literature review. J Clin Med 2021; 10: 349.
[56] Taherkhani S. [Ethical considerations in domestic violence related researches]. J Med Ethics 2016; 10: 141–175. (In Persian)
[57] Ozkan O, Akar ME, Ozkan O, Erdogan O, Hadimioglu N, Yilmaz M, et al. Preliminary results of the first human uterus transplantation from a multiorgan donor. Fertil Steril 2013; 99: 470–476.
[58] Dion L, Santin G, Nyangoh Timoh K, Boudjema K, Jacquot Thierry L, Gauthier T, et al. Procurement of uterus in a deceased donor multi-organ donation national program in France: A scarce resource for uterus transplantation? J Clin Med 2022; 11: 730.
[59] Chmel R, Pastor Z, Novackova M, Matecha J, Cekal M, Fronek J. Clinical pregnancy after deceased donor uterus transplantation: Lessons learned and future perspectives. J Obstet Gynaecol Res 2019; 45: 1458–1465.
[60] Tardieu A, Dion L, Lavoue V, Chazelas P, Marquet P, Piver P, et al. The key role of warm and cold ischemia in uterus transplantation: A review. J Clin Med 2019; 8: 760.
[61] Ngaage LM, Ike S, Elegbede A, Vercler CJ, Gebran S, Liang F, et al. The changing paradigm of ethics in uterus transplantation: A systematic review. Transpl Int 2020; 33: 260–269.
[62] Jones BP, Saso S, Quiroga I, Yazbek J, Smith JR. Re: UK criteria for uterus transplantation: A review. BJOG 2019; 126: 1507–1508.