An Afghanistan war veteran receives a new penis and a scrotum without testicles and a partial abdominal wall from a deceased donor at the John Hopkins in Baltimore.
The soldier was wounded by an improvised explosive device while serving in Afghanistan. The patient’s name was not released to maintain his privacy, but he has already been discharged from the hospital. "When I first woke up [after the intervention], I felt finally more normal... [and with] a level of confidence as well. Confidence... like finally I'm okay now," he explains.
The transplant team included nine plastic surgeons and two urological surgeons, and it took them 14 hours to perform the complicated procedure. “We are optimistic he will regain near-normal urinary and sexual functions,” said W. P. Andrew Lee, director of plastic and reconstructive surgery at the Johns Hopkins University School of Medicine.
Lee described the loss of genitals as an “unspoken injury of war,” with devastating consequences for intimacy and happiness.
Urinary functions will be restored immediately while Sexual function, including sensation and the ability to get an erection, could be gained in about six months, said Richard Redett, a Johns Hopkins plastic and reconstructive surgeon and clinical director of the genitourinary transplant program.
This type of transplant, where a body part or tissue is transferred from one individual to another, is called vascularized composite allotransplantation. The surgery involves transplanting skin, muscles and tendons, nerves, bone and blood vessels. As with any transplant surgery, tissue rejection is a concern.
Two weeks after the penis surgery, the patient received bone marrow infusions from the donor. The procedure, pioneered by the same Johns Hopkins team, modulates the immune response that causes patients to reject transplanted organs, so the patient needs only one low-dose maintenance immunosuppression medication per day.
The team decided not to transplant the testicles after consulting the bioethics committee, as it would have contained sperm from the recently deceased donor.
The identity of the donor was also not disclosed, nor was his cause of death, but his family released a statement praising the sergeant’s service to his country and noting the donor family includes several military veterans.
The surgeons at John Hopkins have been planning for penile transplant since 2013. Dr. Rick Redett, the genitourinary program's clinical director, calls the procedure "the culmination of more than 5 years of research and collaboration across multiple disciplines."
A 2016 report found that from 2001 to 2013, 1,367 men in the United States military suffered injuries to their genitals or urinary tract in Iraq or Afghanistan, 94% were age 35 or younger.
This successful transplant opens new avenues for soldiers who have suffered blast injuries in war. Other men are now undergoing screening for the procedure, Andrew Lee said in a news conference.
In 2016, surgeons at Massachusetts General Hospital performed the first penis transplant in the U.S. on a man who had his penis amputated due to penile cancer, but he did not receive a scrotum during the transplant.
This video animation illustrates the transplantation process of Total Penile and Scrotum Transplant.
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