Tamara Franco, the woman who underwent the first uterus transplant in Spain, at the Clínic hospital, has become a mother. The sacrifices this woman has made to achieve this goal are unimaginable. But she has been worth it, she assures her. Jesus was born prematurely on March 10 and has just been discharged.

This delivery means the culmination of a highly complex surgical milestone that, according to Francisco Carmona, head of Gynecology at the Clínic, places this hospital “in the top ten worldwide”. “There are only a few teams that can perform such complex surgeries both technically and logistically. I have a slide in which 50 people appear, and not all of us are there, but only those who “touched” the patient. Behind there are many more ”.

Jesus has inherited the name of his father and his paternal grandfather. He was born, in the Maternitat, prematurely, with less than two kilos, but in good condition. He fed on breast milk and has been stabilizing and maturing until he was discharged. There cannot be a more desired child. Tamara and Jesús do not separate from him and look at the horizon with optimism. At last they return home, to a town on the outskirts of Murcia.

“I imagine the three of us being very happy together,” speculates the mother. “I hope (Jesus) is good. When he grows up, I would like him to be a gynecologist and to study this transplantation, because he has been a pioneer in this. It would be wonderful if he did it because of where he comes from.”

The happiness of this moment is by no means free. The pioneering transplant took place on October 5, 2020, in the midst of a pandemic. An intervention of more than 17 hours between the extraction of the donor’s uterus (Bárbara, Tamara’s older sister) and her implantation. The surgical team had calculated a period of six months to carry out the transfer of embryos, which had previously been extracted from the woman, and promote the pregnancy.

But the doctors decided to postpone this step and wait for the arrival of the covid-19 vaccines, due to the high risk of the patient due to her state of immunosuppression. As soon as Tamara received the full vaccination, she underwent the first embryo transfer. It didn’t work.

The next one was effective. The woman became pregnant, but at week 8 she suffered a miscarriage. A circumstance that had nothing to do with her transplant, says Dr. Alcaraz. “I had a bad time and, although I tried to overcome it, you always have that fear, but I never gave up a positive attitude”, recalls the patient.

The third fertilization also failed. “We had few embryos and we had to prepare the patient again for a second ovarian stimulation, with which we obtained six or seven embryos”, explains the doctor.

Coinciding with the fourth transfer (the first of the second batch), Tamara caught the covid. She was mild, because she was vaccinated, but the procedure was delayed again and, with it, the level of uncertainty grew several degrees. Finally, on the next try, she got pregnant. “It is true that we expected a shorter period, but the circumstances have been. In the end, the important thing is that we have the baby with us”, celebrates the gynecologist.

“When in the middle of adolescence they tell you that you are not going to be a mother, it is a very hard stick. For me that has been a trauma. I considered adopting, but it’s not easy either. There are many years of waiting and many requirements, and I wanted to be a biological mother, to feel it in my belly and that “.

The woman’s determination and persistence in her goal is proverbial. Since she found out that a pioneering living-donor uterus transplant had been carried out in Sweden in 2019, she has not stopped. She contacted a Spanish doctor who participated in the intervention and, through him, she accessed the Clínic’s research project (Feasibility study of the uterine transplant procedure from a living donor with graft harvesting by robotic surgery).

“She is the one who was most convinced. I have seen few women with Tamara’s strength. She knew perfectly well what she could do for herself, ”says Carmona. The Clínic project received requests from more than a hundred volunteers, but not many suited the conditions: women born without a uterus (which excludes a good number of candidates) and with a living donor related to the first or second degree ( mother or sister).

In the first interview with Dr. Carmona, Tamara was ruled out. Her mother had various pathologies that prevented her from supporting such complex surgery. “She was very frustrated, but she came back after a few days,” recalls the doctor:

Can my sister donate?

-Tell him to come

The program had just ruled out, at the last minute, the chosen candidate because she presented a wrong diagnosis. She did not have Robiransky, but Morris syndrome (phenotypically she was a woman, without a uterus, but with male chromosomes), and the five interventions authorized by the Department of Health (after review by the Clinic’s Research Ethics Committee, the Healthcare Ethics Committee, and the Bioethics Committee of Catalonia) do not contemplate this pathology.

Barbara, the sister, is a mother and did not want more children. She declared before a judge that she wanted to donate the uterus without any pressure. She was beginning an enormously difficult adventure from a technical point of view due to the large number of tiny vessels and highly fragile veins in the uterus, an organ that multiplies her weight seven times during pregnancy.

“The real difficulty of this surgery is that if you don’t do a step correctly, everything goes to hell,” says Francisco Carmona. “The anatomy of the uterus is highly variable. You know that the heart has the aorta artery, the vena cava… it is always the same. Here, each woman is different, and it is also a convoluted anatomy due to the course of the veins. You have to be very meticulous, very precise, a lot of patience, a lot of skill, a lot of experience.”

Added to the technical complexity is the ethical debate. Is it lawful to submit a healthy person to a ten-hour operation to give the uterus to another person? “You have to discuss it,” concedes the surgeon. “Is it lawful to remove a kidney, or a piece of liver from a person, which are vital organs, to implant them in another person?” He questions.

You have to reflect and discuss. “Whoever has cancer undergoes very aggressive treatments (it is clear that life is at stake), but infertile women who or can get pregnant often also are at risk. It seems that we only give importance to diseases in which the patient’s life is at stake, but the quality of life is also very important. If we can provide a solution, our obligation as doctors is to explore it.”

The Clínic team has already carried out the second uterine transplant and plans to carry out two or three more this year until the quota of five authorized is exhausted. In this case, a third fewer professionals took part in the operation than the first time. It was a success and, a few weeks ago, the patient was in the process of fertilization.

The team intends to apply for more permits. “We have to show that we are capable of doing it and, from here, that it be included in the portfolio of services of CatSalut and of all of Spain”, concludes Carmona.