UPDATE 3/9/16 4:01 EST: Due to a serious complication, the trasnplant recipient underwent surgery to remove the donor uterus.

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After nine hours of surgery, surgeons at the Cleveland Clinic successfully completed the first uterus transplant in the U.S. on Februray 24.

The first ever uterine transplant took place in Saudi Arabia in 2000, but eventually failed due to blood clotting. Prior to the Cleveland Clinic’s surgery on February 24, Sweden was the only country that performed uterine transplants successfully, starting in 2012, with the first child born to a transplant recipient in October 2014.

According to the New York Times, all procedures were done at the University of Gothenburg under Dr. Mats Brannstrom. Of the nine women who underwent the transplant process in Sweden, five have given birth to healthy, albeit premature, babies. Two of the transplants failed and had to be removed.

The recipient at the Cleveland Clinic – a 26-year-old woman born without a uterus – has three adopted children, but said she is looking forward to the possibility of pregnancy. However, that could still be two years away at the earliest. She will have to wait a year to heal, and another year will be dedicated to undergoing in vitro fertilization (IVF).

The donor was a healthy woman in her 30s with several children. She died suddenly, but a cause was not given. The program currently uses only deceased donors, but living donors may become a possibility in the future, says the Times.

Dr. Andreas G. Tzakis, the director of solid organ transplantation at the Cleveland Clinic, said the recipient is doing well, but remains under close watch to ensure her body doesn’t reject the new uterus.

The Cleveland Clinic’s ethic panel was granted permission to perform 10 uterine transplants for women between 21 and 39 as part of an experiment, says the New York Times. Once the series of 10 surgeries has concluded, a decision will be made regarding further transplants. Baylor University Medical Center in Dallas and Brigham and Women’s Hospital in Boston have also introduced similar programs.

Uterine transplants, while innovative, pose an interesting, and potentially ethical, conundrum. Women in need of a uterus are generally healthy patients, unlike other transplant recipients, such as those suffering from heart or liver failure.

The surgery isn’t life-saving, but could be fatal. Fetal exposure to anti-rejection drugs and gestation within a womb taken from a donor raise potential dangers, not to mention the routine surgical hazards associated with any major procedure. Furthermore, the transplant itself isn’t the only surgery for which recipients must brace themselves. Recipients receive immune-suppressive therapy, and once pregnancy is no longer an option for the transplant recipient (after about five years or one to two children, according to Cleveland Clinic doctors), a hysterectomy must be performed so patients can stop the therapy medication.

That said, transplants are increasingly viewed as a quality of life matter, along the lines of facial transplants, and soon, maybe even penis transplants. The Times says Johns Hopkins is currently looking into the latter.

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