I’m Dr. Giuliano Testa. I performed the first successful uterus transplant in the U.S. and was named one of TIME’s 100 Most Influential People of 2018. Ask me anything!

Any relation to Chuck Testa?

nope

Hi Dr. Testa. Thanks for doing this. What kind of complications would you expect during a pregnancy where the mother is (presumably) on anti-rejection meds?

same complications like any other organ transplant recipient: hypertension, renal issues, hyperglycemia.

What is the strangest thing you have found in your research?

it is not strange but definitely phenomenal that before uterus transplant i never gave enough thought to the importance of pregnancy and carrying a child.

M3 almost 4 going into either gsurg or obgyn

The importance of this as a life experience you mean? Couldn’t this patient have conceived a child with their own donated eggs and a surrogate? How did you weigh them wanting to carry and deliver themselves vs. surgical and immune therapy risks?

How was a donor found and matched? Surely there isn’t even a uterus category under UNOS?

Do you remove the transplanted uterus after delivery so that anti rejection drugs can be stopped?

yes, life experience, carrying a baby is not the same of letting somebody else doing it. all donors have been altruistic. UNOS category is the one of the VCA: vascular composite allograft. yes the uterus is removed after the delivery, and Immunosuppression is stopped.

As an incoming medical student, I was wondering what inspired you to become a transplant surgeon and what advice you have for students who are just starting medical school?

transplant ( liver) was the coolest and most difficult thing to do when i was in residency. then, at the end of the day it is all about passion and enthusiasm.

How do you feel about the current administrative load on doctors compared to 10-20-30 years ago? I hear I'll be spending 30-40% of my time behind a computer, not interacting with patients and that sounds pretty shitty.

Older doctors always tell me it's "not as great as it used to be". Administrative burden, mindless bureaucracy, lots of regulations, terrible electronic patient files/software. These are some of the things they name that they didn't have to deal with so much "back in the day".

What are your views on that?

i think it depends on what kind of doctor you want to be. i use technology but i do talk and still visit every one of my patients, and i still have a lot of time to interact.

This might be a strange question that you might have addressed elsewhere but Why do this procedure? How is it beneficial compared with alternatives such as surrogates and even adoption, and accounting for the fact that these patients are, I am assuming, on life long immunosuppression?

the women are not on lifelong immunosuppression, it is temporary, as long as the uterus is in. adoption: no same genetical material as the parents. Surrogacy: not the same as carrying your own child.

So the intent is to remove the uterus at a later date?

sure, either after the first or the second pregnancy. there trial speaks for only 2 pregnacies. .

how long did actual surgery take? and how long was the process from determining this patient could have a uterus transplant? thank you!

surgery lasts about 5 hours, the evaluation process takes about 1-2 days after initial selection

If you were to imagine the future, in 10 years time what innovations or breakthroughs have occurred and how will this affect medicine/humankind?

i think artificial organs, i.e. stem cell derived with scaffolding, cells growing within a frame, will be almost there

Hi Dr. Testa, what were you most nervous about while performing the transplant? Who gave you the encouragement along the way? Thanks!

most nervous about not been able to deliver the promise to the future mother. my family gave me the strength

Where do you think medicine is heading towards? What should MedStudents focus the most on?

Tips for a 2nd year MedStudent?

medicine is definitely going toward a lot od artificial intelligence. some old ways of doing medicine will be soon gone, think about radiology: difficult to compete with a computer system that can analyze 1 billion images at once. same for diagnostics. but nothing will ever replace human touch, passion and empathy

Thanks for the reply, I appreciate it.

Would you mind giving me some professional tips on how to be successful in our field?

What are the main things that make a difference between a great Dr and being among the best?

my field is a little different than others, you are on call 24/7 for many years and you need to be a technically very skilled surgeon. if you have endurance and passion and you do not have 2 left hands as the french say, you have a start.

Hahaha, well I'm a lefty so... I hope I don't have two right hands. Thank you Doc.

you will be fine then

Do you think medical students should study bioethics more as scientific capabilities expand? How can they prepare for the ethical decisions that will come with all the new medical technology that's being developed?

i think you have a good point, yes the more we innovate the more ethics we need

Hello sir! Congratulations on the successful procedure! My question is, how did you narrow down a donor? What went into preop preparations while selecting a donor? How did you counsel the patient? This was the 1st time, the patient must have been wary and must've had a ton of questions.

the donor part was amazingly fascinating, we got hundreds of women wanting to donate, altruistic donors i mean. these women must be healthy and then of course undergo specific testing to see if the uterus can be transplanted. there is a system already in place for living donors of kidney and liver, we piggyback into it and modified accordingly.

what's something you wish the public knew about transplants or your journey with these families?

for the specific of uterus transplant, the most amazing thing is the courage these women have and the willingness to undergo so much hardship to have a child. but this is true for any patient who was the first to receive a liver or a kidney or a heart: lot of courage and an incredible desire to live.

where do you see the future of this procedure heading? in cases where someone didn't initially have a uterus (eg Mayer-Rokitansky-Küster-Hauser (MRKH) or other scenarios), what do you think would be the likelihood of it being successful?

i think this procedure has about the same chances of success of any other solid organ transplant, around 90%

Do you think this procedure will ever be adapted to work on transgender women? If so, what difficulties do you foresee in this new procedure?

it might, but too complicated for me. ethical questions about transferring genetic material arise as well.

If a trans man and a trans woman were a couple and used their own genetic material to remove the ethical question, what are the potential complications in having a trans woman carry her own child?

main technical issue is to create an outlet for the menses, like a reconstructed vagina, but then the recipient will be exposed to increased risk of infection, since the reconstructed vagina is most often skin based. then hormonal issues related on how to start and maintain pregnancy.

What are some things that interest you about the future of organ transplants/donation? For example, using pig organs or 3D printing?

the latter i think is the way we will be going. modifying animal organ, used the connective tissue as a frame and repopulating with stem, human, cells.

Do you ever think there will be a point where, socially or technically, it will be possible to perform a uterus transplant into the body of a man?

it may happen, but it will entitle a lot of ethical discussion, because it will need transfer of genetical material, since the men have no ovaries and a lot of hormonal manipulation. too difficult of me, at least.

How can Med Schools better prepare future doctors?

i think med schools are doing a decent job, but i also thing that we do not do enough to attract the best minds to medicine. overall it is more the passion and enthusiasm that you have than the med school where you go that makes a difference.

Hi Dr. Testa! What was it like getting to know the patient? Have you kept in touch?

most rewarding thing, is a matter of fact that the most emotional aspect of all this story is what the mother wrote for the nomination. yes i do keep in touch with them all

What financial hurdles have you had to overcome while researching this?

money is the big thing, and unfortunately there is nom insurance coverage for Uterus Transplant and for this matter not even for any infertility problems. i hope that Uterus transplant will sparkle some discussion about coverage for infertility in the US.

Congratulations on your success. The world's first head transplant has been proposed. Do you think this is surgically achievable, or just science fiction?

there should be a limit to what we can transplant, do not you think so? i believe it is absolutely not smart to even think about transferring another person mind. ( let aside the brain)

What is your opinion on the "big business" aspect of healthcare? How do you see the control of healthcare corporations impacting patient and doctor experiences?

great questions. i think it the patients and the public in general that need to take control of health. it all depends whether we think health is a right or not.

What's the indication for uterus transplant? Mullerian agenesis or even possibly past hysterectomy?

as long as there are ovaries and they are functioning, any conditions where the uterus is missing could and can be an indication.

Knowing what you know now about medicine and being a physician, would you do it all over again? Do you encourage your kids to pursue medicine (if you have any)? Lastly, what advice do you have for current medical students to succeed?

i would go back and study any single page i studied 30 years ago and possibly more. it has been a fascinating ride and yes i would suggest it to anyone who wants to have a never boring life. for young students: go on and make a difference one patient at time

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my be not 50 but in the next 20 : how we make medicine affordable when every single innovation cost so much more than what was available before. whoever will come up with this will be in that list

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i think that cardiac surgeons and thoracic surgeons will always have a place. sure for some procedures they will have to compete with cardiologists similar to what happens between colorectal surgeons and GI docs for colonoscopies.

May I ask you as a surgeon in a cutting edge transplants field what your thoughts are on Paolo Macchiarini and his work? Is he an evil cowboy surgeon or an unlucky victim of a field with too much red tape?

i do not know much about that story, but the point is that there has been no replication of his work to date, ergo either it was too soon to tray it on humans or it was the wrong way of doing it.

What are few interesting cases that you experienced in your career?

i would say all of them, this is what is great bout medicine, we work following the big numbers of medical statistics and then each patient is unique

Given the advancements in AI technology what do you see their role as in medicine? Do you think AI could ever replace a physician or a surgeon? Could one have performed this surgery or designed it?

yes i do believe that certain things in medicine will be replaced, radiology reading for example oe even some small procedure could be performed by robots, but at the end of the day nothing will replace human touch, empathy etc

Hello Dr. Testa! I have great respect to your work. I truly know that it's not an easy feat do achieve and how much work and effort you put into reaching that level of excellence to be able to come up with a new procedure of your own. Here's my question: Do you think AI has a future in surgery in general and robotic surgery in specific?

sure it will specifically for surgeries that have to do with "fixed" organs like the liver or the brain. you can map them , perfectly localized the lesion to be removed and let the robot do the rest.

Will the uterus function the same as it did in the body of the woman it belonged to? Like will the menstrual cycle, menstrual pain etc be the same?

sure thing, 4 weeks after transplant the woman will have menses. followed by regular cycle.

but will the cycle be very similar as it was in the other womans body or can it also differ. for example, more/less blood loss, shorter/longer cycle, more/less menstrual pain?

cycles have been very normal in all our recipients.

Dr. Testa as a medical student starting clinical in a few months what should I do to be successful like you? how can I improve my clinical skills even If I have a bad mentor?

if you have passion and enthusiasm and you work hard no bad mentor will ever stop you. and you can always change to a better mentor, somebody you can look up to.

Do you like Scrubs and if you do was Turk any inspiration in becoming a surgeon?

i do not watch TV and i have never seen it. my inspiration comes from my family.