— -- As doctors and researchers at Johns Hopkins Hospital work to develop plans for the first U.S. penis transplant, they have had to seek answers for unique and complicated questions.
Here’s a breakdown of the challenges:
Who Will Be the 1st Recipients?
Initially, doctors will focus on people with post-traumatic deformities, especially veterans wounded in battle, according to Dr. Richard Redett, director of pediatric plastic and reconstructive surgery at Johns Hopkins Hospital in Baltimore.
He explained on the hospital’s website that many such veterans "have other injuries which make conventional penile reconstruction not feasible," which uses an implant and tissue from other parts of the patient's body.
Additionally, the recipient will have to undergo a battery of tests, including psychiatric evaluations before being approved for surgery.
"Psychiatric evaluations for patients can take up to a year," Carisa Cooney, clinical research manager, Department of Plastic and Reconstructive Surgery, explained on the website. "There’s a significant loss with the initial injury that the patient has to overcome emotionally, so we make sure to have a psychiatrist, who is also an expert in psychosexual disorders, on the team."
How Does the Transplant Work?
Unlike organ donations of the heart, lungs or liver, doctors need to get special permission for this donation. Additionally, the donor tissue will be evaluated to ensure it matches multiple factors, including the recipient’s blood type, skin tone and be within a five- to 10-year range of the recipient's age.
The donor tissue would then be attached to the recipient in a painstaking operation where nerves and blood vessels are reattached.
Even if the operation goes according to plan, the surgeons can't guarantee success in a pioneering surgery like this one.
"We can’t guarantee the outcome or the extent of urinary function, erection and ability to have sexual intercourse or have children," Cooney said.
The doctors expect the nerves from the recipient would be able to grow in the donor tissue and that the patient could regain function in six months to a year.
What Happens After Surgery?
Redett said after the surgery the focus will be on making sure the donated tissue is healthy.
"The first concern will be that the transplanted tissue has an adequate blood supply and is not immediately rejected," Redett said on the Hopkins website. "That is generally known within a few days to weeks. The next priority will be to regain function."
He explained that nerves grow about 1 millimeter per day and doctors anticipate it could be up to a year before the patient could regain urinary or sexual function.
Initially, the patient would start on anti-rejection medications to ensure the immune system doesn't fight the donated tissue. About 10 to 14 days later, the patient would get an infusion of the donor's bone marrow.
This infusion could, in theory, help cut down on a life-time of immunosuppressive medication for the recipient.
Will the Patient Be Able to Have Children?
In theory, yes, "if the patient’s testes are still present," Redett explained.
Will This Be the 1st Penis Transplant?
There have been at least two other penis transplants globally, according to medical literature. A South Africa man underwent a successful surgery in 2014 and a Chinese man had an unsuccessful transplant in 2006.