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A surgeon in New Delhi, India, plans to carry out a uterus transplant, placing a womb from a donor into a transgender woman in the hope that she could become pregnant and carry the baby to term.
Though the procedure may sound out of the realms of current medical capabilities, uterus transplants have been carried out successfully in cis women (women assigned female at birth), with the first woman giving birth following an operation in 2014.
In 2018, another first took place when a baby was born after a woman – who was born without a uterus due to Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome – received a uterus transplant from a deceased donor.
Dr Narendra Kaushik, who runs the Olmec Transgender Surgery Institute, believes that the surgery will soon be possible, and will benefit the health and happiness of trans women who receive a donor womb. Though there is not a particularly huge push for the surgery by the transgender community, a survey of trans women in 2021 found that 90 percent of trans women believed that a uterus transplant would improve their quality of life, "alleviate dysphoric symptoms, and enhance feelings of femininity".
"Every transgender woman wants to be as female as possible," said Dr Kaushik told The Mirror. "And that includes being a mother. The way towards this is with a uterine transplant, the same as a kidney or any other transplant."
"This is the future. We cannot predict exactly when this will happen but it will happen very soon. We have our plans and we are very very optimistic about this."
The uterus used for the operation could come from a dead donor or a living trans man, according to The Mirror. Experts, published in the National Center for Biotechnology Information in 2019, believe that of those options, receiving a utero‐vaginal transplant from a deceased donor would be the safest. This procedure would reduce surgery time and other potential complications in the recipient, as well as the obvious reduced risk for the already deceased donor.
"Despite a number of anatomical, hormonal, fertility, and obstetric considerations that require consideration, there is no overwhelming clinical argument against performing [uterus transplants] as part of [gender reassignment surgery]," the team concluded. "However, the increased radicality associated with the retrieval operation, including a longer vaginal cuff and more extensive ligamentous dissection, potentially necessitates the use of deceased donors."
They added that more studies on animals are needed to determine whether the recipients of wombs would be able to conceive and maintain pregnancy.
As with all surgeries, this procedure is not without its risks. It has been attempted before, with the first attempt of a womb transplant in humans being carried out on Lili Elbe, a painter and trans woman, way back in 1931. She died three months later of a heart attack, following an infection acquired during the operation.
Currently, the Montreal Criteria for the Ethical Feasibility of Uterine Transplantation – a set of guidelines for clinicians and medical professionals when considering carrying out a uterine transplant – do not allow for transplantation of a womb into trans women, primarily due to safety concerns.
"Medical issues concerning uterine transplant with a non-cisgender female recipient include the creation of adequate uterine vascularization de novo, the necessity for appropriate hormone replacement to sustain implantation and pregnancy, and the placement of the uterus in a non-gynecoid pelvis," Dr Amel Alghrani, Professor of Law at the School of Law and Social Justice at the University of Liverpool and former worker at the General Medical Council in the UK, wrote in a paper on the topic in 2018.
"These unique considerations mean that uterine transplant in cisgender men and transgender women fails to meet the first stipulation of Moore's Criteria for Surgical Innovation, which requires that novel surgical procedures have an adequate research background. It is on this basis that the Montreal Criteria exclude non-cisgender female recipients."
Dr Narendra Kaushik, who has not yet set a timescale for the operation, notes that the operation would require the recipient to undergo IVF treatment in order to become pregnant, as the uterus would not be connected via fallopian tubes to the vagina. Another complication a trans woman may face after such an operation would be that cis women generally have wider pelvises, aiding in giving birth. However, c-sections could be used as an option to overcome any complications, just as they have in cis women.
