A 26-year-old patient is the nation's first recipient of a uterus transplant, doctors from the Cleveland Clinic announced on Thursday. The grueling nine-hour surgery took place Wednesday, and the patient — who received the organ of a deceased donor — is reportedly in stable condition.
The clinic has not commented further on the first patient, but she was one of 10 women selected for the approved clinical trial of the procedure. The women were all either born without uteruses (a condition known as Mayer-Rokitansky-Küster-Hauser syndrome) or had to have them removed. For women with cultural, religious or personal conflicts with surrogacy, uterus transplants could provide biological children who would otherwise be impossible.
“I crave that experience,” a 26-year-old prospective recipient told the New York Times when the trial was first announced. “I want the morning sickness, the backaches, the feet swelling. I want to feel the baby move. That is something I’ve wanted for as long as I can remember.”
The announcement comes just two years after the world's first uterine transplants began in Sweden. In October 2014, doctors there announced that a healthy baby boy had been born to one of the patients. Another four have been born as a result of the surgeries to date.
Andreas G. Tzakis, the surgeon leading the U.S. efforts, has performed countless transplants of more traditional organs. Tzakis traveled to Sweden to study the methods being used there.
The process is long, and it doesn't end after the nine-hour surgery is complete: It begins with the same stimulation and egg harvesting from the patient as any IVF procedure. Once 10 frozen embryos are deemed suitable, the patient starts anti-rejection drugs. Doctors remove the uterus and its entire blood supply from a selected donor. It's placed in the patient's pelvis, with the donor's blood vessels connected to her own. If the surgery is a success, the patient will start getting periods a few months later. It takes a year for the womb to heal enough to attempt a pregnancy.
As with any organ transplant, the risks are high — and recipients have to take medication to keep their bodies from rejecting the foreign tissue. This makes the surgery controversial, as it's not life-saving. Along with transplants of hands, faces and genitals, uterine transplants are instead considered "life enhancing." But unlike other organ transplants, after one or two healthy pregnancies, the uterus will be removed so that the patient can stop taking these drugs.
Still, it's vital that the Cleveland Clinic surgeons show that they can make the procedure safe enough to justify the risks. The decision to use uteruses from reproductive-age, compatible deceased donors (as opposed to Sweden, where the organs all came from living donors — many of them post-menopausal friends or family members) is intended to remove the risk to the donor and thus some of the net risk from the procedure.
That actually raises another ethical question: When doctors at Johns Hopkins began working on the country's first penis transplants, they admitted concern that the public might be dissuaded from donating any organs by the misconception that genitals might be harvested. But in fact, donations for these experimental, non-life-saving procedures are strictly opt-in.
The Cleveland Clinic continues to screen additional patients for the trial. You can find more information here.