Turner's Turning Point: Ovarian Transplants
Rajgopal Nidamboor
This article deals with the interesting field of ovarian transplants in India.
In both India and Africa, fertility is an important criterion by which women are
judged - hence, ovarian transplant technology has the potential to reduce
culturally entrenched discrimination against infertile women by restoring
fertility. Ethical discussions concerning restoring fertility
in people have raged across the world.
 Surgical transplants are routine in many fields of medicine. Not so for
ovarian transplants, especially in the third world. China reportedly did the
world's first in February last year. India followed with a well-documented
case, inspired by a South African doctor, a month later....
Gynaecologist Dr Pravin Mhatre and his team at D S Kothari Hospital in
India's commercial capital of Bombay performed India's first-ever ovarian
transplant in a 17-year-old with Turner's syndrome (incidence: 1 in 2,000
births) last year. Girls with the disorder are born with chromosomal aberration
and non-functional ovaries. They require hormonal treatment throughout life.
"Hormonal therapy merely corrects external features," as Dr Mhatre
puts it. "Besides, it increases the risk of cancer."
The donor was the recipient's 26-year-old cousin, the mother of two
children. But the story has roots in an event two decades earlier. "Twenty
years ago," recalls Dr Mhatre, "I got Turner's syndrome as case
presentation in my MD exam. Answering on treatment options, I said my final
conclusion was transplantation. All the eight examiners laughed heartily, and
said I was living in a Fool's Paradise."
He became, in his own words, "Obsessed. That's where it all began. I was
also inspired by the genius of Dr Christian Barnard and his first-ever heart
transplantation procedure. With my own goal in mind, I studied every medical
branch related to transplants - immunology, pathology, microbiology, including
anatomy. I became a student again...I also got engaged in animal experiments.
Moreover, since kidney transplantation was an established faculty, I spent a lot
of time as an observer in various renal transplant units."
His obsession also compelled him to study the legal implications. "The
Organ Transplant Law (1994) stated that I had to obtain government permission.
The State Government of Maharashtra, Department of Health Services, and
Department of Medical Education and Research were kind enough to grant me
permission."
Dr Mhatre says ovarian transplants now offer Turner's syndrome patients the
possibility of menstruation, ovulation, and pregnancy. Ovarian transplants may
also provide a ray of hope to women with premature menopause, or where the
ovaries were removed or damaged for some reason. In addition, developmental
anomalies could also be corrected with transplants of the uterus, cervix and
Fallopian tubes in the future, although reports of a successful uterine
transplant have only just emerged in medical circles.
There are other advantages, too. Hearts and livers cannot be donated from a
live human being (Note: They do partial liver transplants in the first world at
any rate where the donor is living and donates part of his or her liver).
But the supply of ovaries from live, consenting donors is theoretically
plentiful and practical. Donors, says Dr Mhatre, can contribute one of their
ovaries without risking their life or the quality of life, as the remaining
ovary is capable of total function. What's more, the ovary, unlike the
kidney, heart or liver, is not a vital organ. Every normal woman has a pair
of ovaries. One of them can be very easily removed without causing any life
risk.
Says Dr Mhatre: "The procedure may be performed in the future by
gynaecologists who are trained in the technique and also registered as
transplant surgeons."
What about donors? "They should be below 35 years of age, have (had)
children, and good ovaries." While there may not be any age restriction for
the recipient, the procedure, concedes Dr Mhatre, includes minor
complications - mainly because of drug treatment. Also, patients may be
prone to infections; they have to be taken care of. Smartly. What about
expenses? "It could be approximately US $3,000, which
would also include hospital charges and drug therapy."
What about misuse of the procedure? Dr Mhatre worries about that
possibility, like any other new procedure. He calls for rigid controls, and
also monitoring by both government and non-governmental agencies.
Notes Dr Mhatre: "Ovarian transplantation is not life-giving in the true
sense of the term. However, it will definitely improve our women's
quality of life. In addition, it is 'life-producing' for the recipient. A
case in point: in several parts of India, or the developing world, and maybe
elsewhere, a woman without menstruation or fertility is considered barren
and looked down upon or ill-treated by the family and/or society. Ovarian
transplant could provide a new lease of life for such women."
From the clinical angle, Dr Mhatre emphasises that the procedure has been a
success - based on the following pointers:
· Colour Doppler studies have shown successful vascular anastomosis
(blood vessel reconnection) - from the initial stage itself.
· Ultrasound studies suggest no rejection phenomena.
· Hormonal levels also indicate a very favourable response.
· The transplanted ovary has shown continuous progressive function
with no sign of rejection.
Dr Mhatre concludes: "The donor and the recipient are in good health...
Meanwhile, the latter has also had nine normal menstrual cycles."
Currently, Dr Mhatre is also involved in research on ovarian tissue,
cryopreservation and banking.
Rajgopal Nidamboor is a Bombay-based writer-editor. Visit his website at
www.wordoscope.com
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