Establishing a Uterus Transplantation Program: Institutional and Clinical Framework for Implementation.

Uterus transplantation (UTx) is an emerging treatment for absolute uterine factor infertility, enabling gestation in individuals without a functional uterus. Since the first live birth in 2014, more than 150 procedures and over 80 live births have been reported worldwide. Unlike conventional solid organ transplantation, UTx is a temporary intervention aimed at restoring reproductive capacity, requiring integration across transplant surgery, reproductive endocrinology, and maternal-fetal medicine. Despite rapid clinical progress, structured guidance for program development remains limited. UTx requires coordinated institutional infrastructure, multidisciplinary team integration, donor and recipient pathways, reproductive medicine systems, perioperative and immunosuppressive protocols, pregnancy management frameworks, and long-term research infrastructure. This invited review provides a standardized framework for establishing a UTx program in the United States, with emphasis on institutional readiness, clinical pathways, ethical considerations, and sustainability.