This story is part of a partnership between MedPage Today and VICE News.
An American soldier injured in the line of duty will soon be able to undergo the first penile transplant in the United States.
Doctors at Johns Hopkins University Medical Center are preparing to perform the surgery as soon as a few months from now. The center is working with two patients who have undergone all the pre-surgery steps. Now it's a matter of officially putting them on a waiting list and finding the right donors.
"It's very important," said Carisa Cooney, a clinical research manager at the Johns Hopkins department of reconstructive and plastic surgery. "Military publications really emphasize how when a serviceman is wounded and wakes up in the hospital, one of the first things he does is check to see if his genitalia has been injured. A lot of times, that's perceived as more important than losing a limb. it's so closely associated with a sense of identity and a sense of self, especially in a younger male."
Between 2005 and 2010, there were 1,525 genitourinary injuries associated with Operation Iraqi Freedom and Operation Enduring Freedom, according to a 2011 report by Army Dismounted Complex Blast Injury Task Force. These include internal and external injuries, but the report says that the number and severity of external genitalia injuries rose over that time period.
"From the recent conflict, there have been a lot more severe injuries made survivable due to improvements in body armor," Cooney said. "We have a lot more severely injured service men and women coming back. One of these areas, especially with improvised explosive devices, that has sustained devastating injuries is the genitalia."
For both patients, organ procurement organizations will seek a penis from a deceased donor who is about the same age as the transplant recipient and has the same skin tone. Size isn't a top priority, she noted.
Cooney explained that donating a penis is not covered by checking the organ donation box on a driver's license. An additional request must be made by an organ procurement official who will be authorized to share the veteran's story with the families of prospective donors. Since these patients still have testicles, fathering biological children remains a possibility.
"That tends to be very compelling for the family," she said. Even though the request is unconventional, she is confident that donor families will come forward. "So many people are sympathetic to servicemen."
A penis transplant would fall under the relatively new national policies and bylaws for vascularized composite allografts, or VCAs, which were written because face and hand transplants, though once inconceivable, were becoming more common. For instance, the first face transplant was performed in 2005 in France, and now there have been 10 face transplants in the United States. The rules went into effect in July 2014 to make the transplant process go more smoothly.
Given the hospital's success with hand and arm transplants as well as its single-drug immunosuppressant regimen, Johns Hopkins decided it would be an ideal place to offer penile transplantation as an option to patients. In addition to having already screened and selected the first two transplant recipients, they have already done all of the practice surgeries needed to prepare for such a landmark operation.
The first successful penis transplant was performed in South Africa last December, and was declared a success in March. During a nine-hour procedure, doctors attached a donor organ to a young man whose penis was amputated three years ago when a botched circumcision during a traditional rite of passage led to a life-threatening infection. In June, doctors revealed that the 21-year-old man's girlfriend was pregnant.
The first recorded penile transplant attempt was performed in China in 2006, but the surgery was considered a failure. The abnormal swelling of the transplanted organ reportedly caused the patient and his wife psychological distress, and it was soon removed.
Dr. Jamie Levine, chief of microsurgery at NYU Langone Medical Center's Wyss Department of Plastic Surgery, said that although such a transplant has never been performed in the US, genital reattachment surgeries and reconstructive surgeries have been performed for some time, laying the groundwork for the penile procedure to work. Although these surgeries aren't 100 percent perfect for every patient, doctors have the ability to reconnect nerves, vascular systems and urinary systems.
In cases where the penis can't be reattached, Levine explained, doctors can take tissue from other parts of the body and reconstruct the genitals. This is also sometimes done for transgender patients.
The big difference between transplanting a penis and the reattachment and reconstruction surgeries that are already performed in the US is that the recipient of a donated penis runs the risk of rejection. As a result, the person must take drugs that suppress his immune system for the rest of his life.
"It's not like going into the store and giving you a bag and that's it," Levine said. "This is something huge. The surgery involves a huge daily investment in overall time, health, and everything else."
But Levine acknowledged that breakthroughs in this field will help people who have experience grave genital injuries, particularly given the devastating impact the loss of a penis can have on a man's self worth and sexual identity.
"It's one area, one piece of real estate, that's probably very important to most males," he remarked, with mild understatement.