The whole field of uterus transplantation is in its early days. But researchers said that if transplant teams can reliably use uteruses from deceased donors, it could expand the availability of organs and reduce living donors’ risks during surgery to remove the uterus.
“This is really an exciting moment,” said Dr. Rebecca Flyckt, a reproductive endocrinologist at the Cleveland Clinic, who was not involved in the research. “It’s proof-of-concept that a deceased donor is really a good model.”
In the new case report, published in the Lancet, researchers at the University of São Paulo in Brazil removed a uterus from a 45-year-old woman who died from a brain hemorrhage and had had three children. The organ was transplanted into a 32-year-old woman who had a disorder that left her without a uterus. Seven months after the transplant, doctors transferred an embryo made via in-vitro fertilization from the woman’s egg and her husband’s sperm into her womb.
“The use of deceased donors could greatly broaden access to this treatment,” Dr. Dani Ejzenberg, who led the research, said in a statement. He added: “The numbers of people willing and committed to donate organs upon their own deaths are far larger than those of live donors, offering a much wider potential donor population.”
Experts hope uterus transplants will one day be more widely available for women without uteruses or with damaged organs — or potentially even transgender women — seeking to become pregnant. In Sweden in 2014, doctors for the time time helped a woman with a transplanted uterus give birth; since then, there have been about a dozen such babies born around the world. Last year, doctors at Baylor University Medical Center in Dallas delivered the first U.S. baby to be carried in a transplanted uterus.
In all those cases, the uteruses came from living women — often a family member or friend of the recipient. But any donor has to undergo a radical hysterectomy, a lengthy procedure (it once took 10 to 12 hours, and is now four to six hours) that comes with its own risks and recovery period.
Thus the hope that deceased donors could be another source of organs.
Researchers in Turkey performed a uterine transplant in 2011 from a deceased donor but have not had any successful pregnancies. Flyckt and her colleagues in Cleveland have also performed two transplants from deceased donors. In the first, the uterus had to be removed from the recipient after an infection occurred; Flyckt said she couldn’t say where things stood with the second case other than that the recipient was doing well.
Part of the challenge in transplanting a uterus from a deceased donor is that the process — obtaining an organ, matching it to a recipient based on blood type and other qualities, and completing the operation — can take time. The uterus can only survive away from a blood supply for so long. Transplants from living donors are scheduled and can take place in adjacent operating rooms.
The researchers in Brazil reported that the uterus was ischemic — meaning, off a blood supply — for almost eight hours, essentially double the reported time from any of the living donor transplants. It suggested that transplant teams looking for uteruses could broaden the geographic area in which they search for donors.
“This actually tells us that the uterus is very resilient,” Flyckt said.
As with other organ recipients, the patient in this case was put on immune suppression drugs to reduce the chances of her body rejecting the transplant. Surgeons also performed a hysterectomy — they removed the uterus — during the C-section. Uterine transplants are considered “ephemeral,” meaning they only stay in to allow the recipient to have children and are then removed.
Researchers not involved in the study cautioned that, given all the biological constraints, the pool of potential uterus donors is actually quite small, even taking into account deceased donors. But they said that relying on deceased donors could expand the options for women who do not have a friend or family member willing to donate or that would be a good match. Most transplant teams envision one day using uteruses from both living and deceased donors.
“This is a very important birth for the whole uterus transplant community,” said Dr. Liza Johannesson, a uterus transplant surgeon at Baylor who previously worked with the Swedish research team. “It’s a landmark birth.”