Think of all the human organs that can be transplanted today: hearts, kidneys, lungs, livers, corneas, pancreases. The list is long and growing, but until a few days ago there was one important piece missing. The bladder, with its complex network of vessels, nerves, and specialized tissues, had remained uncharted territory in transplant medicine. Until now. On May 4, 2025, at Ronald Reagan UCLA Medical Center, A surgical team has successfully completed the first human bladder transplant in history.
A medical milestone that opens new hopes for millions of people suffering from serious bladder diseases, until now forced to live with artificial urinary diversions or neobladders constructed with portions of intestine.
A historic moment in transplant medicine
We are facing one of those rare events that redefines what we consider possible in the medical field. As surprising as it may seem, the bladder has remained one of the last large human organs to escape the possibilities of transplant medicine.
Not for lack of trying, mind you. Its complex structure, with a dense network of nerves, blood vessels, and highly specialized muscle tissue, has posed a seemingly insurmountable challenge for decades. Although heart, kidney, and other organ transplants are routinely performed, the bladder has remained an unexplored frontier, forcing patients with serious problems to resort to often imperfect alternatives.
The news coming from the University of California at Los Angeles therefore marks a real turning point in the history of medicine.
The Pioneer Patient: A Long Wait Finally Rewarded
Oscar Larrainzar, a 41-year-old man, is the involuntary protagonist of this medical revolution. His medical history is particularly significant: after having lost much of his bladder function following oncological treatments for a rare form of bladder cancer, in the following years he also developed tumors in his kidneys, which were completely removed.
For seven long years, Mr. Larrainzar was dependent on dialysis, with a severely compromised quality of life. His condition made him the ideal candidate for this pioneering procedure: a patient already undergoing immunosuppressive therapy who needed both a kidney and a functioning bladder.
During the surgery, which lasted about eight hours, doctors transplanted not only the bladder but also a kidney, thus almost completely restoring the functionality of the urinary system. A doubly complex operation that represents an exceptional example of surgical ingenuity.
Bladder transplant, a procedure that is the result of years of research
Behind this extraordinary success there is a preparatory work that lasted more than four years. The surgical team led by Dr. Inderbir Gill, chairman of the Department of Urology at the University of Southern California, and Dr. Nima Nassiri of the University of California at Los Angeles, developed the technique through numerous tests and simulations.
“This surgery is a historic moment in medicine and will have a significant impact on the management of select patients with highly symptomatic, non-functioning ‘terminal’ bladders,” Dr. Gill said in a press release.
Before moving on to human surgery, the team performed numerous preparatory procedures at Keck Medical Center of USC, including the first robotic bladder harvests and successful robotic transplants in five recently deceased donors with cardiac function maintained by ventilator support.
The collaboration between two leading California medical institutions has played a key role in this success: USC Urology is at the forefront of robotic urologic oncology surgery, while UCLA Urology has long been at the forefront of urologic transplant research.
Why is this bladder transplant so important?
The answer lies in the very nature of the organ.
The bladder is not simply a “container” for urine. It is a complex muscular structure that must contract and relax in response to nerve signals, while maintaining a waterproof lining that prevents toxins in the urine from entering the bloodstream. In addition, its location in the body and connections to the ureters and urethra make the procedure technically extremely difficult.
Before this pioneering procedure, patients who lost bladder function due to cancer, trauma, or other conditions had few options, none of them optimal. The most common was to create a “neobladder” using a section of the patient’s own intestine—a procedure that, while ingenious, comes with numerous short- and long-term problems.
“While these operations can be effective, they carry many short- and long-term risks that compromise the patient's health, such as recurrent infections, impaired kidney function and digestive problems,” explained the Dr. Gill.
Encouraging results and future challenges
Two weeks after the surgery, the preliminary results are extremely encouraging. According to the doctors who are treating him, Oscar Larrainzar is showing signs of a good recovery.
“The kidney immediately produced a large volume of urine, and the patient’s kidney function improved immediately,” Dr. Nassiri said. “There was no need for dialysis after the procedure, and urine drained properly into the new bladder.”
Of course, as with any transplant, the risk of rejection remains a significant concern. For this reason, doctors believe that the ideal candidates for future bladder transplants will be people who have already undergone immunosuppressive therapy for other transplants or who require combined kidney and bladder transplants.
Long-term monitoring will be necessary to fully assess the success of the surgery and to ensure that the new bladder maintains its function over time. Experts are cautiously optimistic, but they stress that there are still many unanswered questions about the longevity of the transplanted organ and the level of immunosuppression needed to prevent rejection.
Bladder Transplantation: Implications for the Future of Medicine
The implications of this success go far beyond the single clinical case. It is estimated that millions of people worldwide suffer from some form of bladder dysfunction, with hundreds of thousands of severe cases potentially benefiting from this procedure once it is perfected and made more accessible.
Bladder transplantation could revolutionize the treatment of conditions such as advanced bladder cancer, severe interstitial cystitis, neurological bladder dysfunction, and irreversible damage caused by radiation or chemotherapy drugs.
What strikes me particularly is how this development fits into the broader context of regenerative medicine, a rapidly evolving field that seeks to replace or regenerate damaged human tissues and organs. While transplantation is a traditional approach, parallel research into bioengineered bladders created using a patient’s own stem cells may one day eliminate the need for donors and immunosuppressive therapies.
Potential candidates and ethical considerations
Who might benefit from this revolutionary procedure? According to the doctors who performed the surgery, ideal candidates would be patients with severely compromised or “terminal” bladders who already require immunosuppressive therapy for other reasons.
Patients with bladder cancer that required organ removal, those with bladder damage caused by radiation, and people with severe birth defects could all be potential candidates for future transplants.
As always with pioneering medical procedures, complex ethical issues arise. The limited availability of donor organs, patient selection criteria, and allocation of medical resources are all considerations that will need to be addressed as this procedure becomes more widespread.
The history of transplant medicine continues
The first human bladder transplant marks another important milestone in the extraordinary history of transplant medicine. Since Joseph Murray performed the first successful kidney transplant between identical twins in 1954, when Christian Barnard He amazed the world with the first heart transplant in 1967, each new milestone has pushed the boundaries of what we consider possible.
Each new type of transplant has followed a similar path: first considered impossible, then experimental, and finally becoming (in many cases) a standard procedure that saves countless lives. Bladder transplantation is now taking its first steps along this path.
Il Dr. Mark Litwin, chairman of the UCLA Department of Urology, emphasized the importance of this moment: “Bladder transplantation has been Dr. Nassiri’s primary academic interest since we recruited him to the UCLA faculty several years ago. It is incredibly gratifying to see him take this work from the lab to human patients at UCLA, which operates the busiest and most successful solid organ transplant program in the Western United States.”
Italy in transplant medicine
It is worth remembering that Italy also has a long tradition of excellence in the field of transplant surgery and advanced urology. Facilities such as theRegina Elena National Cancer Institute of Rome were pioneers in the introduction of robotic techniques for cystectomy and bladder reconstruction.
In 2016, for example, an Italian-American collaboration between urologists at Regina Elena and the University of Southern California had already led to the development of innovative procedures for the removal of the bladder with a totally intracorporeal continent skin diversion, eliminating the need for external bags for urine collection.
More recently, the San Donato Hospital in Arezzo has developed advanced techniques for the Robotic bladder reconstruction which have achieved international recognition. In 2024, researchers from Arezzo have even developed a mathematical formula to precisely calculate the amount of intestine needed to reconstruct a functional bladder.
These advances demonstrate how Italian medicine is at the forefront of advanced surgical techniques, laying solid foundations for the eventual adoption of bladder transplant procedures in our country once they are standardized.
A new chapter in medicine
The success of this first human bladder transplant opens an exciting new chapter in the history of medicine. It represents not only a triumph of surgical technique, but also the culmination of years of basic research into bladder structure and function, organ preservation techniques, and immunosuppressive protocols.
Gill and Nassiri hope to perform more bladder transplants together in the near future, potentially helping countless patients with severely compromised bladders live healthier lives. The ongoing clinical trial at UCLA will continue to monitor long-term outcomes and refine the procedure.
Medicine advances in this way, one step at a time, pushing ever further in the exploration of the possible. What yesterday seemed like science fiction is now clinical reality, and what today is a pioneering intervention could become routine tomorrow. The first human bladder transplant reminds us that, in medicine as in every field of human ingenuity, the boundaries of the impossible are made to be surpassed.
