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This is how we performed the first uterus transplant in Spain

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Rocío (not her real name), at just 15 years old, discovered that she could never be a mother. In 2005, she learned that she was not having her period. This is how she realized that she could not have biological children because she suffered from Rokitansky syndrome, a congenital disorder that affects 1 in 5,000 women in the world. In most cases, it is characterized by the complete or partial absence of the uterus, the vagina, or both.

Years later, in 2014, she learned hopeful news from the press: a 35-year-old Swedish woman who, like her, suffered from Rokitansky syndrome, had become the first woman in the world to give birth to a baby after receiving a transplant. from the uterus of a friend of her family.

Once the transplant had been carried out, the Swedish woman’s pregnancy, carried out by in vitro fertilization and transfer of a single embryo, had developed without great difficulties. In this way, both the mother and the baby, who was born by cesarean section at 32 weeks’ gestation and weighing almost 2 kilos, were doing well.

Rocío and her sister, encouraged by this news, investigated for months until they found out that the Gynecology team at the Clinic had been preparing for more than five years to carry out an intervention of this complexity. We were interested in developing the technique in Spain as part of a research project. This is how the first uterus transplant from a living donor began in Spain.

So far, around seventy uterus transplants have been performed in the world, carried out by medical teams from countries such as Sweden, the United States, Brazil, the Czech Republic and others.

How was the transplant process

Rocío’s operation was carried out in October 2020 by a multidisciplinary team from the Hospital Clínic de Barcelona led by myself and Dr. Antonio Alcaraz. It was a complex intervention that was successfully completed and that has become a milestone in medicine in this country, since it had never been performed before.

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The intervention lasted around 17 hours. More than 20 professionals actively participated in it. Among them, gynecologists, anesthetists, surgeons and other health professionals.

The process had two phases. The first of these was the extraction of the uterus, carried out for 12 hours by robotic surgery. The second, implantation in the recipient through open surgery, which lasted approximately over 4 hours.

The transplant could be carried out thanks to the fact that a woman decided to donate her uterus to her younger sister so that she would achieve her desire to try to be a biological mother. It was also possible thanks to the involvement of a team of top-level specialists who had been preparing for a surgical feat unprecedented in our country for more than five years.

The requirements that had to be met to make the donation

Living donation of the organ was essential because it allows scheduling the transplant. This is an extremely important detail in long-term interventions and makes possible a more adequate selection of the ideal donor.

On the other hand, the donor had to be of the same blood group as the recipient. It was also a requirement that she had been a mother previously, to ensure that her uterus was working properly. Furthermore, the delivery should not have been performed by cesarean section.

In fact, the first to offer herself as a uterus donor was the patient’s mother, but the medical team had to discard her because she had been treated for breast cancer. It was then that the recipient’s sister, who had already been a mother and did not wish to have any more children, offered to donate her uterus to her sister.

The intervention was a complete success thanks to the extreme coordination of a highly trained team of specialists. Currently, months later, the two sisters, both the donor and the recipient, are in good health. In addition, the transplanted organ is working properly, the recipient of the uterus continues to have an excellent evolution and has already had her menstruation several times.

The next step in the process is planned to consist of embryo transfer, that is, the implantation of one of the 12 previously fertilized in vitro embryos. The objective is that the recipient of the transplanted uterus, for whom not being able to become pregnant was a great frustration, can achieve her dream of being a biological mother.

Benefits of advanced surgery in gynecology

Having managed to carry out the first uterus transplant in Spain, a transplant that we can consider historic, also represents an unquestionable advance for the field of gynecological surgery. Therefore, it is a medical benefit for countless patients suffering from many other pathologies.

Undoubtedly, in addition to the direct benefit for the transplanted patient, this operation will have repercussions on all the patients who will be operated on in the coming years. That is, for those who have the same disease and for those who lack the uterus for another reason. All this, thanks to the level of training and surgical technical demand that had to be developed by a large team of specialists.

The work carried out, the specialization, the coordination and the union in the same team of great professionals at the service of a project of this dimension mark a path that shows that Spanish surgery is at a very high level.

This article was originally published on The Conversation. Read the original.

Francisco Carmona Herrera does not receive a salary, nor does he carry out consulting work, nor does he own shares, nor does he receive financing from any company or organization that can benefit from this article, and he has declared that he lacks relevant links beyond the academic position cited.

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