Uterus harvesting is the surgical removal of a uterus from either a living or deceased donor so it can be transplanted into a woman who lacks a functioning uterus. The formal medical term is uterus procurement, and it is one step in the broader process of uterine transplantation. The procedure is far more complex than a standard hysterectomy because surgeons must carefully preserve the blood vessels that will keep the organ alive once it is connected to the recipient’s body.
Why a Uterus Would Be Harvested
The sole purpose of uterus procurement is to give a woman with absolute uterine factor infertility the ability to carry a pregnancy. This means she either has no uterus at all or has one that cannot support a pregnancy. The causes fall into two broad categories.
Some women are born without a uterus. The most common congenital cause is MRKH syndrome (Mayer-Rokitansky-Küster-Hauser syndrome), a condition in which the uterus never develops despite otherwise normal female chromosomes and external anatomy. Complete androgen insensitivity syndrome is another, rarer congenital cause.
Other women lose their uterus through surgery. Emergency hysterectomy after severe postpartum bleeding is one example. Hysterectomies for conditions like large fibroids, severe endometriosis, or cancers of the cervix, uterus, or ovaries are others. For all of these women, uterine transplantation represents the only path to carrying their own pregnancy, since surrogacy and adoption are the only other options for parenthood.
Living Donor Procurement
In a living donor procedure, the uterus is removed from a healthy woman, ideally one who is premenopausal and has already had successful pregnancies. The operation resembles a radical hysterectomy in its scope and potential risks, which is significantly more involved than a routine hysterectomy. Surgeons must dissect deep into the pelvis to isolate the uterine arteries and veins while preserving surrounding structures like the ureters, bladder, and rectum. The donor’s ovaries are left in place.
A standardized robotic-assisted approach involves six main steps: cutting and sealing the round ligaments to access the space behind the uterus, isolating the veins that drain the upper uterus, isolating the uterine arteries and lower veins, carefully freeing the organ from the ureters and bladder, cutting around the top of the vagina and severing the blood vessels, and finally extracting the uterus through the vagina. The vaginal opening is then closed.
According to the International Society of Uterus Transplantation’s global registry, about 54% of living donor procedures have been performed through open abdominal surgery, 28% with robotic assistance, and 18% with traditional laparoscopy. Robotic-assisted surgery has increasingly become the preferred minimally invasive approach, with better live birth outcomes (about 65%) compared to traditional laparoscopy (about 8%). The data suggest that conventional laparoscopy is unlikely to remain a suitable technique where robotic surgery is available.
Deceased Donor Procurement
When the donor is someone who has been declared brain dead, the uterus is removed during the same operation in which other organs are collected. Early protocols retrieved the uterus after all life-saving organs (heart, liver, kidneys) had been procured, but newer techniques perform the uterus procurement first, before the blood supply is clamped off. This gives the surgical team more time to carefully dissect the delicate pelvic vessels while the organ is still receiving oxygenated blood.
A key advantage of deceased donation is that surgeons can take wider segments of the surrounding blood vessels, making the later connection to the recipient’s vessels easier. It also eliminates all surgical risk to a living person. The trade-off is less control over timing, since the team must coordinate with procurement of other organs, and the uterus spends more time without blood flow. Research shows human uterine tissue can tolerate cold storage for at least six hours when kept at 4°C in protective preservation solutions.
Who Can Be a Donor
The American Society for Reproductive Medicine outlines specific criteria. Living donors should be medically healthy, have given birth before, and have a favorable obstetric history. They cannot have gynecologic conditions that would compromise the organ’s function: fibroids growing into the uterine cavity, significant adenomyosis, uterine malformations, or endometrial abnormalities. Active HPV infection or cervical precancer disqualifies a donor. Conditions that damage blood vessels, including diabetes, high blood pressure, and significant cholesterol problems, are also exclusionary because the transplant depends entirely on healthy blood flow.
Deceased donors must be of reproductive age and meet standard criteria for brain death or cardiac death. Because the uterus is classified as a vascularized composite allograft (a non-life-saving tissue), U.S. policy requires that consent for uterus donation be obtained separately and explicitly. It cannot simply be assumed from a general organ donation consent.
Risks to the Living Donor
The living donor procedure carries real surgical risk. The uterine blood vessels sit in a narrow, deep area of the pelvis surrounded by a dense network of other vessels and nerves. This makes isolation difficult and can lead to significant blood loss. Because the surgery is performed near the nerves that control bladder function, some donors experience difficulty urinating afterward. Ureteral injuries, including lacerations and blockages from blood clots, have been documented across multiple transplant centers. Other reported complications include bladder dysfunction and bowel problems.
These risks are a central part of the ethical discussion around the procedure. Unlike kidney or liver donation, where the recipient would die without the transplant, uterus transplantation improves quality of life but is not life-saving. This means a healthy donor is exposed to the potential for serious harm so that another person can experience pregnancy rather than survive a fatal condition. Transplant centers are required to approve donors through a thorough evaluation process, and physicians have an obligation to decline a willing donor if the medical risks outweigh the benefits.
What Happens After Procurement
Once removed, the uterus is flushed with cold preservation fluid and kept on ice during transport and preparation. The warm time outside the body (at room temperature during initial handling) averages about 40 minutes, followed by cold storage. The organ is then surgically connected to the recipient’s blood vessels in a separate, lengthy operation.
The transplanted uterus is not permanent. It is designed as a temporary graft. After the recipient has one or two children via cesarean delivery, the uterus is removed so she can stop taking the immunosuppressive drugs needed to prevent rejection.
Success Rates So Far
Data from the United States Uterus Transplant Consortium, covering the first 33 recipients in the U.S., show a one-year graft survival rate of 74%, meaning the transplanted uterus was still functioning in about three out of four women a year after surgery. Among women whose graft survived to the one-year mark, 83% went on to deliver at least one baby. Overall, 58% of all recipients (19 out of 33) delivered a total of 21 live-born children. The procedure has been shown to be safe for the recipient, the living donor, and the child.
These numbers reflect a procedure still in its relatively early stages. Globally, more than 100 uterine transplants have been performed since the first successful case, and outcomes have improved as surgical teams gain experience, particularly with robotic techniques that reduce operating time and complication rates for living donors.