Surgeons at Johns Hopkins Hospital last month performed the world's first penis and scrotum transplant on an Afghanistan war veteran whose genitals were blown off by a roadside bomb.
While surgeons in the United States and abroad have performed penis transplants, the Hopkins team said their procedure is the most extensive to date, as it included the full penis, scrotum, and tissue from the lower abdomen.
About the surgery
According to the New York Times, the transplant is part of an evolving branch of medicine developed largely in response to war injuries.
The transplant was the culmination of many years of research involving cadavers and studies, according to the Washington Post's "To Your Health." In particular, medical teams in Baltimore and Boston spent several years preparing for the surgery by practicing and refining their surgery techniques on cadavers, according to Times.
The procedure lasted 14 hours and involved nine plastic surgeons and two urological surgeons at Johns Hopkins Hospital. The surgeons transplanted the penis, scrotum, and partial abdominal wall from a deceased donor to the recipient, who asked remain anonymous.
Damon Cooney, a member of the transplant team and an assistant professor of plastic and reconstructive surgery at Hopkins, said the surgery did not include the donor's testicles, as such a transplant would raise ethical questions about any children fathered using the genetics of the donor. As such, the patient will not be able to father children. "There were too many unanswered ethical questions with [this] kind of transplant," Cooney said.
According to the Times, the transplant involved a single piece of tissue—which measured 10 inches by 11 inches and weighed about four or five pounds.
As part of the procedure, the surgeons connected the veteran's blood vessels and nerves—including three arteries, four veins, and two nerves—to the donated tissue. Richard Redett, a plastic surgeon and Johns Hopkins professor, said the surgeons connected the blood vessels and nerves "to provide complete blood transfusion and sensation." In addition, providers gave the patient a transfusion of bone marrow from the donor, to reduce the amount of anti-rejection drugs the veteran will need to take for life.
According to "To Your Health," the procedure cost between $300,000 to $400,000 and was not covered by the patient's insurance. However, NPR reports that the Hopkins team volunteered their services, with the hospital covering the majority of the costs of the highly experimental procedure.
The Hopkins team said they expect the patient, who will likely be discharged from the hospital this week, to regain "near-normal" urinary and sexual functions over the next six months as he recovers and his nerves heal.
The patient said, "It's a real mind-boggling injury to suffer; it is not an easy one to accept." He said, "When I first woke up (after surgery), I felt finally more normal ... (with) a level of confidence as well. Confidence ... like finally I'm OK."
W.P. Andrew Lee, chair of the department of plastic and reconstructive surgery at Johns Hopkins University School of Medicine, said, "While extremity amputations are visible and resultant disability obvious, some war injuries are hidden and their impact not widely appreciated by others." He said genital injuries can have a "devastating impact" on a man's identity, self-esteem and relationships. He said, "We believe that genital-urinary transplantation can help those warriors with missing genitalia, just as hand and arm transplants transformed the lives of amputees."
About 1,367 men in the military have sustained genitourinary injuries from 2001 to 2013, according to data from the Department of Defense Trauma Registry, "To Your Health" reports.
The family of the deceased donor released a statement through New England Donor Services, saying, "We are all very proud that our loved one was able to help a young man that served this country. We are so thankful to say that our loved one would be proud and honored to know he provided such a special gift to you" (Rosenberg, "To Your Health," Washington Post, 4/23; Grady, New York Times, 4/23; Harris, "Shots," NPR, 4/13; Simpson, Reuters, 4/23).
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