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Establish Membership Requirements for Uterus Transplant Programs

eye iconAt a glance

Current policy

Uterus is the most sought-after Vascularized Composite Allograft (VCA) transplant, with 44 candidates added to the waiting list since 2016. The majority of uterus transplants performed to date (20 out of the 32) were made possible through living donation. Currently, uterus transplant programs are subject to the general VCA membership requirements that apply to several types of VCA. Since uterus transplantation is expected to continue increasing, specific requirements for programs performing uterus transplants and living donor uterus recoveries are proposed.

Supporting media

Presentation

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Proposed changes

  • Establishes uterus as a type of VCA separate from other genitourinary organs.
  • Establishes primary surgeon and primary obstetrician-gynecologist requirements specific to uterus transplant programs.
  • Adds requirements for uterus transplant programs that recover uteri from living donors.

Anticipated impact

  • What it's expected to do
    • Promote living donor and transplant recipient safety by establishing more tailored membership requirements for uterus transplant programs that reflect the expertise needed to safely perform these transplants
  • What it won't do
    • This proposal does not include any changes to membership requirements for VCA types that are subject to the membership requirements for “other VCA” transplant programs

Themes

  • Uterus transplantation
  • Membership requirements
  • Living donors

Terms to know

  • Vascularized Composite Allograft (VCA): Transplant of multiple structures, which may include connective tissue, skin, bone, muscles, blood vessels, and nerves. For example, face and hand transplants are two of the most well-known types of VCA transplants.
  • Living donor: A living individual from whom at least one organ is recovered for transplant.

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Provide feedback

eye iconComments

Region 1 | 09/24/2021

Region 1 sentiment: 3 Strongly Support, 2 Support, 3 Neutral/Abstain, 0 Oppose, 0 Strongly Oppose. Comments: A member commented that it will be important to consider how to support new programs, as their volumes for all will be low initially.

Region 6 | 09/23/2021

Region 6 sentiment: 3 Strongly Support; 14 Support; 5 Neutral/Abstain; 0 Oppose; 0 Strongly Oppose. No comments.

Region 8 | 09/22/2021

Region 8 sentiment: 4 strongly support, 10 support, 9 neutral/abstain, 0 oppose, 0 strongly oppose. Comments: Region 8 supports this proposal.

OPTN Membership and Professional Standards Committee (MPSC) | 09/17/2021

The MPSC thanks the VCA Committee for presenting its proposal “Establish Membership Requirements for Uterus Transplant Programs.” The MPSC offers the following comments: The medical expert support requirements should specify what qualifies individuals for those roles, such as board certification in a certain discipline, for example. It would be helpful for the VCA Committee to define “demonstrates collaboration” in the medical expert support requirements so the MPSC knows what sort of evidence or documentation a member should provide to prove they have met the requirement.

Region 7 | 09/15/2021

Region 7 sentiment: 5 strongly support, 9 support, 3 neutral/abstain, 0 oppose, 0 strongly oppose. No comments.

Region 9 | 09/14/2021

Region 9 sentiment:  1 Strongly Support; 4 Support; 4 Neutral/Abstain; 1 Oppose; 0 Strongly Oppose. No Comments.

Region 3 | 09/10/2021

Region 3 sentiment: 2 strongly support, 8 support, 5 neutral/abstain, 0 oppose, 0 strongly oppose

Region 2 | 09/10/2021

• Region 2 sentiment: 7 Strongly Support, 15 Support, 5 Neutral/Abstain, 0 Oppose, 0 Strongly Oppose • Comments: None

Region 5 | 08/30/2021

Region 5 sentiment: 8 strongly support, 13 support, 8 neutral/abstain, 0 oppose, 0 strongly oppose. Region 5 supported the proposal to Establish Membership Requirements for Uterus Transplant Programs.

Region 4 | 08/27/2021

3 strongly support, 5 support, 2 neutral/abstain, 0 oppose, 0 strongly oppose. Region 4 supported this proposal.

Adam Frank | 08/14/2021

My comment is not a reflection of my transplant program and is based on my individual opinion. I have great concern about uterus transplant procedure(s), and in that regard I do have a desire to distance the OPTN from them. The surgical and medical risks associated with uterus transplantation for both the potential mother and for living donors are too high in my opinion in comparison to the benefit. The purpose/benefit of these procedures is to have the recipient experience of pregnancy and childbirth. I understand that there will be some who disagree with me on this, but I am troubled by the number of procedures involved and the risks. In most cases, the uterus is procured from a living donor. (If that donor, develops renal failure later in life will they not be highly advantaged towards getting a deceased donor kidney transplant?) The procured uterus is then transplanted into the mother and an embryo is implanted. This is hopefully followed by the pregnancy and childbirth which are the benefits of this transplant. Following this, the transplanted uterus usually must be removed with another surgery. Of course, during the time the uterus is in place, immunosuppression must given to the recipient with its associated potential problems. Considering the unique risk benefit equation associated with uterus transplantation, I do not think the OPTN should be overly engaged. Uterus transplantation requires a lot infrastructure and expertise and thus engaged institutions likely enjoy having guidance and thus seek help from the OPTN. It is my opinion though that uterus transplantation is different than the majority of OPTN work were prolonging life or making a person whole with the minimum number of surgeries is the more typical goal. In this regard, I feel another body should be charged with its development and promulgation.