Uterus Transplant Living Donor Evaluation and Selection: An Approach to Optimizing Donor and Recipient Outcomes

BACKGROUND: Since the first live birth from uterus transplantation (UTx) in 2014, there has been an ever-growing interest in the technique from patients and transplant programs worldwide. The Dallas UTx program first reported a live birth in the United States in 2017 and has subsequently completed 40 transplants with a living-donor-predominant approach. To date, the published scientific literature has focused on recipient and newborn outcomes, with relatively limited discussion surrounding living donor evaluation. METHODS: The aim of this study was to describe the methodology, evolution, and outcomes from living donor evaluation at the Dallas UTx program. RESULTS: Over a 9-y period, 1329 women volunteered for living donation evaluation. A total of 72 women proceeded to full evaluation, with 38 deemed eligible (37 nondirected donation, 97%). Six women withdrew following evaluation, and 28 were deemed ineligible. Thirteen were declined for vasculature concerns (the main reason for exclusion), and 8 because of other abnormalities found on imaging. Two potential candidates were deemed ineligible because of medical comorbidities, and a further 3 on psychological evaluation. An additional 2 candidates were ineligible following committee review. Twenty-seven (68%) recipients have delivered a child, 4 have delivered 2 children, and 6 are currently pregnant. CONCLUSIONS: Successful living donor UTx requires thorough donor evaluation. Favorable donor, recipient, and newborn outcomes were observed within the context of this comprehensive donor evaluation and selection process.