Any man will tell you that his penis is no ordinary organ, and a transplant surgeon will agree. Unlike a lung or a liver, penises are made up of multiple types of tissue: skin, muscles, nerves, and erectile chambers. Each is one more opportunity for the host’s body to reject a transplant.
That’s why yesterday, April 23, when a team from Johns Hopkins University in Baltimore and Massachusetts General Hospital announced they had successfully completed the first-ever penis, scrotum, and partial abdominal wall transplant, it made medical history.
“I feel whole again,” the US veteran who received the organ said a month after surgery, the New York Times reported.
The vet, who was injured by an improvised explosive device while on tour in the Middle East, had spent years feeling isolated and depressed. In addition to losing his penis, he lost the lower halves and the knees of both legs. His peers, many of whom were also amputees, would joke about killing themselves if they lost their genitals. The patient himself, who has not been named, said these suicidal thoughts crept into his own head, too. But, he told the Times, “I would think, ‘Am I really just gonna kill myself over a penis?’”
After a long recovery involving weaning himself off opioid painkillers, learning to walk with prosthetics, and therapy, he went to college and got a degree. That’s when he consulted a reconstructive surgeon about phalloplasty, a procedure involving building a penis with tissue from other parts of the body like the forearm and lining of the mouth, along with silicone implants to serve as erectile chambers. His surgeon, though, identified him as an ideal candidate for a penis and scrotum transplant instead.
Although the field of phalloplasty has greatly improved thanks to growing demand for sex-reassignment surgery, penis-transplant procedures haven’t progressed nearly as quickly. In part, this is because there are so few candidates. Genital injuries are rare outside of combat, and even then they are not common: according to Mary Roach, the author of Grunt: The Curious Science of Humans at War, there are about 300 genital injuries per 18,000 lower-limb injuries. In addition, to qualify for a penis transplant, a potential recipient must have the right supporting internal blood vessels. Up to this point, there had only been two successful penis transplants, one in 2014 in South Africa and one in 2016 at Massachusetts General Hospital.
In addition to being technically complicated, there are psychological element to undergoing a penis transplant that are not present in other organ donations. The donor penis is always visible, as opposed to being hidden within the body, meaning it doubles as a constant reminder of the previous trauma. In 2006, doctors in Guangzhou, surgeons in China performed a successful penis transplant, but afterwards, the patient’s partner experienced a “severe psychological problem…beyond our and the patient’s imagination.” The transplanted penis was removed after two weeks.
This veteran was psychologically evaluated to make sure he was prepared for his operation, and given the usual donor-compatibility checks like blood and tissue matching. Roach reports that for penis transplants, the donor organ is matched for age and skin color as well. In this case, a year after the veteran had been added to the waiting list, doctors identified a donor who was brain-dead. The 11 surgeons who performed the 14-hour operation worked pro-bono; otherwise, it would have cost an estimated $300,000 to $400,000.
A penis may not seem like critical organ to replace for a veteran, compared to a leg or arm—men don’t need to have sex—but intimacy is one of the best parts of being human. The surgical feat is similar to a face transplant in the sense that, in addition to being highly complicated, it restores an extremely personal body part. “It’s more personal in a way, because no one sees it,” Damon Cooney, a reconstructive surgeon at Johns Hopkins University, told Roach.
The veteran told the Times that he hopes to go on to medical school, and perhaps meet a significant other. “Just that normal stuff,” he said.