“We’re on our way to Scotland, both my daughters are in the car,” Mr Richard Smith, leader of the UK Uterine Transplantation research team, tells me.
The family are travelling for the Easter bank holiday weekend back to where Smith was born.
“Say hello, girls” he tells his daughters. In the distance, I hear a chorus of hellos.
Smith is a difficult person to track down. He is just back from the US and the road trip North was the only slot he could afford for an interview.
“I have six hours on the road, so you can ask all the questions you like.”
His voice is jolly and despite navigating traffic and roadworks, he is an attentive interviewee.
Smith hopes to be performing the UK’s first womb transplant in the summer. As part of The Huffington Post UK’s ‘All Women Everywhere’ project, we spoke to him about the importance of the surgeries.
One in 5000 women in the UK are born without a womb, a condition known as Mayer Rokitansky Küster Hauser.
However, the consultant gynaecologist says his research could impact the lives of around 50,000 women in the UK.
This includes those who have had their uteruses removed because of cancer, heavy bleeding as well as those with uteruses affected by fibroids – noncancerous growths.
He leads a team at Womb Transplant UK, a charity running the UK’s first womb transplant trial, aiming to surgically implant ten selective women with uteruses.
Smith’s patients will get their transplant organs from cadaveric (brain dead) donors, instead of live donors.
What inspired you start this programme?
I’ve had a long running interest in fertility sparing surgery for women with cancer. Myself, an American and a Hungarian invented a procedure in 1995 to allow young women with cervical cancer to have their cancer removed and still have a baby. What became clear then was that the blood supply to the uterus could be modified in such a way to make uterine transplantation a possibility.
A lot of people would argue that surrogacy is a safer option that offers less risk than having a womb transplant.
For the women who I’ve met, being born without a uterus has been quite catastrophic…
When you get to age 16 and haven’t had a period, you get taken to the doctor, get referred for a scan and you find out you have no womb. That’s a terrible thing.
I’m not saying all women but many, many women have a very strong innate desire to carry a baby. Surrogacy suits many people but it certainly does not suit all people. There are emotional issues with surrogacy, [plus] surrogacy is illegal in many countries – right across the middle East and in many European countries.
I have many patients who have undergone surrogacy and many of them feel great regret that they could not carry the babies themselves.
One of the strongest reasons for women wanting to have a uterine transplantation is to allow them to carry a baby.
So, what’s the process?
The matching [between donor and recipient] is only done through blood groups. If you’re blood groups are compatible you can have the organ.
[First] you’ll [the patient] be on the list on call, waiting for your organ for two years and your phone will go and you will be asked to get yourself to the centre where the implantation is going to take place.
The patient will arrive at the hospital, they will have their abdomen opened and the uterus will be stitched on at the vagina with ligamentous support (the ligaments that support the uterus will all be stitched back together).
There is a big artery on each side and a big vessel on each side. The patient’s abdomen will then be closed. Like any procedure…there is a small risk of infection, there is a small risk of damaging other organs. All of the risks are low….it is anticipated that the patient will be in the hospital for three to five nights and then she’ll go home. She’ll be monitored regularly over the first year for immunosuppression, then she will have her embryo transfers.
Her pregnancy will be closely monitored and the baby will be delivered by caesarean section. Six months after that, she may have a complete hysterectomy or choose to have another child.
How do you know your method will work?
We don’t know 100 per cent. There is no reason to suppose that it won’t. If you look at any other transplant program, be it live transplants or kidney transplants, [there is] very little difference between cadaveric and live donors.
This is where the public gets it wrong, when they refer to cadaveric donors, people think of patients in fridges – it is not like that. The patient’s heart is beating and [they are] brain dead. So, they are an intensive care patient when you retrieve the organ. It is not a corpse that is in the fridge.
If anything, there should be an advantage with cadaveric because you can get a better graft (the portion of tissue being transplanted) because you can do more dissection.
[In a cadaveric donor] you don’t have the fear of getting closer to even larger vessels. With a live donor, there are risks of major surgery, which includes death.
Do you have reservations about the project?
There are three surgical procedures involved and there’s a short time on immunosuppressive therapy, maximum of around 5 years.
Immunosuppressive therapy carries some risk. It slightly increases your risk of cancer and it increases your risk of infection.
One of the criticisms levelled at your research is whether should we be pursuing a procedure that will not actually save any lives?
That is a criticism that was levelled at this project 20 years ago. There are lots of things that are done in medicine that are not lifesaving at all. I mean, IVF is not lifesaving. There are tens of thousands of babies born by IVF, does that mean that we should never have invested in IVF? That is what many people claimed 30 years ago. It was absolutely rubbish.
Without reproduction there would be no human race. If the only thing I did as doctors was saving lives, I think I would be a pretty pathetic doctor. We’re here to care for the whole patient…that is to look after them both physically and both psychology.
What keeps you going?
As the years have gone by, I have had some big reservations with this project, wondering if we were doing the right thing. But some of the women, either because they are orthodox Jews or Muslim, are precluded from surrogacy. When you meet those women, as a doctor and as a surgeon that is what has kept me going. It’s people’s heartfelt desire to have a baby. Deep inside many of us, not all of us, is a great desire to reproduce.
In the case of a woman, it is to carry that baby herself.
What are the chances that this procedure will become available on the NHS?
The answer I have to that is that as far as these first ten cases, we have a charity and we have enough money to pay for two transplants but we need more money to pay for the remaining eight. Where the project goes thereafter is a harder question. We would hope that the NHS would be able to fund these procedures in the future. The NHS at the moment funds lots of major surgery, which is non-lifesaving but which is life enhancing. Will it fund this? I don’t know. But that is going to be the battle years from now. We’re in the process of reaching out to them [the department of health] now.