The History of Penis Transplants

Earlier this month, the first penis transplant in the United States was completed successfully. This was the world’s third penis transplant since the procedure was first attempted ten years ago.

In penis transplants, the penis is taken from a deceased donor only after special written permission is given by the deceased man’s family. The blood type of the recipient must match that of the donor. The recipient must have certain nerves and blood vessels intact as well as an intact urethra in order to be considered for a penis transplant. Skin tone similarities between the donor and the recipient are taken into consideration to allow the recipient to have a more natural look after transplantation.

Only the penis is transplanted; testicles are never transplanted due to potential ethical and moral objections. If a recipient has one or both of his testicles intact, he may be able to father his own biological children after a successful penis transplant because his sperm production has been unimpeded.

All transplant patients must take anti-rejection medications, such as tacrolimus, for the rest of their lives in order to keep their own bodies from physically rejecting the transplanted organ(s). There is a vetting process of potential transplant patients to ensure the patients will adhere to daily anti-rejection medication regimes.

The world’s first penis transplant occurred in China in 2006 at Guangzhou General Hospital. The recipient was a 44-year-old man whose own penis had been damaged beyond repair in an accident. He was left with one centimeter (less than one-half inch) of his original penis and was unable to urinate. The 15-hour transplant surgery was considered a success.

Within ten days, the recipient was able to urinate through his new penis. Unfortunately, two weeks after the transplant, the penis transplant was removed. The transplant surgeons reported the removal was due to the patient suffering from severe psychological rejection of his new penis.

Psychological rejection occurs when patients receiving a transplant cannot accept the transplanted organ as their own. There is a high risk of psychological rejection in transplants involving non-life sustaining organs, such as hands, faces and penises. The recipient must accept the new organ as his own, which can be difficult for some people.

American surgeons who recently studied photographs of the transplanted organ from the Chinese transplant surgery reported there was dead tissue on the donor penis after transplantation, suggesting physical rejection of the organ as well.

In December 2014, South African doctors completed the world’s first successful penis transplant on a 21-year-old recipient who lost his penis during a botched circumcision. He was 18 years old and already sexually active when he took part in a circumcision ceremony, which are common in certain parts of Africa. The ceremony left him with only one centimeter (less than one-half inch) of his original penis. His nine-hour transplant surgery was completed by surgeons from Stellenbosch University and Tygerberg Hospital.

His recovery was considered rapid by his surgeons and the young man was able to pass urine, have an erection, orgasm and ejaculate with his transplanted penis within months after the transplant. It is unclear if he now has full sensation in the transplanted organ. He recently fathered his first biological child.

Surgical teams at two American hospitals, Massachusetts General Hospital in Boston and John Hopkins University School of Medicine in Baltimore, were both preparing to complete the first penis transplant in America.

The honor went to Massachusetts General on May 8. A team of about a dozen surgeons and thirty other health care workers worked together during the 15-hour transplant that has given American Thomas Manning, a 64-year-old bank courier from Halifax, Mass., renewed hope.

In 2012, Manning’s penis was amputated due to a penile cancer growth. After his amputation Manning began lobbying for a penis transplant. Doctors began making preparations for the surgery two years ago.

The experimental surgery was conducted as part of a research program that focuses on ultimately helping combat veterans with severe pelvic injuries as well as cancer patients and accident victims impacted by genital injuries.

So far, Manning shows no signs of infection, bleeding or rejection.

Normal urination should be possible for Manning within a few weeks while sexual function may return in weeks or months, according to Dr. Curtis Cetrulo in a New York Times interview. Cetrulo is a plastic and reconstructive surgeon and leader of the surgical team who performed the transplant in Boston.

Dr. Cetrulo stated in the same interview that another patient, whose penis was destroyed by burns sustained in a car accident, will receive a transplant at Massachusetts General as soon as a matching donor becomes available.

The potential penis transplant patient at John Hopkins is a young American soldier who suffered genital injuries after being wounded by a bomb blast in Afghanistan. He has been on the transplant waiting list for several months.

According to the Department of Defense Trauma Registry, 1,367 men in military service in Iraq and Afghanistan between 2001 and 2013 have suffered wounds to their genitals. Nearly all the wounded were under the age of 35 and were hurt by improvised explosive devices, or IED’s. Some of these young men lost some or all of their penises or testicles. These types of injuries are classified as genitourinary injuries. Most of these injuries are not physically life-threatening although these injuries can be traumatic and can impact patients emotionally, mentally and psychologically.

Manning told reporters that he wanted to speak out about his penis transplant in order to help others overcome the shame and stigma associated with genital cancers and injuries.

John Hopkins has given doctors permission to perform up to 60 penis transplants. The university will monitor results of the surgeries before deciding if penis transplants will move from being experimental to a standard treatment of care at the facility.

Penis transplants are currently unavailable to transgender patients seeking gender reassignment surgery. Those patients seeking to become a physical male are limited to a penile implant as the only way to physically reassign their gender. If penis transplants become the standard of care, the procedure could become available for transgender people seeking physical gender reassignment.

The risks of any transplant surgery include bleeding, infection and rejection of the transplant. The daily use of anti-rejection medications, especially tacrolimus, increase the odds of the transplant recipient developing skin cancer or lymphoma due to the medication’s suppression of the body’s normal immune defenses against cancer.

Opponents of penis transplants believe the surgery is not life-saving due to its cosmetic nature and is therefore not necessary.

“You may say it doesn’t save their life, but many of these young men when they have penile amputations are ostracized, stigmatized and take their own life,” South African transplant surgeon Dr. Andre van der Merwe told the BBC during an interview. “If you don’t have a penis, you are essentially dead. If you give a penis back, you can bring them back to life.”