Womb Transplants to Take Place in the UK Before the End of the Year 

Siobhan Harris

Disclosures

September 11, 2018

The first womb transplants in the UK are expected to be carried out by the end of this year.

It's a major development in the treatment of uterine factor infertility. The transplants offer hope to women who otherwise would not be able to carry a child.

The charity Womb Transplant UK plans to fund 15 transplants at NHS transplant centres. Ten will involve cadaveric donors and five live donors. The charity currently has funding for three of those transplants and is hoping for further funding.

   

Mr Richard Smith


The surgeon who'll lead the transplant team is Mr Richard Smith, who is clinical lead at Womb Transplant UK.

He's also a consultant gynaecologist at Queen Charlotte's and Chelsea Hospital, Imperial College London.

 

Q&A

Medscape UK: What's the latest news about the forthcoming transplants?

Richard Smith: We are about to start two separate programmes. In the first programme 10 women will have uterine transplants from heart beating, brain dead cadaveric donors.

We are also hoping to start to undertake five live donor transplants. Both of those programmes are due to start within the next 2 to 3 months. We are very close to research programme contracts being signed off and we have ethics committee approval.

With respect to live donors there have been more than 40 procedures done and 11 babies born worldwide. As such it has already begun making the transition into clinical care. The Donation after Brain Death (DBD) programme is still classed as research as only one baby has been born worldwide using that technique.

Medscape UK: What are the differences between womb transplants from cadaveric and live donors?

Richard Smith: For many years we said we would only do cadaveric donations because there's no risk to the donors. The original technique, which we were involved with developing, used a large vessel patch technique instead of utilising the uterine arteries and ovarian arteries. For live donations we have always been uncomfortable using that technique because of the risk to the urinary tract of the donor.

Then about a year ago there was a game changer from Dallas which showed that you didn’t need to retrieve the internal iliac veins but instead you could retrieve the smaller ovarian veins. This makes the operation much less risky, and shrinks the surgery time from 10-13 hours to 3-4 hours.

That's why we have decided to use live donors as well as brain dead donors.  

Medscape UK: What are the criteria for the procedure and what does it involve?

Richard Smith: The retrieval is a similar procedure to a radical hysterectomy. 90% of the recipients have Mayer-Rokitansky-Küster-Hauser syndrome, which means they have been born without a uterus. To be eligible for a transplant you need to have a normal length natural vagina, not one created from skin or bowel. You also have to have had embryos created from your own eggs.

The recipient's surgery involves vagina dissection and the bladder taken off the top. When you retrieve the uterus, you retrieve the upper vagina as well.

Medscape UK: Who is likely to donate a womb?

Richard Smith: When it comes to live donations it's exclusively mothers and sisters who've completed their families.

For DBD the donor needs to be on ITU, declared brain dead, and their relatives are happy for the uterus to be retrieved.

However, we have been literally inundated with emails from hundreds of women who altruistically want to donate their uteruses to our programme. Women say ‘My greatest joy in life is my children, it must be awful to be born without a uterus, and if I can give another woman the pleasure I have had then please can I donate?’”

Even though that's not a route we intend to go down at the moment this may come on the agenda at a later date.

Medscape UK: Is there a demand for the procedure?

Richard Smith: We've been contacted by over 500 women looking for a womb transplant. We know that in the UK there are about 50,000 women with absolute uterus infertility meaning they don’t have a uterus or they have a uterus so damaged it doesn’t work. We know 100 to 200 women go through surrogacy each year. We know there are 6000 women with Mayer-Rokitansky-Küster-Hauser. Of the 500 who approached us, the number has now fallen to 50 once we went into specifics like: Do you have a normal renal tract? Do you have your own vagina or a neo vagina? Have you got any current medical conditions?

Medscape UK: What are your predictions for future development?

Richard Smith: The charity has funding to carry out three transplants. We have also applied to NHS England for the possibility of setting up a uterine transplant centre in a partnership between Imperial College London and the University of Oxford. That is a 4 year process. What's likely to happen is across London and the South East with a possible population of 20 million, the calculations we have is that the DBD programme will produce between 10 to 20 uteruses a year. From the point of view of NHS funding the DBD programme is relatively small.

As for live donor transplants that's much more difficult to work out. I don't know how many people are out there so I don’t have the answer as to how many women would want one.

Medscape UK: How much does a womb transplant cost?

Richard Smith: We are very fortunate, we have all of our IVF and pre-embryo implantation genetics, which is about £200,000 worth of stuff, all already funded, helped by the Lister Clinic. Transplants themselves cost £30,000. The charity funds other research and may look in the future at growing uterus on scaffolds. You can make donations at the website wombtransplantuk.org.

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