The charity Womb Transplant UK has announced that it will carry out the first womb transplant in the UK by the end of 2018, with living as well as deceased donors.
Consultant gynaecologist Dr Richard Smith, who leads the charity's research team, has already had permission to start the transplant programme using organs from ten deceased donors. Now an additional five procedures using tissue from living donors has been approved.
The approval is a result of improvements in the technique used to retrieve the womb from a living donor. What was previously an operation lasting more than 11 hours has been 'dramatically' reduced to about 4 hours due to the use of robot-assisted surgical techniques.
'Patient safety has always been of paramount importance to our team,' said Dr Smith. 'We have changed our protocols to include proven advances achieved by respected transplant teams elsewhere in the world.'
The women will first undergo IVF treatment in order to create embryos and will then receive a donor womb, usually from their mother or sister. Providing there are no complications six months after the surgery, an embryo will be implanted into the donated womb and the baby will be delivered by caesarean section at around 35-37 weeks' gestation.
More than 40 women worldwide have undergone a womb transplant to date. A total of 11 babies have been born to the organ recipients, with the first to a mother in Sweden in 2014.
Despite these successes, the surgery needed to retrieve a donor womb and transplant it into a recipient is still considered experimental. Writing in a commentary paper in BJOG, a team of Japanese researchers led by Dr Iori Kisu of Keio University, Japan, stated that the procedure was 'highly invasive due to the difficulty procuring the uterine veins running along the pelvic floor'. Following promising results from Chinese researchers, retreiving the ovarian vein instead with the aid of robotic surgical assistance could be a less risky alternative, Dr Kisu wrote.
Dr Smith and his colleagues will employ these techniques when they carry out their transplants between now and the end of 2018. The team is in contact with 50 women who have been shortlisted as suitable for the procedure. The women who go on to have the procedure will have surgery at NHS transplant centres funded by Womb Transplant UK. The total number of transplants to be provided has yet to be finalised.
'Infertility can have a devastating impact upon couples, particularly for women with absolute uterine factor infertility, for which there has been no effective treatment to date and – for some of these women, womb transplantation is the only way they can carry a pregnancy,' said Dr Smith.