Give Me a Crash Course in ... womb transplants

I’ve heard of kidney, lung and heart transplants, but a womb transplant sounds novel. Is this the first one in the world?

No, the first successful womb transplant took place in Sweden in 2014 when a woman, who received a donated womb from a friend in her 60s, became the first woman to have a baby following this surgery. Since then about 100 womb transplants have taken place worldwide and about 50 babies have been born, mostly in the US and Sweden but also in Turkey, India, Brazil, China, the Czech Republic, Germany and France. Surgeons in the UK were given permission to perform womb transplants in 2015 but this is the first successful womb transplant to take place there. Womb transplantation can, for some couples, be an alternative to adoption or surrogacy.

What sort of preparation goes into this type of surgery?

Both women – the 34-year-old recipient and her 40-year-old donor sister – had counselling before surgery. Their case was also reviewed by the Human Tissue Authority in the UK, which is the independent approval body for donations. The NHS costs of the womb transplant, estimated at £25,000, were paid for by the charity Womb Transplant UK, and the staff at the Churchill Hospital gave their time for free. The surgery took place in February 2023 but both women, who live in England, decided to remain anonymous.

What happened in this case and how are both women feeling now?

The 34-year-old woman who received the womb was born with a very rare condition, Type 1 Mayer-Rokitansky-Kuster-Hauser, where the uterus is absent or underdeveloped yet the ovaries function normally. Prior to surgery, she had fertility treatment with her husband and they have eight embryos in storage. Her sister, who chose to donate her womb, had two children already and felt her family was complete.

How did the doctors feel about carrying out such long and risky complex surgery?

Prof Richard Smith, the gynaecological surgeon, who led the organ retrieval team, told reporters it was an emotional experience. “I think it was probably the most stressful week in my surgical career but also unbelievably positive. I think we were all a bit tearful afterwards,” he said.

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The transplant surgeon, Isabel Quiroga, who led the team implanting the womb, said the recipient was delighted. “She was absolutely over the moon, very happy and is hoping that she can go on to have not one but two babies. Her womb is functioning perfectly and we are monitoring her progress very closely,” Quiroga said. A team or more than 30 carried out the procedures, which lasted about 17 hours in adjoining operating theatres.

What happens next?

The woman had her first period two weeks after the surgery. But like other transplant patients, she needs to take immunosuppressive drugs to prevent rejection of the organ. These drugs carry some long-term health risks, so the uterus will be removed after a maximum of two pregnancies.

Will womb transplantation become more common and is it likely to become available in Ireland?

Prof Smith, who is the chairman of Womb Transplant UK, said the team had been authorised to carry out 15 transplants – five with live donors and 10 with deceased brain-dead donors – but would need another £300,000 to pay for all the procedures. He said there were more than 15,000 women of child-bearing age in the UK with infertility issues due to being born without a womb or because they had their womb removed due to cancer or other abnormalities.

Prof Sam Coulter-Smith, chairman of the Institute of Obstetricians and Gynaecologists in Ireland, said earlier this week that we wouldn’t have the numbers of patients in Ireland to perform this type of surgery. “In Oxford they plan to do about 30 uterine transplants a year so we would expect people from Ireland would go to a centre in the UK to have it done,” he said.