Uterus Transplant Living Donor Evaluation and Selection: An Approach to Optimizing Donor and Recipient Outcomes

Since the first live birth from uterus transplantation (UTx) in 2014, there has been an ever-growing interest in the technique from patients and transplant programs worldwide. The Dallas UTx program first reported a live birth in the United States in 2017 and has subsequently completed 40 transplants with a living-donor-predominant approach. To date, the published scientific literature has focused on recipient and newborn outcomes, with relatively limited discussion surrounding living donor evaluation.

The aim of this study was to describe the methodology, evolution, and outcomes from living donor evaluation at the Dallas UTx program.

Over a 9-y period, 1329 women volunteered for living donation evaluation. A total of 72 women proceeded to full evaluation, with 38 deemed eligible (37 nondirected donation, 97%). Six women withdrew following evaluation, and 28 were deemed ineligible. Thirteen were declined for vasculature concerns (the main reason for exclusion), and 8 because of other abnormalities found on imaging. Two potential candidates were deemed ineligible because of medical comorbidities, and a further 3 on psychological evaluation. An additional 2 candidates were ineligible following committee review. Twenty-seven (68%) recipients have delivered a child, 4 have delivered 2 children, and 6 are currently pregnant.

Successful living donor UTx requires thorough donor evaluation. Favorable donor, recipient, and newborn outcomes were observed within the context of this comprehensive donor evaluation and selection process.