Laboratory Equipment
02/19/2016
Michelle Taylor, Editor-in-Chief
Just two months after doctors from Johns Hopkins University announced their intention to perform the first penis transplant in the U.S., they have selected a wounded soldier as patient number one. Since the announcement in early December 2015, surgeons have been practicing the 12-hour procedure on cadavers.
According to the Department of Defense Trauma Registry, from 2001 to 2013, 1,367 men in military service suffered wounds to their genitals in Iraq or Afghanistan. Nearly all were under 35 and injured by IEDs. Some lost all or part of their penises or testicles. While missing limbs have become obvious symbols of war, the somewhat-common loss of genitals is shrouded in secrecy—although it is often the opposite for soldiers. To some, especially young soldiers, that is one of the worst injuries to experience. Beside not being able to father biological children, experts have pointed to loss of self and identity, sometimes leading to problems beyond the physical.
According to The New York Times, for a transplant to be possible, certain nerves and blood vessels have to be intact in the recipient, as does the urethra. Surgeons will connect two to six nerves, and six or seven veins and arteries, stitching them together under a microscope. For the first few weeks after the surgery, a catheter will be left in place to drain urine. Sexual function will take longer to develop—nerves will grow from the recipient into the transplant at a rate of about one inch per month, so the timing will depend on the extent of the recipient’s injuries and how far the nerves need to go. Just the penis will be transplanted, not the testes—therefore, if the recipient does become a father in time, the child will genetically be his own.
Of the two other penis transplants reported in medical journals, a successful one in South Africa in 2014 resulted in the young man recently becoming a father. A 2006 transplant in China failed when the recipient asked for the organ to be removed due to psychological reasons.
Risks
The risks associated with a penis transplant are the same as with any major transplant operation, including bleeding, infection and transplant rejection.
The screening process to identify the right patient is also the same as with other organ transplants. It involves making sure the candidate is psychologically ready, understands the risks and benefits, can stick to the regimen of anti-rejection medicine and has a family support network.
To minimize the risks, the Johns Hopkins team has found a way to use just one drug, rather than the three usually needed for transplants, reported The New York Times. At the time of transplant, the recipient will receive medication that reduces immune system cells. About two weeks later, he will receive an infusion of stem cells from the donor. The infusion reduces the tendency of the recipient’s immune system to attack the transplant, and just one anti-rejection drug, tacrolimus, is then enough to keep it in check. Previously, doctors have used this technique successfully in patients who have had hand transplants.
Jeffrey Kahn, a bioethicist at Johns Hopkins told The New York Times that it is essential the families of organ donors be asked specifically for permission to use the penis, just as special permission is required for face and hand transplants. It is not assumed that people willing to donate kidneys or livers will also consent to having their loved one’s genitals removed. The surgeons chose a relatively young donor to increase the odds that the transplanted organ will function sexually.
For now, the operation is being offered only to men injured in combat; however, that could change to include transgender people in the future.
02/19/2016
Michelle Taylor, Editor-in-Chief
Just two months after doctors from Johns Hopkins University announced their intention to perform the first penis transplant in the U.S., they have selected a wounded soldier as patient number one. Since the announcement in early December 2015, surgeons have been practicing the 12-hour procedure on cadavers.
According to the Department of Defense Trauma Registry, from 2001 to 2013, 1,367 men in military service suffered wounds to their genitals in Iraq or Afghanistan. Nearly all were under 35 and injured by IEDs. Some lost all or part of their penises or testicles. While missing limbs have become obvious symbols of war, the somewhat-common loss of genitals is shrouded in secrecy—although it is often the opposite for soldiers. To some, especially young soldiers, that is one of the worst injuries to experience. Beside not being able to father biological children, experts have pointed to loss of self and identity, sometimes leading to problems beyond the physical.
According to The New York Times, for a transplant to be possible, certain nerves and blood vessels have to be intact in the recipient, as does the urethra. Surgeons will connect two to six nerves, and six or seven veins and arteries, stitching them together under a microscope. For the first few weeks after the surgery, a catheter will be left in place to drain urine. Sexual function will take longer to develop—nerves will grow from the recipient into the transplant at a rate of about one inch per month, so the timing will depend on the extent of the recipient’s injuries and how far the nerves need to go. Just the penis will be transplanted, not the testes—therefore, if the recipient does become a father in time, the child will genetically be his own.
Of the two other penis transplants reported in medical journals, a successful one in South Africa in 2014 resulted in the young man recently becoming a father. A 2006 transplant in China failed when the recipient asked for the organ to be removed due to psychological reasons.
Risks
The risks associated with a penis transplant are the same as with any major transplant operation, including bleeding, infection and transplant rejection.
The screening process to identify the right patient is also the same as with other organ transplants. It involves making sure the candidate is psychologically ready, understands the risks and benefits, can stick to the regimen of anti-rejection medicine and has a family support network.
To minimize the risks, the Johns Hopkins team has found a way to use just one drug, rather than the three usually needed for transplants, reported The New York Times. At the time of transplant, the recipient will receive medication that reduces immune system cells. About two weeks later, he will receive an infusion of stem cells from the donor. The infusion reduces the tendency of the recipient’s immune system to attack the transplant, and just one anti-rejection drug, tacrolimus, is then enough to keep it in check. Previously, doctors have used this technique successfully in patients who have had hand transplants.
Jeffrey Kahn, a bioethicist at Johns Hopkins told The New York Times that it is essential the families of organ donors be asked specifically for permission to use the penis, just as special permission is required for face and hand transplants. It is not assumed that people willing to donate kidneys or livers will also consent to having their loved one’s genitals removed. The surgeons chose a relatively young donor to increase the odds that the transplanted organ will function sexually.
For now, the operation is being offered only to men injured in combat; however, that could change to include transgender people in the future.