Can Chinese organ transplant model benefit female fertility treatments?
Henry Zheng

Two weeks ago, a woman in northwest China became the first mother in the country to give birth with a transplanted uterus. The achievement has given infertile females hope, but the development signifies how the country's medical advances could benefit from more robust regulations.

The 26-year-old woman, which local media identify as Yang Hua, delivered her baby by cesarean section in Shaanxi Province. Doctors had told Yang five years ago that she did not have a uterus or a vagina, as she suffers from a syndrome known as MRKH. Her options at the time were limited, as China's Ministry of Health banned surrogacy – having one's child carried in the womb of another woman – in 2001. They told her that the only option at the time was to receive a uterine transplant.

Yang's mother agreed to donate her uterus, and eventually, a team at Xijing Hospital in the provincial capital Xi'an completed the procedure by implanting one of Yang's embryos into the transplanted womb. The child is the 14th baby in the world to be born from such a transplant. 

Although the technique has matured to become a viable option for an estimated 760,000 women in the country who cannot bear children, there are still significant risks involved. After the transplant, the recipient's immune system can reject the uterus, so she has to take immunosuppressant drugs. For couples that want another child after the first, they're encouraged to have one as soon as possible so that the uterus can be removed and the mother won't have to take the drugs for life.

Complications can occur during a recipient's pregnancy. The first successful birth from a transplanted womb was in Sweden in 2013, but the baby was born prematurely after the mother developed high blood pressure and related problems. 

An organ donor also takes on risks during the operation such as severe internal bleeding or infection of the surrounding organs. The dangers to living donors has created a need for organs from deceased donors, of which there is insufficient supply.

The ‘Chinese Model' for regulating transplants

China has emerged as an authority in the international transplant community in recent years thanks to its scientific contributions and policy reforms. It had once courted controversy for using organs from questionable sources, but officials have advocated for stringent regulations so that only organs from voluntary donors would be accepted. A strong legal and ethical regulatory framework for organ donations would establish a solid foundation for surgeries intended to improve one's quality of life.

Government figures show that voluntary organ donations have increased in recent years. Guo Yanhong, deputy head of medical administration at the National Health Commission, wrote in an article last year that the rate of organ donation was 124 times higher in 2017 at 3.71 per million compared with that of 2010 when the volunteer system was first established. He also noted that about 300,000 people have registered as organ donors. 

These voluntary donations signify a departure from traditional thinking. Some Chinese have been reluctant to donate because Confucian ethics dictate that the body not be damaged as it belongs to one's parents, the country's leading organ transplant reformer Huang Jiefu wrote in 2008. 

This combination of ensuring regulatory transparency as well as encouraging ethical organ donations is being touted as the “Chinese model” by officials such as Huang and Guo. Guo stated that a defining characteristic of the model is that the donation must be done after brain and cardiac death.

Along with changing societal values on organ donation, the model could widen the pool of supply from live and deceased donors, fulfilling a demand that previously left China's infertile females with few options.