Behind the breakthrough: why uterus transplants need global insight

The recent announcement of the first birth in the UK after a uterus transplant invites us to think about the long-term implications of this reproductive technology. In this blog, Dr Natasha Hammond-Browning, a Senior Lecturer in Law at Cardiff University’s School of Law and Politics highlights the importance of global data sharing and long-term studies in uterus transplantation to improve patient safety, inform clinical practice, and guide future participants.

On the 7 April 2025, the birth of baby Amy Isabel was announced, marking another milestone in the history of reproductive firsts in the United Kingdom. Amy Isabel was born in February 2025 and is the first baby born in the United Kingdom after a uterus transplant.

Uterus transplantation first hit the headlines with the birth of baby Vincent in Sweden in 2014. Vincent was the first baby born as part of a clinical trial on uterus transplantation, and since 2014 the interest in uterus transplantation has grown, with clinical trials taking place globally. Over 140 transplants have occurred with more than 70 babies born.

Uterus transplantation is a process that is available to women with absolute uterine factor infertility (AUFI) who meet the eligibility criteria for the clinical trial in the country in which they live. Currently, two centres in the United States (Baylor University Medical Centre and UAB Medicine) offer uterus transplantation as a treatment option for AUFI.

What does uterus transplantation involve?

It is a unique organ donation as it crosses the boundaries of organ donation/transplantation medicine and assisted reproduction medicine. It is intended to be a temporary transplant, with a reproductive purpose, and it is performed on essentially healthy individuals.

Uterus transplantation is a lengthy process that involve multiple steps on the path to potential parenthood. The process starts with a medical evaluation to determine suitability for the transplant, then if accepted, the recipient must undergo egg retrieval and IVF to create embryos (if they do not have any already stored), the transplant procedure itself followed by a period of recovery. The recipient will then undergo embryo transfer(s) that will hopefully result in a successful pregnancy, caesarean delivery, a possible second attempt at pregnancy if desired by the recipient and medically safe to proceed, and finally the uterus is removed. Throughout the time that the recipient has the uterus, they must take immunosuppressant medication to prevent rejection of the uterus.

Uterus transplantation has been performed with living and deceased donors, most often the living donor is known to the recipient. This was the case with the first uterus transplant in the United Kingdom, the donor was the recipient’s sister. Womb Transplant UK have also performed 3 uterus transplants from deceased donors. In 2017 in Brazil, the first baby was born after a deceased donation, so proof of concept has been shown.

With the announcement of the first birth in the United Kingdom after a uterus transplant, it is timely to consider some of the long-term considerations as uterus transplants change the reproductive options available for women with absolute uterine factor infertility (AUFI).

Data sharing

Uterus transplantation is a relatively new reproductive technology, and while there are large numbers of success stories with babies born, there have also been uterus transplants that have failed. The medical knowledge in this new area of organ donation / transplantation and assisted reproduction is expanding rapidly, although most countries have just one clinical team working in this area. It is therefore important that clinical teams are able to share patient data, best practices, and outcomes amongst themselves in order to increase efficacy and safety. The sharing of data is not without its legal conundrums though, as sharing of personal data must be done in a way that is legally compliant and maintains patient privacy and confidentiality. For those operating within the jurisdiction of the General Data Protection Regulation (GDPR), there is a clear framework to conform with. For those operating outside the jurisdiction of the General Data Protection Regulation, they may be able to choose to comply with this framework in order to share data, but this may depend upon the legal jurisdiction within which they are working.

Long-term follow up studies

The long-term follow up of recipients, children and living donors is of vital importance for clinicians to understand the long-term impacts of uterus transplantation, for the past and current participants in the clinical trials, and for future participants. Long-term studies will allow for full assessment of the risks, impacts, and benefits of this novel reproductive procedure. The data and information resulting from those studies will directly impact future work in this field of medicine, as well as providing essential information to future participants that will help to inform and shape the decisions that they make whether to pursue uterus transplantation as a reproductive option.

Information provision is of fundamental importance, with consent being the cornerstone of healthcare. Patients can only provide consent to procedures if they have sufficient information upon which to base their decision. By conducting long term follow up studies, future living donors will be better informed about the likely and possible health implications of undergoing an extensive and lengthy hysterectomy which may determine their willingness to donate. Future recipients will have greater knowledge about possible impacts of taking immunosuppression medications, and any possible implications for the children born, as well as greater knowledge of the success rates and the potential risks and health implications. There will also be greater knowledge around the use of deceased donations, and a case may be made for preferring to utilise deceased donors over living donors.

Future decisions

The announcement of the first baby born in the United Kingdom after a uterus transplant is no doubt one to be celebrated. The birth of baby Amy Isabel is the result of decades of work by the Womb Transplant UK clinical team, and this news will bring hope to many women with AUFI. With long term-follow up, those future participants will be well informed to decide if a uterus transplant is the route to parenthood that they wish to pursue, or if adoption or surrogacy would be their preferred option.

Further reading

Hammond-Browning, N. and Williams, N. J. eds. 2024. International legal and ethical perspectives on uterus transplantation. Elgar Studies in Health and the Law. Edward Elgar. (10.4337/9781803920498.00009)

Hammond-Browning, N. and Yao, S. L. 2021. Deceased donation uterus transplantation: a review. Transplantology 2(2), pp. 140-148. (10.3390/transplantology2020014)

Hammond-Browning, N. 2019. Uterus transplantation: five years after the world’s first birth. BioNews(1022)