Surgeon Christoph Haller and a team of researchers at Toronto's Hospital for Sick Children are working on a technology that could one day create an artificial womb to help extremely premature babies.
NPR's Chloe Ellingson
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Surgeon Christoph Haller and a team of researchers at Toronto's Hospital for Sick Children are working on a technology that could one day create an artificial womb to help extremely premature babies.
NPR's Chloe Ellingson
TORONTO — A surgical team races around a pregnant sow lying unconscious on an operating table. They are about to take part in an experiment that could offer new options to help premature babies survive.
“Today's ultimate goal is to transfer the fetus into an artificial womb,” says Dr. Christoph Haller, pointing to a clear rectangular plastic bag with tubes going in and out.
“We're moving the fetus into an artificial environment where it can maintain its normal physiology,” says Haller, a pediatric cardiac surgeon at The Hospital for Sick Children.
Today, it's pig fetuses that Haller and his colleagues use to test artificial wombs. But their hope is that such technology will one day allow humans to survive extremely premature births and avoid severe complications such as blindness and permanent damage to the lungs and brain.
“We're basically trying to find a new concept on how to preserve the fetus so that it reaches more physiological maturity compared to a normal preterm baby. That would be the goal. Extremely. to treat premature infants,” says Haller, who is also an assistant professor. He received his doctorate in surgery from the University of Toronto. “I hope this is a big thing, a game changer.”
Such research has generated great excitement among physicians who treat preterm infants, a leading cause of infant mortality and disability. However, many questions arise when considering the possibility of an artificial womb.
“I think this is a really promising and fascinating technology,” says Dr. Mark Mercurio, a professor of pediatrics who directs the biomedical ethics program at Yale School of Medicine. “But it certainly raises ethical concerns and questions that need to be addressed.”
This procedure is still very experimental
The metal tray next to the pig's belly is covered with blue paper. Haller's team has just drawn a picture of a pig's face on a piece of paper, surrounded by the words “Oink, Oink, Oink.” and “We are ❤ you.” And placed an artificial womb on top of it. Some people refer to this type of device as a “biobag.”
The surgical team then arranges for equipment and performs an ultrasound scan of the 10 fetuses inside the sow's uterus. Haller uses clippers to make final adjustments to the tube that will be sewn into the umbilical cord of the pig's fetus.
Technicians scan a pregnant pig's abdomen before the surgery to transfer the fetus into an artificial womb.
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Technicians scan a pregnant pig's abdomen before the surgery to transfer the fetus into an artificial womb.
NPR's Chloe Ellingson
The tubes oxygenate the fetus's blood, remove carbon dioxide from the blood, and deliver nutrients and medications.
“I'm MacGyvering here to make things work,” he says with a laugh.
Finally, everyone was ready to remove one of the fetuses.
“Okay, let's get started,” Haller said, urging his team to huddle around the pig.
Smoke billows from the pig's belly as Haller makes an incision with an electric scalpel. An assistant will suction the area to keep it dry.
“So what you're looking at is basically the uterus. And here's the fetus. The head is somewhere here, and that's where I have my hands. The rest of the body is still inside. ,” he says.
Dr. Christoph Haller performs surgery to remove fetal pigs from the uterus of adult pigs.
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Dr. Christoph Haller performs surgery to remove fetal pigs from the uterus of adult pigs.
NPR's Chloe Ellingson
After using an ultrasound to determine which fetus looked best, Haller made another incision in the uterus and removed the bright pink piglet fetus. The fetus appears to be sleeping peacefully.
Once the fetus was fully expelled, Haller and his team quickly assessed its health so the umbilical cord could be cut and transferred to an artificial womb.
“Biobag” becomes a new uterus
After carefully slipping the fetus into the “biobag,” Dr. Haller quickly attaches three umbilical cord tubes. His colleagues will fill the bag with a clear, warm liquid meant to mimic amniotic fluid and seal the artificial uterus.
“It's going to be a bit of a tough time from now on,” Haller said.
The team carefully monitors the fetus's heart rate, blood pressure, and other vital signs. Once it appears stable, the researchers surround the biobag with heating pads.
A pig fetus sleeping in an artificial womb.
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A pig fetus sleeping in an artificial womb.
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“I think we're as close to a good transition as we can get,” Haller said. “I'm as excited as I would be for any proper human surgery, just because I want it to be right and I want to see the fetus grow and thrive there.”
This goes on for hours.
“You might see the fetus starting to make breathing-like movements, but that's consistent with what's happening inside the womb as well. It's almost like they're basically training the fetus a little bit. You might see him kicking his legs,” Haller said. “We want to see that because it indicates a certain level of health.”
Artificial womb could be a bridge to improved health
If very premature babies can safely survive just a few weeks in such a device, it could make the difference between life and death, or whether they live with severe disabilities or health problems. There is, says Haller.
Blood clots and heart problems have been confirmed in the Toronto group. So far, the researchers have been able to keep the pig fetuses alive for only about a week.
But researchers at the Children's Hospital of Philadelphia safely maintained sheep fetuses for four weeks in a very similar device, leading the Toronto group and others to believe that this approach may ultimately work. I'm optimistic that it will go well.
“If this artificial womb technology can sustain patients for even a few weeks, grow them to later stages, and grow them to larger sizes, it could potentially bring about some pretty dramatic changes in our field.” “Yes,” says Associate Professor Dr. Mike Seed. A pediatrician at the University of Toronto who collaborates with Haller.
Scientific advances raise ethical concerns
But the possibility of an artificial womb also raises many questions. When is it safe to try artificial wombs in humans? Which preterm babies are good candidates? What should they be called? Fetus? baby?
“How we assign moral status to individuals is important,” says Mercurio, a bioethicist at Yale University. “How important should their interests, their well-being, be? And what can and cannot be done for or to them.”
But Mercurio is optimistic that these problems can be solved, and the technology's potential clearly warrants pursuing it.
The Food and Drug Administration will hold a workshop in September 2023 to discuss the latest scientific efforts to create artificial wombs, the ethical issues this technology raises, and how to proceed before allowing artificial wombs to be tested on humans. We discussed what questions needed to be answered.
“I'm absolutely in favor of this technology because it has a huge potential to save babies,” said Valdit Lavitsky, president and CEO of the Hastings Center, a bioethics think tank. That's because I think so.”
However, there are special challenges posed by the current political and legal environment.
“My concern is that rather than pregnant people being allowed to terminate their pregnancies, they will be forced to allow their fetuses to be removed from their bodies and placed in artificial wombs. In short, it's a new way to take away the right to abortion,” Ravitsky said.
She also wonders, “What if it were possible to carry a fetus for the entire gestation period using an artificial womb, making natural conception unnecessary?”
“Science fiction writers have been playing with this concept for decades. It's not like we haven't thought about it at all. It's not like we haven't thought about it at all. Thinking about it as a thought experiment versus thinking about it as something that could be right around the corner. We just think differently,” Lavitsky says. “The scenario of completely using artificial wombs could quickly become very frightening.”
But Haller and others argue that the darkest fears are unfounded.
“We heard from people who were concerned that this meant that women would not have to experience a full pregnancy. matrix“It's a dystopian future style,” Haller said.
“But it's outrageous to think that human intervention in any form is superior to nature. So if you haven't had any problems during pregnancy, you're not born the way you are.” “I think there's a lot of evidence that it's better to do what nature intended,” he says.
Haller and his colleagues are just trying to save the baby, he says.
“Every tool can be misused,” he says. “Like AI, it has benefits, but it can do just as much harm if it’s not properly regulated.”
Meanwhile, pig fetuses are settling into new artificial wombs.
“I think it looks cute and is very comfortable and calming,” says Haller. “You look very pretty and very happy. Yeah, that's good.”
