Uterus donation is an advanced medical procedure offering a path to pregnancy for individuals diagnosed with absolute uterine factor infertility (AUFI). This condition means a person is unable to carry a pregnancy due to the absence of a uterus, a non-functioning uterus, or a uterus that was surgically removed. Uterus transplantation enables recipients to experience pregnancy and childbirth, addressing a previously irreversible form of infertility. This complex process involves a multidisciplinary team and rigorous evaluation for both the donor and the recipient.
Who Can Be a Uterus Donor
Becoming a uterus donor involves meeting comprehensive medical and psychological criteria to ensure safety and suitability for both the donor and the recipient. Donors can be living or deceased, though living donation is currently more common. This strict selection process aims to maximize the chances of a successful transplant.
Living uterus donors are typically women between 30 and 50 years old who have completed their own childbearing. A history of at least one successful live birth is often preferred, as it indicates proven uterine function. Donors must be in excellent general health, free from chronic medical conditions such as diabetes, uncontrolled hypertension, or severe heart disease.
A healthy body mass index (BMI) of less than 30 is generally required, and donors must be cancer-free for at least five years. Screening also includes testing negative for infectious diseases like HIV, hepatitis B, and hepatitis C. Furthermore, donors should have no history of major uterine surgery or uterine pathologies that could compromise the transplanted organ’s health.
Extensive psychological evaluation is a mandatory part of the donor screening process. This assessment ensures the donor fully comprehends the risks involved, possesses stable mental health, and has clear, altruistic motivations for donation. The evaluation also provides psychosocial support throughout the donation journey.
Deceased uterus donors are also considered, with similar age and health criteria applied post-mortem to assess organ viability. The procurement of a uterus from a deceased donor must occur swiftly after brain death to maintain the organ’s quality. While deceased donation eliminates surgical risks for a living donor, the supply of suitable organs can be a concern, making living donation a more frequent pathway.
The Donor’s Surgical Journey
Once a potential donor is deemed eligible, a comprehensive pre-operative assessment begins. This includes detailed imaging, such as MRI and CT angiograms, to map the complex network of blood vessels supplying the uterus. Further counseling ensures the donor has a complete understanding of the surgical process, potential risks, and recovery expectations.
The uterus retrieval surgery is a lengthy and intricate procedure, often lasting between six and twelve hours. Surgeons meticulously disconnect the uterus, along with its vital blood vessels, ligaments, and a portion of the fallopian tubes and cervix. The goal is to preserve the vascular supply necessary for the transplanted uterus to function effectively in the recipient.
The procedure may begin with laparoscopic or robotic assistance for initial dissection, transitioning to an open abdominal incision for the final removal of the uterus. This approach ensures the integrity of the organ and its vascular connections.
Following the surgery, donors typically remain in the hospital for approximately five to seven days for recovery and monitoring. Pain management is a significant aspect of post-operative care, and gradual mobilization is encouraged. Full recovery and a return to normal activities usually take several weeks to a few months, depending on the individual.
Potential short-term risks for the donor include general surgical complications such as bleeding, infection, and blood clots. There is also a small risk of injury to surrounding organs like the bladder or bowel. The donor’s well-being is monitored throughout the recovery period.
Achieving Pregnancy Through Transplantation
Uterus transplantation offers a unique opportunity for individuals with uterine factor infertility (UFI) to carry a pregnancy. Recipients are typically those born without a uterus, such as individuals with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, or those who have had a hysterectomy. They must be of childbearing age, generally between 20 and 45 years old, and otherwise healthy.
The transplantation surgery for the recipient involves connecting the donor uterus to the recipient’s pelvic blood vessels and ligaments. This procedure often takes four to six hours. The fallopian tubes are not typically reconnected, meaning natural conception is not possible post-transplant.
After the transplant, recipients must take immunosuppressive medications to prevent their body from rejecting the new organ. These medications are taken continuously while the uterus remains in place, including throughout any pregnancies. While essential for graft survival, immunosuppressants can carry side effects, such as increased susceptibility to infection or potential impacts on kidney function.
Pregnancy is typically achieved through in vitro fertilization (IVF), with embryos created and frozen before the transplant. After a waiting period, usually six to twelve months for the uterus to heal and stabilize, these embryos are transferred into the transplanted uterus. Deliveries from a transplanted uterus are almost always performed via Cesarean section to avoid stress on the organ.
The transplanted uterus is intended to be temporary, remaining in place for one or two successful pregnancies. It is usually removed after two to five years to allow the recipient to discontinue immunosuppressive therapy, reducing associated long-term health risks. This approach prioritizes the recipient’s long-term health.