Investigational · Specialist centres only
Larynx-trachea transplant — an investigational option, honestly explained.
A composite allotransplant of donor larynx and trachea for a very small group of patients with irreparable laryngeal loss. Fewer than thirty cases worldwide, not routinely commissioned in the UK, and never the first conversation.
Why patients trust us with this conversation
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Investigational, and we say so
Fewer than thirty larynx-trachea transplants have ever been performed worldwide. We frame this as experimental — not a routine option — before anything else.
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MDT-first, before referral
No introduction is made until a transplant, ENT, plastic-surgery, SLT, immunology and psychology team have looked at your case together.
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Independent, and free
We are paid by no clinic or research centre, so the recommendation — including “not you, not now” — is impartial and costs you nothing.
Pathway & costs
There is no “price list” for a larynx transplant.
What we can show is the pathway — from a free honest read of your situation, through MDT review, to formal assessment on a research protocol if it is appropriate.
In short
Not commissioned in the UK. Access is via research protocol or exceptional overseas referral.
| Step | Cost basis | Time | Output |
|---|---|---|---|
| Initial pathway review (Pulse Atlas) | Free | 1 working day | Written response |
| Specialist MDT case review | Case-by-case | 2–6 weeks | Report to you and referrer |
| Formal transplant assessment (imaging, tissue typing, psychology) | Research protocol or self-funded | Several visits | Weeks to months |
| Larynx-trachea composite allotransplant | Not routinely commissioned in the UK | 12–24 hour operation | Months of inpatient care |
| Alternative: laryngotracheal reconstruction | See dedicated page | Half-day operation | Weeks |
| Alternative: laryngectomy with voice prosthesis (TEP) | See dedicated page | Half-day operation | Weeks |
NHS Blood and Transplant does not currently commission larynx-trachea composite allotransplantation. Where transplant is discussed at all, it is on a research protocol at a specialist centre — usually overseas — and the exact commercial and consent framework varies case by case.
The problem
The right conversation, in the right order.
Patients who have lost their larynx often hear about “transplant” before they hear about laryngotracheal reconstruction, a voice prosthesis, or a well-fitted speaking valve. We reorder the conversation.
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Living with a permanent tracheostomy?
A voice prosthesis (TEP with Provox), laryngotracheal reconstruction or cricotracheal resection may restore voice or airway without immunosuppression. Those come first.
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Told transplant might be an option?
It might. But it means a lifelong medication regimen with real risks, and specialist-centre-only care. We tell you what that actually looks like.
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Long-term disease-free after cancer?
If you are five or more years clear after a laryngectomy for cancer, oncological safety can be discussed. The MDT decides, not a website.
The journey
From enquiry to lifelong follow-up — what happens, in order.
One team from first message to MDT — and, if you are a realistic candidate, into formal assessment.
Phase 1 · Before
Triage, MDT, honest read
Phase 2 · Assessment & operation
Specialist centre, months of care
Phase 3 · After
Lifelong follow-up
- 01
Before
You tell us your story
A confidential form. What happened to your larynx, how long ago, current voice and airway, and what you are hoping for.
- 02
Before
We come back honestly
Within one working day: whether this is even a realistic conversation, and what conventional options (voice prosthesis, laryngotracheal reconstruction, permanent tracheostomy) should be explored first.
- 03
Before
MDT case review
If appropriate, your imaging, oncological history and psychosocial assessment are put in front of a specialist team — transplant surgery, ENT, plastic surgery, SLT, immunology, psychology and ethics.
- 04
Assessment & op
Assessment at a specialist centre
CT angiography of neck vessels, tracheal length imaging, HLA and PRA tissue typing, infection screen, and formal counselling on lifelong immunosuppression.
- 05
Assessment & op
The operation itself
A 12–24 hour composite tissue allotransplant — donor larynx and trachea, vessel and nerve anastomoses, careful airway alignment. Reconstructive plastic and microvascular teams work alongside transplant surgery.
- 06
Assessment & op
ITU and the first weeks
Intensive care for weeks, hospital stay in months. A protective tracheostomy is typically kept until the airway is secure.
- 07
After
Rehabilitation and lifelong follow-up
Voice retraining with SLT, swallow therapy, physiotherapy, and lifelong immunosuppression clinics. Rejection episodes are treated with pulse steroids and, if needed, escalation.
Typical timeline to MDT decision: weeks. To operation, where appropriate: many months. Follow-up is lifelong.
Who it is for
The very small group this conversation is even about.
The situations that lead to a serious transplant conversation, plus the red flag that means it is not the right conversation at all.
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Caustic ingestion injury
End-stage laryngeal scarring after accidental or deliberate caustic ingestion, where reconstruction has failed or is not feasible.
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Severe post-radiation necrosis
Radionecrosis of the larynx in a disease-free head-and-neck cancer patient who is currently living with a permanent tracheostomy and no voice.
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Extensive laryngeal trauma
Blunt or penetrating neck trauma, or high-energy strangulation injury, leaving the larynx irreparably destroyed.
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Failed reconstruction
Multiple failed attempts at laryngotracheal reconstruction or cricotracheal resection, with no further conventional options.
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Long-term disease-free post-laryngectomy
A motivated patient, five or more years disease-free after laryngectomy for cancer, whose oncological risk is judged acceptable by the MDT.
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Motivated, informed, realistic
Someone who has understood the experimental nature, the lifelong immunosuppression, and the real possibility of graft loss — and still wants to be considered.
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Investigational pathway only
Any assessment or transplant is via a research protocol or exceptional overseas referral. Not a routine NHS or private service.
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Red flag: active cancer
An active or recent malignancy is an absolute contraindication — immunosuppression is unsafe. This is not the right conversation yet.
Options to consider
Transplant is one option — and rarely the first.
What each option actually involves — and which situations each one fits.
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Larynx-trachea transplant
The investigational option itself — donor larynx and trachea transplanted as a composite allotransplant with vessels, nerves and airway rejoined. Fewer than thirty cases worldwide.
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Laryngotracheal reconstruction
Using your own tissue (rib cartilage grafts) to widen a stenosed airway. Established, no immunosuppression — worth exhausting first where feasible.
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Cricotracheal resection
Removing the diseased segment and rejoining healthy airway. Suitable for shorter, defined stenoses.
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Laryngectomy with voice prosthesis
Removing the larynx and restoring speech with a tracheoesophageal puncture and Provox valve. The standard salvage for irreparable larynx.
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Permanent tracheostomy and speaking valve
Where the airway can be secured but the voice cannot be restored surgically. A stable, low-risk endpoint.
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Voice therapy and electrolarynx
Non-surgical voice options for patients who cannot or do not want further surgery.
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Research protocol enrolment
The only current pathway to transplant assessment — enrolment in a specialist centre’s research programme, usually overseas.
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Consultation only
An honest discussion of whether transplant is a realistic conversation for you, and what to do next if it is not.
Our vetted specialist network
A small panel of head-and-neck teams, we picked them.
Consultant ENT and head-and-neck surgeons in London, with established transplant, plastic-surgery and immunology links for the rare cases that reach a transplant conversation. Introductions are made privately.
Selection criteria
How we choose every specialist we introduce.
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Consultant ENT and head-and-neck surgeons, not trainees or general clinicians
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Formal multidisciplinary team review before any transplant conversation
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Established transplant, immunology and plastic-surgery links for composite tissue cases
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Honest counselling on the investigational nature, and on conventional alternatives first
Risks & realities
What you need to have understood before saying yes.
A larynx-trachea transplant is not routine day-case surgery. It is a lifelong commitment with serious risks, an uncertain functional outcome and — at global level — very limited experience. Read this carefully.
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This is investigational
Larynx-trachea transplant is not a routine or commissioned procedure in the UK. Global experience is fewer than thirty cases. Anyone offering it as routine is not being straight with you.
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Lifelong immunosuppression
Tacrolimus, mycophenolate mofetil and prednisolone — for life. That carries risk of opportunistic infection, PTLD, secondary cancers, kidney damage, cardiovascular disease and diabetes.
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Rejection is expected
Acute rejection episodes are the rule, not the exception. Most are treated with pulse steroids; some need escalation. Chronic rejection can cause airway stenosis or graft loss.
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Voice is the goal — not guaranteed
The best-published case has functional voice more than twenty-five years on. Other cases have had mixed outcomes. Voice retraining with a speech and language therapist is central.
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Protective tracheostomy
A tracheostomy is typically kept in place for the first months until the airway is proven secure. Plan for it — it is not a complication.
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Complications are real and serious
Vascular thrombosis and graft loss, airway breakdown, CMV, PJP, EBV-driven PTLD, wound problems, aspiration, dysphonia and chronic pain are all on the list.
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You must be able to comply
Missing immunosuppression doses is graft loss. Anyone with cognitive, psychosocial or logistical barriers to lifelong complex care will not be a safe candidate.
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Prior neck surgery and radiation matter
Extensive prior surgery or radiotherapy to the neck can make vessel and nerve anastomoses unsafe or impossible. This is decided on imaging, not on hope.
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Red flags
Active malignancy, uncontrolled infection, inability to tolerate immunosuppression, or an unstable psychosocial situation are contraindications, not obstacles to work around.
Reading the MDT report
The MDT letter in four parts. Read the last one first.
Whatever the recommendation, the letter from the multidisciplinary team keeps to the same shape.
A quiet reminder
MDT language is careful and can read coldly — we translate it for you.
If you would like us to talk you through the letter before your review, just ask.
- 01 Header
Indication and history
Why transplant is even being discussed — caustic injury, post-radiation necrosis, trauma, or long-term disease-free post-laryngectomy — and the full oncological history.
- 02 Assessment
Imaging, tissue typing and immunology
CT angiography of neck vessels, tracheal length, HLA and PRA screen, virology, and the results of psychology and ethics review.
- 03 Findings
MDT recommendation
The team’s consensus — whether you are a candidate for research-protocol assessment, whether an alternative pathway is safer, or whether you should not proceed.
- 04 Impression
Next steps and expectations
Read this first: what happens next, timelines, and — honestly — what the realistic range of outcomes looks like for someone in your situation.
Recognised by major UK insurers
UK insurers do not routinely fund larynx-trachea transplantation. They can fund conventional alternatives (laryngotracheal reconstruction, laryngectomy with voice prosthesis) where medically indicated. We confirm cover before booking.
Frequently asked
Everything we get asked about larynx-trachea transplant.
Straight answers on availability, candidacy, alternatives and what Pulse Atlas actually does for you here.
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Is a larynx-trachea transplant available in the UK?
Not routinely. NHS Blood and Transplant does not currently commission larynx-trachea composite allotransplants. Access is through a research protocol, and in practice usually via exceptional individual referral overseas.
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How many of these operations have been done?
Fewer than thirty worldwide since the first case (Timothy Heidler, Cleveland Clinic, 1998). The Cleveland patient still had a functional voice more than twenty-five years later. Other cases have had mixed outcomes, including rejection episodes and graft loss.
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Who is a realistic candidate?
Highly selected patients only: benign end-stage laryngeal disease unsuitable for reconstruction (caustic ingestion, severe post-radiation necrosis, extensive trauma), or disease-free five or more years after laryngectomy for cancer with acceptable oncological risk. Motivated, informed, and able to tolerate lifelong immunosuppression.
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Who is not a candidate?
Anyone with active malignancy, anyone unable to tolerate immunosuppression, anyone with cognitive or psychosocial barriers to complex lifelong care, and often anyone whose neck has had so much prior surgery or radiotherapy that the vessels and nerves cannot be safely rejoined.
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What would the operation involve?
A composite tissue allotransplant lasting twelve to twenty-four hours, with rejoining of the recurrent and superior laryngeal nerves, the superior thyroid arteries and veins, and careful mucosal alignment of the airway. It needs combined transplant, plastic and microvascular surgical teams in a specialist centre.
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What are the alternatives worth exhausting first?
Voice prosthesis (TEP with a Provox valve) after laryngectomy, laryngotracheal reconstruction using your own cartilage, cricotracheal resection, and a permanent tracheostomy with a speaking valve. All of these avoid lifelong immunosuppression.
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What does Pulse Atlas actually do here?
We give you an honest, independent read on whether this is even a realistic conversation for your situation, arrange the specialist MDT review, and — if it is not the right path — introduce you to the right conventional pathway (see our pages on laryngectomy, laryngotracheal reconstruction and head-and-neck surgery).
Related treatments
Looking for something else?
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Laryngectomy
Removing the larynx and restoring voice with a prosthesis (TEP with Provox).
Learn more -
Laryngotracheal reconstruction
Widening a stenosed airway using your own cartilage — no immunosuppression.
Learn more -
Head and neck surgery
The broader surgical service for the larynx, pharynx, thyroid and neck.
Learn more -
All tests
Every test and procedure we arrange.
Learn more