A team of surgeons in the USA has successfully performed the first full penis and scrotum transplant on a wounded veteran.
The anonymous recipient sustained life-changing injuries while serving in Afghanistan when an improvised explosive device, or IED, caused multiple wounds to his lower pelvis and legs. Eleven surgeons carried out the 14-hour surgery to transplant the entire penis, scrotum and surrounding abdominal wall from a deceased donor. It is the first surgery to transplant such a large and complete part of the genital area.
However, the donor's testes and vas deferens – the tube that carries the semen to the urethra – were not transplanted due to ethical concerns.
'We would not want to transplant the germline from the donor, because that would mean that, were the recipient to father a child, that actually the genetic background of the child would be from the donor and not from the recipient,' said Dr Gerald Brandacher, scientific director of the Composite Tissue Allotransplantation Programme at Johns Hopkins Medicine in Baltimore, Maryland, and a surgeon on the case. The recipient will eventually receive a testes prothesis.
The operation is hoped to restore urinary and sexual function for the man, said Dr W.P. Andrew Lee, director of plastic and reconstructive surgery at Johns Hopkins.
'While extremity amputations are visible and resultant disability obvious, some war injuries are hidden and their impact not widely appreciated by others,' said Dr Lee. 'Genitourinary injury, where the male service members' external genitalia are lost or severely damaged, is one such "unspoken injury of war", [which has] a devastating impact on their identity, self-esteem and intimate relationships.'
The soldier released a statement following the surgery. 'It's a real mind-boggling injury to suffer; it is not an easy one to accept,' he said. 'When I first woke up, I felt finally more normal… [with] a level of confidence as well. Confidence… like finally I'm OK now.'
Male genital reconstruction procedures are usually performed using tissues from other parts of the body, with a prosthesis implant to enable erection. However, this comes with a higher risk of infection. In addition, with injured veterans there is often insufficient suitable, healthy tissue elsewhere in the body to use for the reconstruction.
By performing a full genital transplant, all components can be transplanted including nerves, tendons, bone and blood vessels, allowing almost normal function of the genitalia to be restored. As with other types of transplant, tissue rejection is one risk associated with the procedure, which can be limited by using immunosuppressant drugs.
The surgery was funded by The Johns Hopkins Genital Transplant Programme, which focuses on post-traumatic cases, particularly injured soldiers who often have wounds that make conventional options impossible. The transplant team has announced that the university has approved 60 genital transplant surgeries as a part of the programme.