Deceased donor uterine transplantation

Abstract

Objective: To share our experience in performing the first-ever deceased-donor uterine transplant in the United States.

Design: This video uses an animation and footage from a uterine transplantation procedure to review the steps and techniques involved in performing a uterine transplant.

Setting: Academic, multisite medical center.

Patient(s): A reproductive-age patient with Mayer-Rokitansky-Kuster-Hauser syndrome.

Intervention(s): Transplantation of a viable uterus from a deceased donor.

Main outcome measure(s): Assessment of posttransplantation uterine graft viability.

Result(s): This video article describes the essential steps in the uterine transplant process, including selecting an appropriate donor with no history of infertility or uterine malformations. Furthermore, a deceased donor should exhibit brain death but not cardiac death. We also review our inclusion criteria for suitable recipients. In this video we outline the key steps in a uterine transplantation procedure and demonstrate footage from an actual transplant procedure. These steps include establishing bilateral end-to-side vascular anastomoses between the donor uterine artery and vein and the recipient's external iliac vessels. Once this has been completed and reperfusion noted of the donor uterus, connection to the recipient vaginal cuff is then performed.

Conclusion(s): Uterine transplantation, although currently experimental, has gained the potential to become the first true treatment for uterine factor infertility. This procedure can become a promising option for the approximately 1.5 million women worldwide for whom pregnancy is not possible because of the absence of the uterus or presence of a nonfunctional uterus. Deceased donor uterine transplantation will further serve to broaden accessibility for this procedure.

Keywords: Uterine factor infertility; deceased donor uterine transplant; reproductive transplant; uterine transplantation.