The New York Times

'Whole Again': A Vet Maimed by an IED Receives a Transplanted Penis

BALTIMORE — In a 14-hour operation, a young military veteran whose genitals were blown off by a bomb received an extraordinary transplant: a penis, scrotum and portion of the abdominal wall, taken from a deceased organ donor. The surgery, performed last month at Johns Hopkins Hospital, was the most complex and extensive penis transplant to date, and the first performed on a combat veteran maimed by a blast. Two other successful penis transplants have been performed — in South Africa in 2014 and at the Massachusetts General Hospital in 2016 — but they involved only the organ itself, not the scrotum or surrounding flesh. This latest operation transplanted a single piece of tissue that measured 10 inches by 11 inches and weighed 4 or 5 pounds. This is an evolving branch of medicine spurred in large part by the wounds of war — particularly the blast injuries from improvised explosive devices, or IEDs. The medical teams in Baltimore and Boston The patient at Johns Hopkins is just one of many soldiers whose lives were shattered in a split second when they stepped on hidden bombs in Iraq or Afghanistan. He lost both legs above the knee, but the genital damage was even more devastating to him. “That injury, I felt like it banished me from a relationship,” he said in an interview last week. “Like, that’s it, you’re done, you’re by yourself for the rest of your life. I struggled with even viewing myself as a man for a long time.” But now, four weeks after the surgery, he said, “I feel whole again.” He asked that his name not be published, because of the stigma associated with genital injuries. Except for his immediate family and a few close friends, he has told no one about the nature of his wounds, he said. Dr. W.P. Andrew Lee, chairman of plastic and reconstructive surgery at Johns Hopkins, said the goal of this type of transplant is “to restore a person’s sense of identity and manhood.” For most men, that means regaining the ability to urinate while standing up and to have sex. Lee thinks transplantation can make both possible, though healing and nerve regeneration will take time. Urination is expected first, within a few months. Nerves grow from the recipient into the transplant at the rate of about 1 inch a month. “We’re hopeful we can restore sexual function in terms of spontaneous erection and orgasm,” Lee said. Although the scrotum was transplanted, the donor’s testes had been removed for ethical reasons: Keeping them might enable the recipient to father children that belonged genetically to the organ donor, something not considered acceptable by medical guidelines. Because the recipient’s own reproductive tissue was destroyed, he will not be able to have biological children. He takes testosterone to compensate for the loss of his testes, and is being treated with another drug, Cialis, to encourage erectile function. How many men might need this type of transplant is not known. Data from the Defense Department show that more than 1,300 men suffered so-called genitourinary injuries in Iraq and Afghanistan, and that 31 percent of those injuries involved the penis. About 20 percent of the penile injuries were considered severe — but how many might warrant a transplant is not clear. Women in the military have also suffered genitourinary and reproductive injuries, but they are less common. Teams at Johns Hopkins and at the Massachusetts General Hospital are both evaluating more candidates for the surgery — some hurt in the military, others affected by accidents or illness. But it can take a long time to find a matching donor — the Johns Hopkins patient waited more than a year on the transplant list — so no rush of operations is expected. The Department of Defense has funded some of the research, but Johns Hopkins is paying for the first operation, which Lee estimated would cost from $300,000 to $400,000. The surgeons — nine plastic and reconstructive surgeons, and two urologists — worked for free. Lee said he hoped for grants from the Pentagon to help pay for future operations, and also for insurance coverage, which is not available now for this type of transplant. After the explosion that injured the soldier, he remained conscious, he remembered, but knew he was sinking into shock. He passed out on the medevac helicopter. His next memory was waking up in the United States, relieved to be alive. Soon, the gravity of the damage hit. A military doctor told him it was permanent and irreparable. “That was crushing, but when he walked away I thought, he hasn’t been a doctor long enough, he doesn’t know what he’s talking about,” the patient said. “You got all this technology, how can you tell me this is permanent? There’s got to be something.”

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