Uterus Transplant
Uterus transplantation is a recent medical innovation that can make pregnancy possible for people with absolute uterine factor infertility (AUFI). Uterus donors can be living or deceased. The transplantation is an extensive process that involves more than just surgery.
A uterus transplant involves removing a uterus from a donor and transferring it to someone who has absolute uterine factor infertility (AUFI). AUFI is a condition in which you’re unable to get pregnant because you don’t have a uterus or it isn’t functioning. A uterus transplant may make it possible for you to become pregnant if you have AUFI.
If you have AUFI, it may feel like you don’t have control over your ability to build a family. A uterus transplant could give you an opportunity to take that control back. You may be able to redefine how AUFI affects your life.
Uterus transplantation is a complex process that involves much more than the transplant surgery. This is because the overarching goal is to have a live birth. In general, the intended process involves:
- Thorough health screenings and evaluations
- Finding a donor match
- IVF (in vitro fertilization)
- Uterus transplant surgery
- Taking immunosuppressants (antirejection medications)
- Embryo transfer
- Pregnancy (with potential high-risk complications)
- C-section
- Hysterectomy to remove the donated uterus after one or two live births
Uterus transplants are a recent — and uncommon — medical innovation. There have been over 100 uterus transplants performed worldwide, with over 70 live births. The first successful transplant was in 2011 in Sweden.
Uterus donation
Two types of donors can give a person a uterus: living and deceased. The hospital doing your transplant may only accept certain types of donors. Your healthcare team matches you to a donor through blood type.
Living donors
A living donor can be directed (known) or non-directed (anonymous).
A directed donor is often a biological family member (a mother or sister) who chooses to give their uterus. These are called directed donors because you know who they are. There’s often a clear connection between the person giving the organ and the person receiving it.
Anonymous donors (non-directed) are people who decide that they want to donate their uterus while alive. But they don’t have any one person in mind for their uterus.
Deceased donors
In this case, the donor is someone who has died and previously expressed a wish to give their organs to others. The donor typically has no relationship with the recipient in this type of organ donation.
It can take several months or years of planning before the uterus transplant surgery happens. You’ll undergo an extensive screening process. This evaluation makes sure you’re physically, mentally and emotionally fit to go through every aspect of the transplantation.
You’ll meet with several specialists, including:
- Reproductive endocrinologists.
- Obstetrician-gynecologists.
- Transplant and gynecologic surgeons.
- Anesthesiologists.
- Maternal-fetal medicine (MFM) specialists (perinatologists).
- Infectious disease specialists.
- Psychiatrists or psychologists.
- Social workers.
- Nurse coordinators.
You’ll have a variety of medical tests and exams to check if you’re eligible for the transplant. This includes laboratory tests, imaging tests and psychological evaluations.
Not every hospital system does uterine transplants. And each hospital has its own criteria for who’s able to donate and receive a uterus. In general, criteria for receiving a uterus transplant may include:
- Having AUFI and at least one functioning ovary.
- Being of reproductive age.
- Being healthy enough to undergo all the surgical aspects of uterus transplantation and childbirth.
- Meeting the criteria of a psychiatric evaluation.
- Being able to receive immunosuppressive medications.
- Not having HIV, hepatitis B, hepatitis C or other active infections.
- Not smoking.
- Being able to give informed consent.
Retrieving and implanting a uterus are both very complex surgeries. Whether you’re the donor or recipient, your healthcare team will go over the procedure in great detail. Don’t hesitate to ask questions.
Living donor hysterectomy
If you’re donating your uterus, your surgeon will do the hysterectomy by a laparotomy, laparoscopy or robotics. A laparotomy is an open incision (cut) in your abdomen to access your uterus. Laparoscopy or robotic surgery typically involves five ports (access points) to remove your uterus.
Your surgeon also removes:
- Blood vessels connected to your uterus
- Your cervix
- A small amount of vaginal tissue
Uterus recipient surgery
Before surgery, you’ll start taking medications to help make sure your immune system doesn’t attack the donor uterus (antirejection medications).
In general, during a uterus transplant surgery, your surgeons connect the donated uterus to your blood vessels. They also create a connection to your vagina.
They don’t connect your fallopian tubes to the transplanted uterus. This is why pregnancy can only happen with IVF after the transplant.
The surgery type is usually a laparotomy. This means your surgeon makes an incision in your abdomen to get to the space where the donor uterus will go. Some centers do the transplant robotically.
The surgery for transplanting a uterus usually takes six to eight hours. But this can vary.
Surgery to remove a uterus from a living donor typically takes up to 10 hours. It’s often longer than the surgery to transplant it. This is because the surgeons must be very careful to preserve all of the uterus. They also make sure not to damage surrounding tissues in the donor.
After the transplant surgery, your healthcare team will check you for signs of organ rejection or complications. The success of the surgery largely depends on if there’s proper blood supply to the uterus.
A few months after a successful transplant, you’ll start to have menstrual periods. Within three to 12 months of surgery, you’ll have an embryo transfer. Your healthcare provider will only implant one embryo at a time.
Pregnancy with a transplanted uterus
During pregnancy, you’ll continue to take antirejection medications. A team of maternal-fetal medicine (MFM) providers will monitor you and your pregnancy. You’ll also have cervical biopsies to check for organ rejection.
Birth with a transplanted uterus
You’ll have your baby via a C-section. Vaginal delivery isn’t possible with uterus transplantation.
After birth, your healthcare team will continue to monitor you and your baby. Together, you’ll assess if you want to try for another pregnancy and if it’s safe to do so. Healthcare providers generally give a limit of two live births with a transplanted uterus.
Removal of the donated uterus
A uterus transplant is meant to be temporary. Eventually, you’ll need a hysterectomy to remove the donated uterus. This may happen at the time of your C-section or a later date.
If the uterus becomes nonviable at any point during the process, a surgeon will need to remove it. Your healthcare team will also recommend removing the transplant if you have several unsuccessful embryo transfers or repeated miscarriages.
After the hysterectomy, you’ll stop taking antirejection medications.
If you have AUFI, uterus transplantation is the only way to try for pregnancy and childbirth.
Adoption and surrogacy are other options to build a family. Some uterus recipients saw the transplant process as an opportunity to play an active role in their future child’s health and well-being, according to one study. They viewed adoption and surrogacy as a more passive role.
How successful is it?
The overall goal of uterus transplantation is to have a live birth. But there are many steps to get there. So, researchers define the success of a uterus transplant in different ways. The two main ways are if the transplant is viable (healthy) and if the transplant results in a live birth.
According to one study of uterus transplants in the U.S., 25 of 33 uterus transplants (76%) were successful. Under the study’s definition, this means that the uterus was viable 30 days after surgery.
At the time of that same study, 19 of 33 of those transplant recipients (58%) had a least one live birth.
There are risks and possible complications for both the living donor and recipient.
Risks for a living uterus donor
For a living donor, there are general surgical risks, like:
- Complications from anesthesia
- Infection
- Bleeding
- Blood clot formation (thrombosis)
Complications specific to removing your uterus include injury to surrounding organs and structures. Urinary system issues are the most common complications. They include:
- Swelling of one or both kidneys (hydronephrosis)
- Abnormal connection between your ureter and another organ (ureteric fistula)
- Underactive bladder (hypotonic or neurogenic bladder)
It’s also important to consider the potential mental and emotional tolls of donating your uterus. Some donors have expressed feeling intense guilt when the transplant wasn’t successful.
Risks and possible complications for the uterus transplant recipient include:
- Surgical risks for the initial transplant surgery
- Surgical risks for C-section delivery
- Surgical risks for removal of the donated uterus
- Uterine graft failure — most often due to blood clots forming in the vessels connected to the uterus
- Rejection of the uterus
- Exposure to immunosuppression with the risk of kidney damage (nephrotoxicity)
- Risks related to IVF and pregnancy
Your healthcare team will go over all the possible risks and complications in detail with you. Uterine transplant is a newer medical innovation. So, researchers don’t know the long-term health impacts of it.
It’s important to remember that a uterus transplant doesn’t guarantee a live birth. Pregnancy is very complex. Other factors could lead to implantation issues and miscarriages.
On average, it takes about three to six months for your transplanted uterus to heal after surgery.
For donors, it may take about four to six weeks to recover. Recovery depends on the type of hysterectomy method your surgeon uses.
References
- Medicine Position Statement on Uterus Transplantation: A Committee Opinion (2018) (https://www.asrm.org/practice-guidance/practice-committee-documents/asrm-position-statement-on-uterus-transplantation-a-committee-opinion-2018/). Accessed 6/12/2025.
- Frisch EH, Falcone T, Flyckt RL, Tzakis AG, Kodish E, Richards EG. Uterus Transplantation: Revisiting the Question of Deceased Donors versus Living Donors for Organ Procurement (https://pmc.ncbi.nlm.nih.gov/articles/PMC9369769/). J Clin Med. 2022;11(15):4516. Accessed 6/12/2025.
- Johannesson L, Richards E, Reddy V, et al. The First 5 Years of Uterus Transplant in the US: A Report From the United States Uterus Transplant Consortium (https://pubmed.ncbi.nlm.nih.gov/35793102/). JAMA Surg. 2022;157(9):790-797. Accessed 6/12/2025.
- Richards EG, Agatisa PK, Davis AC, et al. Framing the diagnosis and treatment of absolute uterine factor infertility: Insights from in-depth interviews with uterus transplant trial participants (https://pubmed.ncbi.nlm.nih.gov/30855220/). AJOB Empir Bioeth. 2019;10(1):23-35. Accessed 6/12/2025.
- Testa G, McKenna GJ, Wall A, et al. Uterus Transplant in Women With Absolute Uterine-Factor Infertility (https://pubmed.ncbi.nlm.nih.gov/39145955/). JAMA. 2024;332(10):817-824. Accessed 6/12/2025.
- Wall AE, Testa G, Axelrod D, Johannesson L. Uterus transplantation-questions and answers about the procedure that is expanding the field of solid organ transplantation (https://pmc.ncbi.nlm.nih.gov/articles/PMC8366946/). Proc (Bayl Univ Med Cent). 2021;34(5):581-585. Accessed 6/12/2025.
- Walter JR, O’Neill KE. Reproductive Technology Considerations in Uterus Transplant (https://pmc.ncbi.nlm.nih.gov/articles/PMC10209693/). Clin Obstet Gynecol. 2022;65(1):68-75. Accessed 6/12/2025.
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