For the first time, a woman has given birth after receiving a uterus from a deceased donor.
A reported 11 women have had babies after uterus transplants from living donors. But this breakthrough, described online December 4 in the Lancet, could boost the availability of viable organs for women who want to become pregnant but lack a womb.
“Everyone was waiting to see whether [a deceased donor] would work with the same success” as a living donor, says abdominal transplant surgeon Giuliano Testa. Testa, who was not involved in this case, was a member of the team at Baylor University Medical Center at Dallas that reported earlier this year the first U.S. baby born, in 2017, after a living donor uterus transplant. The first such birth worldwide occurred in Sweden in 2014.
An estimated 1.5 million women worldwide suffer from infertility because their uterus is missing — from a congenital condition, for example — or the organ is abnormal or damaged. In the deceased donor case, the recipient was born without a womb due to Mayer-Rokitansky-Küster-Hauser, or MRKH, syndrome, which affects 1 in 4,500 women. The donated uterus came from a 45-year-old woman who’d had three vaginal deliveries and died of a stroke.
The recipient had the transplantation surgery in Brazil in September 2016, when she was 32 years old. She menstruated for the first time 37 days later. Seven months after the surgery, doctors transferred a single embryo — created via in vitro fertilization four months before the transplantation — to the uterus. During the pregnancy, blood flowed normally through the arteries in the uterus and the umbilical cord to the fetus, the medical team reports. Doctors removed the donated uterus after the delivery.
The woman gave birth to a healthy 2.5-kilogram (5.5-pound) baby girl by cesarean section on December 15, 2017. The infant scored highly on a measure of newborn health, called the Apgar score. At seven months, the girl, now nearly a year old, was healthy and developing normally, the doctors write in the study.
Uterus transplantation surgery is technically challenging, Testa says, but the cases so far demonstrate that “it’s a very well-tolerated procedure.” The recipients, including the woman in Brazil, were young and otherwise healthy; the only thing missing was the uterus, he says.
More research is needed to figure out what distinguishes a uterus that will work well after transplantation from one that won’t, Testa says, as well as how long the organ can remain viable outside of the body. But, as far as organs go, the uterus is “very resilient.”