Deceased donor availability for uterus transplantation in Australia

Abstract

BackgroundUterus transplantation is an emerging treatment option for uterine factor infertility. Most uterus transplantation research programs use living donors, although this comes with considerable surgical and psychological risks and not all women desiring uterus transplantation will have an available living donor. A deceased donor program eliminates donor risks; however, the availability of deceased uterus donors is currently unknown in Australia.AimsTo establish the feasibility of a deceased donor uterus transplantation program in Australia and consider expanded inclusion criteria for this model.Materials and MethodsA retrospective review of the New South Wales (NSW) Organ and Tissue Donation Service database was undertaken to identify potential deceased uterus donors, with comparison to the broad deceased donor inclusion criteria from three international uterus transplantation trials including female, brain‐dead, multi‐organ donation, no major abdominal surgery, and <60 years of age.ResultsBetween January 1, 2018, and December 31, 2022, 648 deceased donors were available in NSW. Of these, 43% (279/648) were female and 67% of the women (187/279) were also multi‐organ donors. When the brain‐dead donor‐only and age criteria (<60 years) were applied, a total of 107 deceased donors met the available criteria for uterus transplantation, with an average of 21 deceased donors per year in NSW.ConclusionsThere appears to be adequate deceased donor organ availability to establish a deceased uterus transplantation program in NSW, Australia. Should interest in uterus transplantation increase, including criteria such as older and nulliparous donors could increase organ availability for a uterus transplantation program.

Living-Donor Uterus Transplantation: A Clinical Review

“…While there is a potential deceased donor availability for uterus transplantation, only 1-8.5% of all deceased donors are finally considered potentially suitable for uterus transplantation [14,30,31]. On the other hand, LDs have a careful preoperative assessment, including preoperative uterine imaging for assessing uterus vasculature, which is very difficult to plan in deceased donors [5].…”

Final thoughts from ANZJOG in 2023

“…Pittman et al describe deceased donor availability in uterine transplantation as this technique is developed locally, having been successfully pioneered internationally. 11 Current protocols employ living altruistic uterine donation but alternative strategies to source suitable donor uteri may be required if this technique becomes more common. Other fertility-related articles discuss attitudes toward gamete donation in New Zealand and the use of controlled ovarian hyperstimulation in women with a history of breast cancer.…”