Uterine Transplantation

Abstract

A uterine transplant, or womb transplant, provides a potential treatment for women who cannot become pregnant or carry a pregnancy because they do not have a womb, or have a womb that is unable to maintain a pregnancy. This is estimated to affect one in 500 women. Options for those who wish to start a family include adoption and surrogacy, but these are associated with legal, cultural, ethical and religious implications that may not be appropriate for some women and their families. A womb transplant is undertaken when the woman is ready to start a family, and is removed following the completion of their family.Womb transplants have been performed all over the world, with more than 70 procedures carried out so far. At least 23 babies have been born as a result, demonstrating that womb transplants can work. While the procedure offers a different option to adoption and surrogacy, it is associated with significant risks, including multiple major surgeries and the need to take medications that help to dampen the immune system to prevent rejection of the womb. To date there has been a 30% risk of a transplant being unsuccessful.Although the number of transplants to date is still relatively small, the number being performed globally is growing, providing an opportunity to learn from the experience gained so far. This paper looks at the issues that have been encountered, which may arise at each step of the process, and proposes a framework for the future. However, long term follow-up of cases will be essential to draw reliable conclusions about any overall benefits of this procedure.

Social support criteria in vascularized composite allotransplantation versus solid organ transplantation: Should the same ethical considerations apply?

“…VCA types vary greatly by total volume of procedures performed and by rate of performance over time. Moreover, as previously noted, VCA types differ in their status on the developmental trajectory from highly experimental research to innovative therapy approaching standard of care (Diep et al, 2021;Jones et al, 2021;Lake et al, 2022;Wells et al, 2022).…”

“…Uterine – Compared to other forms of VCA, the volume of uterine transplants (UTx) performed annually has increased steeply in a relatively short period of time. To date, data for over 70 UTx have been published ( Jones et al, 2021 ). This is due in part to the nature of UTx, which arguably may be considered more akin to solid organ transplants ( Johannesson et al, 2014 ).…”

Attitudes, knowledge, and perceptions among women toward uterus transplantation and donation in the United Kingdom

“…Therefore, we anticipate that between 120 and 130 donors will be broadly eligible for uterine retrieval each year. On the basis of current selection criteria, including necessity for being parous, having an uncomplicated obstetric history, and lack of significant medical problems, this number will decrease significantly further ( 17 , 18 ). Following donor family consent and authorization, and subsequent pre-operative investigations, it is expected that DBD donors who fully meet the criteria for uterine retrieval will be less than 50 women per year in the United Kingdom ( 19 ).…”