Surgeons perform UK’s first womb transplant with sister donor

Recipient hoping she can go on to have not one but two babies, doctors say

The surgeon leading the procedure said it was 'probably the most stressful week in my surgical career but also unbelievably positive'. PA

Surgeons have performed the UK’s first womb transplant on a woman whose sister was the living donor.

During an operation lasting nine hours and 20 minutes at the Churchill Hospital in Oxford, the woman, 34, received the womb.

Her sister, 40, was willing to donate her womb after completing her own family by giving birth to two children.

The woman who received the womb lives in England and does not wish to be named. She has stored embryos to undergo IVF later this year.

The lead surgeons for the transplant, which took place on a Sunday in early February, were Prof Richard Smith, clinical lead at the charity Womb Transplant UK and consultant gynaecological surgeon at Imperial College Healthcare NHS Trust, and Isabel Quiroga, consultant surgeon at the Oxford Transplant Centre, part of Oxford University Hospitals.

Prof Smith told reporters the experience had been “quite remarkable”, adding that the operation had been a “massive success”.

“It was incredible. I think it was probably the most stressful week in my surgical career but also unbelievably positive,” he added.

“The donor and recipient are over the Moon, just over the Moon.

“I’m just really happy that we’ve got a donor who is completely back to normal after her big op and the recipient is, after her big op, doing really well on her immunosuppressive therapy and looking forward to hopefully having a baby.”

Ms Quiroga said she was “thrilled”, adding that, following the operation, transplant staff were still cautiously taking it all in.

“It was a very proud moment but still quite reserved – the first two weeks after the operation are nerve-racking,” she said.

“Now, I feel extremely proud of what we’ve achieved and desperately happy for her.”

Ms Quiroga said the patient was “incredibly happy”, adding: “She was absolutely over the moon, very happy and is hoping that she can go on to have not one but two babies.

“Her womb is functioning perfectly and we are monitoring her progress very closely.”

The woman receiving the womb was born with Mayer-Rokitansky-Kuster-Hauser (MRKH), a rare condition that affects around one in every 5,000 women.

In MRKH, women have an underdeveloped vagina and an underdeveloped or missing womb. The first sign of the condition is when a teenage girl does not have periods.

However, their ovaries are intact and still function to produce eggs and female hormones, making conceiving via fertility treatment a possibility.

Before receiving her new womb, the woman had two rounds of fertility stimulation to produce eggs, followed by intracytoplasmic sperm injection (ICSI) to create embryos.

Eight embryos have reached the blastocyst stage – which means they have a good chance of success in IVF – and were frozen for when the patient undergoes treatment at the Lister Fertility Clinic in central London later this year.

Prof Smith said that, at present, the transplanted womb is “functioning exactly as it should” and the plans for IVF are on track.

The woman will need to take immunosuppressant drugs throughout any future pregnancy to prevent her body from rejecting the donor organ.

The transplant is expected to last for a maximum of five years before the womb is removed.

A second UK womb transplant on another woman is scheduled to take place this autumn, with more patients in the preparation stages.

“The operation surgically has been incredibly successful,” Prof Smith said.

“The donor and the recipient are two absolutely lovely women. We couldn’t have a better result.

“People say we must feel proud, actually we feel relieved.

“I feel emotional about it all. The first consultation with the recipient post-op, we were all almost in tears.”

He said the day of the surgery, which involved more than 30 staff, was a “big and long day”.

The operation to remove the older sister’s womb took eight hours and 12 minutes.

An hour before the womb was extracted, surgeons began operating on the younger sister.

“All of the surgical staff met at 7am and we were back in our hotel at 6.30am the following morning,” Prof Smith said.

Asked if they felt nervous going into theatre, Prof Smith said: “Not nervous, I would say focused and well aware that failure was not an option.”

“Richard has been preparing for this for 25 years, I’ve been involved for nine, and we were fully ready to go way before Covid happened,” Ms Quiroga said

“So, we are just delighted that this day had come.

“The whole team worked extremely well, it was an incredibly proud moment. It was such an amazing feeling.”

Before surgery, both sisters underwent extensive counselling and were reviewed by gynaecologists, transplant surgeons, obstetricians, psychologists, anaesthetists and pharmacists.

They were also assessed by a Human Tissue Authority independent assessor to ensure they were aware of the risks and to confirm they were entering into the surgery of their own free will.

The case was also reviewed by an HTA panel before permission was granted to proceed.

The transplant cost of around £25,000 ($32,000) was paid for by donations to the Womb Transplant UK charity.

This included paying the NHS for theatre time (the transplant happened when the operating room was not being used for NHS work), plus the patient’s hospital stay.

Surgeons and medical staff involved in the transplant were not paid for their time.

Prof Smith said he was looking forward to when the patient can undergo IVF.

“Hopefully that embryo will take, and hopefully nine months later she’ll (have a) Caesarean section,” he said.

“Once she’s had a Caesarean section, she does have a choice – six months later – of a complete hysterectomy or to go and have another baby.

“We know right now she wants to have another baby, that’s for sure.”

“The reason why we’re waiting and not going straight for IVF is because we want to make sure she’s stable and the transplant is stable, and so far she’s been very, very stable,” Ms Quiroga said.

If the woman falls pregnant, she will be cared for in a specialist antenatal clinic at Queen Charlotte’s and Chelsea Hospital, where the delivery would also take place.

To date, Womb Transplant UK has approval for 10 operations involving brain-dead donors plus five using a living donor, most likely a womb from a sister or mother. It currently has enough funds for four of these operations.

To be eligible for the programme, women must live in the UK and be aged 24 to 40 (or 42 if embryos are frozen before the age of 38).

More than 500 women have contacted the charity over the years. Around 50 are currently going through checks, with a smaller number at an advanced stage.

Asked how many could benefit from womb transplants in future, Prof Smith said: “Realistically you’re talking maximum numbers of 20 to 30 per year on the living donor side for the foreseeable future.

“My guess is that, in future, there’ll be a centre which is based here or between Oxford and Imperial, and another centre in the north.”

The team also hopes to eventually use living donors who are not relatives but are offering their organs altruistically.

“We have women contacting the charity … such as young women who say ‘I don’t want to have children but I would love to help others have a child’ or’ I’ve already had my children I would love other women to have that experience',” Ms Quiroga said.

“So yes, there will definitely be a time in which that is a main source of donors.”

NHS England chief midwifery officer Kate Brintworth welcomed the “potentially exciting development for the NHS” which would give the recipient “the priceless chance of carrying a baby”.

“On behalf of the whole health service, I would like to send my best wishes for a speedy recovery to the donor and recipient on what is an amazing milestone,” she added.

“This is an excellent and highly significant achievement, being the first uterine transplant to be performed in the UK and I congratulate the Oxford/London team,” said Adam Balen of Leeds Teaching Hospitals NHS Trust.