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Article: Uterus transplantation: what the world's religions have to say.

da Graca, Briget / Wall, Anji E / Testa, Giuliano / Johannesson, Liza

Proceedings (Baylor University. Medical Center)

2024 Volume 37, Issue 3, Page(s) 373–380

Abstract: Uterus transplantation (UTx) has evolved from a purely experimental procedure to a clinical treatment option available outside the clinical trial context, offering women with absolute uterine-factor infertility an opportunity to experience pregnancy. As ... ...

Abstract	Uterus transplantation (UTx) has evolved from a purely experimental procedure to a clinical treatment option available outside the clinical trial context, offering women with absolute uterine-factor infertility an opportunity to experience pregnancy. As UTx becomes better established and more widely known and performed, it is likely to be sought out by geographically and culturally diverse patients, particularly those whose religious beliefs impose barriers to other paths to achieve parenthood, such as gestational surrogacy and adoption. Many religions do not currently have official positions on UTx, meaning that clinicians involved in screening candidates can expect questions about how the UTx process aligns with various religious beliefs. This article provides a broad background on the current positions major world religions have taken on UTx (or its components) and the alternative paths to parenthood of gestational surrogacy and adoption. It is intended to help clinicians communicate the information necessary for individuals interested in uterus donation or transplantation to determine-in consultation with their spiritual advisors or religious authorities when needed-how these options align with religious beliefs or teachings.
Language	English
Publishing date	2024-02-14
Publishing country	United States
Document type	Journal Article
ZDB-ID	2703932-8
ISSN	1525-3252 ; 0899-8280
ISSN (online)	1525-3252
ISSN	0899-8280
DOI	10.1080/08998280.2024.2308475
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Article ; Online: Ethical Issues in Donation following Circulatory Death: A Scoping Review Examining Changes over Time from 1993 to 2022.

da Graca, Briget / Borries, Trevor / Polk, Heather / Ramakrishnan, Sudha / Testa, Giuliano / Wall, Anji

AJOB empirical bioethics

2023 Volume 14, Issue 4, Page(s) 237–277

Abstract: Background: ...

Abstract	Background:
MeSH term(s)	Humans ; Tissue Donors ; Tissue and Organ Procurement ; Heart Transplantation ; Perfusion
Language	English
Publishing date	2023-06-21
Publishing country	United States
Document type	Review ; Journal Article
ZDB-ID	2763190-4
ISSN	2329-4523 ; 2329-4515
ISSN (online)	2329-4523
ISSN	2329-4515
DOI	10.1080/23294515.2023.2224590
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Zs.A 6890: Show issues

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Article ; Online: How Surgical Research Gave Birth to a New Clinical Surgical Field: A Viewpoint from the Dallas Uterus Transplant Study.

Johannesson, Liza / Testa, Giuliano / da Graca, Briget / Wall, Anji

European surgical research. Europaische chirurgische Forschung. Recherches chirurgicales europeennes

2023 Volume 64, Issue 2, Page(s) 158–168

Abstract: Background: Uterus transplantation (UTx) has come of age in the 21st century, building on the 20th century developments in vascular anastomosis and effective immunosuppressive protocols that have enabled solid organ transplantation to become the life- ... ...

Abstract	Background: Uterus transplantation (UTx) has come of age in the 21st century, building on the 20th century developments in vascular anastomosis and effective immunosuppressive protocols that have enabled solid organ transplantation to become the life-extending and life-improving treatment option we know today. However, UTx has the goal of enabling reproduction, meaning that research has focused on establishment of pregnancy and healthy live birth in addition to surgical technique and immunosuppression. Summary: The Dallas Uterus Transplant Study (DUETS), established at Baylor University Medical Center in 2015, is one of four UTx programs in the USA, and it holds the distinction of being home not only to the first US live birth but also the highest volume UTx program worldwide, with 23 uterus transplants performed to date, resulting in 15 live births. Innovations pioneered at our center span all aspects of the UTx process, all seeking to improve success for recipients in terms of achieving pregnancy and live birth, while also minimizing the burden on donors and recipients. They have included the following: (1) a deceased donor hysterectomy approach that allows the uterus to be procured prior to cross clamp; (2) proof of concept with use of only superior uterine veins after procuring both the superior and inferior uterine veins during the donor surgery, enabling the choice of the best option in terms of size and location for outflow, while also preserving ovary viability in living donors; (3) contribution to robot-assisted technique/minimally invasive technique with vaginal extraction of the uterus graft for living donor surgeries, shortening donor recovery times; (4) developing a robot-assisted technique for graft hysterectomies, improving recovery times for recipients at the end of their UTx journey; (5) refining immunosuppression protocols to enable embryo transfer as early as 3 months after induction therapy, increasing recipients' chances for achieving up to two live births during the 5 years posttransplant the UTx protocol specifies; and (6) building on our clinical trial experience to now offer UTx in the U.S. outside the setting of a clinical study. Key messages: Our center along with others throughout the world has demonstrated that UTx can be reproducible, result in live births from both living and deceased donors, and be safely introduced as a clinical option. Due to the complexity of UTx as well as the need for long-term multidisciplinary care, centers implementing UTx should have an established abdominal transplant program, a gynecologic surgery program, high-risk obstetric and neonatal care, and institutional support and oversight, and should partner with established UTx programs for protocol development and operative proctoring.
MeSH term(s)	Pregnancy ; Infant, Newborn ; Female ; Humans ; Infertility, Female/surgery ; Uterus/transplantation ; Living Donors ; Live Birth
Language	English
Publishing date	2023-01-09
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	205700-1
ISSN	1421-9921 ; 0014-312X
ISSN (online)	1421-9921
ISSN	0014-312X
DOI	10.1159/000528989
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Article ; Online: The Ethical Evolution of Uterus Transplantation From Concept to Clinical Procedure.

da Graca, Briget / Johannesson, Liza / Testa, Giuliano / Wall, Anji E

Clinical obstetrics and gynecology

2022 Volume 65, Issue 1, Page(s) 24–36

Abstract: Uterus transplantation (UTx) offers women with absolute uterine factor infertility a path to motherhood that enables them to carry their own pregnancy. Debates about the ethics of UTx have evolved in tandem with its clinical evolution: clinical trials ... ...

Abstract	Uterus transplantation (UTx) offers women with absolute uterine factor infertility a path to motherhood that enables them to carry their own pregnancy. Debates about the ethics of UTx have evolved in tandem with its clinical evolution: clinical trials have provided evidence regarding risks and benefits to donors and recipients that were initially uncertain; technical advances have altered the balance between risks and benefits; and the experiences of donors and recipients has revealed questions that were not anticipated. As UTx transitions to a clinical procedure, questions remain about long-term risks and benefits, applications beyond carrying a pregnancy, and cost and access.
MeSH term(s)	Female ; Humans ; Infertility, Female/surgery ; Pregnancy ; Tissue Donors ; Uterus/transplantation
Language	English
Publishing date	2022-01-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	391207-3
ISSN	1532-5520 ; 0009-9201
ISSN (online)	1532-5520
ISSN	0009-9201
DOI	10.1097/GRF.0000000000000687
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Article ; Online: Use of Telehealth Early and Late in the COVID-19 Public Health Emergency: Policy Implications for Improving Health Equity.

Sanchez, Katherine / Kitzman, Heather / Khan, Mahbuba / da Graca, Briget / Zsohar, Jeffrey / McStay, Frank

Journal of the American Board of Family Medicine : JABFM

2023 Volume 36, Issue 5, Page(s) 746–754

Abstract: Introduction: Early in the COVID-19 pandemic, primary care adopted telehealth rapidly to preserve access. Although policy flexibilities persist, but with in-person access restored, insight regarding long-term policy reform is needed for equitable access, ...

Abstract	Introduction: Early in the COVID-19 pandemic, primary care adopted telehealth rapidly to preserve access. Although policy flexibilities persist, but with in-person access restored, insight regarding long-term policy reform is needed for equitable access, especially for underserved, low income, and rural populations. Methods: We used electronic health record data to compare primary care telehealth use in practices serving primarily commercially insured patients versus clinics serving low-income uninsured patients, in March-June 2020 ("early COVID") and March-June 2022 ("late COVID"). Results: Primary care visit mode differed significantly ( Conclusions: Findings demonstrate the importance of both phone and video visits in preserving primary care access early in the pandemic. Telehealth use declined in late COVID, but still accounted for ∼20% of primary care visits in the commercially insured setting and less than 10% of visits in the community care clinics. Differences in telehealth use were largely by setting, reflecting income/insurance status, indicating disparities needing to be addressed.
Language	English
Publishing date	2023-08-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	2239939-2
ISSN	1558-7118 ; 1557-2625
ISSN (online)	1558-7118
ISSN	1557-2625
DOI	10.3122/jabfm.2023.230080R1
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Zs.A 2626: Show issues

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Article ; Online: Keep Your Move in the Tube® Method and Self-Confidence After Coronary Artery Bypass Graft Surgery.

Brown, Katelyn D / van Zyl, Johanna S / da Graca, Briget / Adams, Jenny / Meyer, Dan M

Journal of cardiopulmonary rehabilitation and prevention

2021 Volume 41, Issue 6, Page(s) 438–440

MeSH term(s)	Coronary Artery Bypass ; Humans
Language	English
Publishing date	2021-10-28
Publishing country	United States
Document type	Letter ; Research Support, Non-U.S. Gov't
ZDB-ID	2272063-7
ISSN	1932-751X ; 1932-7501
ISSN (online)	1932-751X
ISSN	1932-7501
DOI	10.1097/HCR.0000000000000648
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Article ; Online: A cost comparison of liver acquisition fees for donation after circulatory death versus donation after brain death donors.

Wall, Anji E / Da Graca, Briget / Asrani, Sumeet K / Ruiz, Richard / Fernandez, Hoylan / Gupta, Amar / Martinez, Eric / Bayer, Johanna / McKenna, Gregory / He Lee, Seung / Trotter, James F / Testa, Giuliano

Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society

2024

Abstract: Donation after circulatory death (DCD) donors now represent over 30% of the deceased donor pool in the United States. Compared to donation after brain death, DCD is less likely to result in transplantation. For each potential donor whose organs cannot be ...

Abstract	Donation after circulatory death (DCD) donors now represent over 30% of the deceased donor pool in the United States. Compared to donation after brain death, DCD is less likely to result in transplantation. For each potential donor whose organs cannot be utilized for transplantation (ie, dry run), fees are associated with the attempted donation, which add to the overall costs of organ acquisition. To better characterize the true costs of DCD liver acquisition, we performed a cost comparison of the fees associated with organ acquisition for DCD versus donation after brain death at a single transplant institute that comprises 2 liver transplant centers. Cost, recipient, and transportation data for all cases, including fees associated with liver acquisition from July 1, 2019, to October 31, 2021, were collected. We found that the total cost of DCD liver acquisition per liver transplant was $15,029 more than that for donation after brain death donation, with 18% of the costs of the DCD transplant attributed to dry runs. Overall, the costs associated with DCD transplantation accounted for 34.5% of the total organ acquisition costs; however, DCD transplantation accounted for 30.3% of the transplantation volume. Because the expansion of DCD is essential to increasing the availability of liver grafts for transplantation, strategies need to be implemented to decrease the costs associated with dry runs, including using local recovery, transferring donors to hospitals close to transplant centers, and performing more prerecovery organ analysis. Moreover, these strategies are needed to ensure that financial disincentives to DCD procurement and utilization do not reverse the gains made by expanding the organ donor pool using machine perfusion technologies.
Language	English
Publishing date	2024-01-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	2006866-9
ISSN	1527-6473 ; 1527-6465
ISSN (online)	1527-6473
ISSN	1527-6465
DOI	10.1097/LVT.0000000000000328
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Article ; Online: Psychosocial Outcomes in Nondirected Uterus Donors 1 Y After Donation.

Warren, Ann Marie / da Graca, Briget / Wall, Anji / Powers, Mark B / Saracino, Giovanna / Testa, Giuliano / Johannesson, Liza

Transplantation

2023 Volume 107, Issue 12, Page(s) e355–e362

Abstract: Background: As uterus transplantation transitions to a clinical procedure for women with absolute uterine-factor infertility, transplant centers performing uterus transplantation need information about the experience of living donors. This study ... ...

Abstract	Background: As uterus transplantation transitions to a clinical procedure for women with absolute uterine-factor infertility, transplant centers performing uterus transplantation need information about the experience of living donors. This study examined the psychosocial impact on 17 nondirected uterus donors in the Dallas UtErus Transplant Study 1 y following donation. Methods: A prospective longitudinal study was conducted to measure psychosocial outcomes of depression, anxiety, posttraumatic stress, quality of life, and resilience [measured using the Hospital Anxiety and Depression Scale or Patient Health Questionnaire 9-Item, Generalized Anxiety Disorder 7-Item, Posttraumatic Stress Disorder Checklist for the DSM-5, health-related quality of life Short Form-36, and Connor-Davidson Resilience Scale 10-Item, respectively) assessed at baseline, at 6-mo and 1-y follow-up. Differences among baseline, 6-mo, and 1-y postdonation were analyzed. Results: The median age was 38.0 y, 16 were married, 15 were of non-Hispanic/Latino ethnicity. Most donors did not report psychosocial distress; however, 1 donor reported decline on the role limitations because of Emotional Problems Scale and also showed an increase in depression symptoms at the 6 mo, but at 1 y was below the clinical cutoff for depression. A second donor showed modest decline in emotional well-being. Improvements were seen in other donors on the Physical Functioning Scale and posttraumatic stress symptoms. Conclusions: Although most nondirected donors appeared to remain stable, both positive and negative changes were observed over the first year. Larger studies are needed to determine psychosocial risks and benefit and what additional resources might be needed to ensure optimal psychosocial outcomes.
MeSH term(s)	Humans ; Female ; Adult ; Quality of Life ; Prospective Studies ; Longitudinal Studies ; Uterus/transplantation ; Living Donors/psychology
Language	English
Publishing date	2023-09-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	208424-7
ISSN	1534-6080 ; 0041-1337
ISSN (online)	1534-6080
ISSN	0041-1337
DOI	10.1097/TP.0000000000004799
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Article ; Online: Uterus transplantation: ethical considerations.

da Graca, Briget / Johannesson, Liza / Testa, Giuliano / Wall, Anji

Current opinion in organ transplantation

2021 Volume 26, Issue 6, Page(s) 664–668

Abstract: Purpose of review: Uterus transplantation (Utx) offers women with absolute uterine factor infertility the opportunity to carry their own pregnancies. As Utx transitions from an experimental to standard clinical procedure, we review the status of the ... ...

Abstract	Purpose of review: Uterus transplantation (Utx) offers women with absolute uterine factor infertility the opportunity to carry their own pregnancies. As Utx transitions from an experimental to standard clinical procedure, we review the status of the ethical issues applicable to the stakeholders involved. Recent findings: With more than 65 Utx procedures reported to date, evidence is accruing that enables the chance of success - a live birth - for the recipient to be weighed against the risks the recipient incurs through the Utx process, as well as risks to living donors undergoing surgery, to children exposed in utero to immunosuppressants and the uterine graft environment, and to third parties related to uterus procurement from multiorgan deceased donors. Experience has also informed aspects of recipient and donor autonomy that must be safeguarded. Summary: Clinical trial results provides a basis for weighing the interests of the stakeholders implicated in Utx, and so can inform transplant centers' and regulatory bodies' development of policies and protocols that will determine access to Utx and allocation of organs, together with other considerations of justice. Additional evidence, particularly on long-term outcomes, is needed, and new questions can be expected to arise as access to and indications for Utx broaden.
MeSH term(s)	Child ; Female ; Humans ; Infertility, Female/surgery ; Living Donors ; Organ Transplantation/adverse effects ; Pregnancy ; Uterus/transplantation
Language	English
Publishing date	2021-10-08
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1390429-2
ISSN	1531-7013 ; 1087-2418
ISSN (online)	1531-7013
ISSN	1087-2418
DOI	10.1097/MOT.0000000000000932
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Article ; Online: Associations of Mental Health and Experience of the COVID-19 Pandemic with United States Adults' Intentions to Be Vaccinated.

da Graca, Briget / Bennett, Monica M / Gottlieb, Robert L / Douglas, Megan E / Powers, Mark B / Warren, Ann Marie

Population health management

2023 Volume 26, Issue 5, Page(s) 317–324

Abstract: COVID-19 vaccine uptake in the United States has proved challenging. A deeper characterization extending beyond demographics and political ideologies of those hesitating or resisting is needed to guide ongoing conversations. This study examined ... ...

Abstract	COVID-19 vaccine uptake in the United States has proved challenging. A deeper characterization extending beyond demographics and political ideologies of those hesitating or resisting is needed to guide ongoing conversations. This study examined associations between US adults' vaccination intentions and mental health history, experience of the COVID-19 pandemic, and mental health outcomes. An online population-based cross-sectional survey was administered nationwide during January 4-7, 2021. Participants were questioned about past and current mental health, and completed the Patient Health Questionnaire 8 (PHQ-8), Generalized Anxiety Disorder 7-item (GAD-7), and Posttraumatic Diagnostic Scale (PDS)-5 (to capture symptoms of depression, anxiety, and traumatic stress, respectively). Experience of the pandemic included cumulative county-level COVID case and death rates, self-reported COVID-19 testing/exposure/diagnosis, and self-reported impact on routines, resources, and relationships. Of 936 respondents, 66% intended to be vaccinated, 14.7% responded "maybe," and 19.6% "no." Past diagnosis of obsessive compulsive disorder, less impact on routines or social supports, not having been screened or tested for COVID-19, not knowing someone who tested positive, and not self-isolating were associated with less intention to vaccinate. After controlling for demographic and pandemic experience factors, symptoms of traumatic stress, but not other mental health outcomes, were associated with less intention to vaccinate. The apparent contradiction between less negative impact of the pandemic and symptoms of traumatic stress being associated with less intention to be vaccinated indicates the complex nature of barriers to vaccine uptake. Results from this study contribute to the evidence base needed to improve ongoing and future communications about, and strategies to increase uptake of, vaccination.
MeSH term(s)	Adult ; Humans ; United States/epidemiology ; COVID-19/epidemiology ; COVID-19/prevention & control ; Mental Health ; COVID-19 Vaccines ; Intention ; Pandemics ; COVID-19 Testing ; Cross-Sectional Studies
Chemical Substances	COVID-19 Vaccines
Language	English
Publishing date	2023-08-29
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2454546-6
ISSN	1942-7905 ; 1942-7891
ISSN (online)	1942-7905
ISSN	1942-7891
DOI	10.1089/pop.2023.0136
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