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The moving story behind America’s first penis transplant

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Over the past few days, the internet has been collectively guffawing at a set of news stories detailing the first penis transplant in the US, which could happen as soon as sometime in the next few weeks.

Sure, the notion of a "penis transplant" might incite a case of the giggles. Penises aren’t medically necessary to keep a patient alive, after all, unlike procedures like heart transplants.

But consider: doctors at Johns Hopkins, the first medical team to perform the procedure in the US, intends only to perform the surgeries on veterans who lost their genitalia during combat.

Missing arms and legs have become a potent symbol of the toll that war can take, but a damaged penis can often carry a deeper emotional cost, one that’s veiled in embarrassment and shame. When these men first come to in hospitals, medical staff say, they invariably ask whether their genitals are intact before thinking about other parts of their bodies.

In that light, the feat this medical team is attempting to pull off is hugely impressive – and quite touching.

Johns Hopkins will perform 60 penis transplant surgeries

Last month, Johns Hopkins selected the first wounded soldier to undergo a penis transplant in the US.

The young man, whose name hasn't been made public, lost most of his penis in an explosion overseas. According to the Defense Department’s trauma registry, this is not uncommon: 1,367 troops sustained injuries to the genitals between 2001 and 2013. Nearly all the men were under the age of 35 at the time of their injuries.

"When they wake up after getting hurt, they don't care if they're missing an arm or a leg. The first thing they do is to make sure, 'Is my penis still intact?'" Johns Hopkins spokesperson Taylor Graham told Philly.com. "They worry about the arms and legs later."

Doctors will perform 60 such surgeries on combat veterans – and more than 60 additional men are already on the waitlist to have the procedure performed. Johns Hopkins will pay for the first surgery, which it estimates to cost between $200,000 and $400,000, and it has asked the government to chip in for subsequent operations. The Department of Veterans Affairs will pay for the cocktail of anti-rejection medicines the men must take once the surgery has been performed.

The first recipient was selected following a physical and mental screening process, including an extensive psychological evaluation to ensure he had recovered from the emotional loss that may have accompanied his injury.

His surgery could happen as soon as a few weeks from now, pending a donor of the right age and skin color whose family gives the hospital special permission to use their loved one’s organ.

Doctors say it will then be a matter of months before the penis regains urinary function, sensation and, eventually, the ability to have sex.

How the penis transplant works

The Johns Hopkins project has been years in the making, according to the New York Times, with extensive practice performed on cadavers. For some of the work, researchers injected food coloring into the cadavers to map out the circulatory system in the penis, to better help them reconnect blood vessels during the operation.

The operation should take about 12 hours, the doctors told the Times. The surgeons will connect up to six nerves and six or seven arteries, stitching them together under a microscope. Nerves will then grow into the penis at a rate of about one inch per month, so full healing will vary depending on the extent of the patient’s injuries.

For the first few weeks after the surgery, a catheter will be inserted to drain urine, and sexual function will take longer to return. The men will also immediately have to begin taking anti-rejection medication, which suppresses their immune systems’ instinct to fight against a foreign organ. They must take the medication for the rest of their lives, a proposition that carries increased risks of infection and perhaps even cancer.

Outside the US, doctors have already performed two penis transplant operations, only one of which was successful. The first, which Chinese doctors performed in 2006, was quickly reversed after 15 days because the implant caused the donor and his wife severe psychological damage. (The Johns Hopkins doctors have said that if their first penis transplant proves unsuccessful for any number of reasons, they can reverse the surgery, leaving the patient no worse off than when he started.)

The second, which took place in South Africa in 2014, was an unqualified success. The recipient, who lost his own penis after severe complications from a botched circumcision, regained full urinary and reproductive function within three months of his surgery. He has even since fathered a child, according to his doctor.

Doctors in the US also plan to transplant just the penis, not the testes, where sperm are produced. So if a transplant recipient does become a father, the child will be his own genetically, not the offspring of the donor. Men who have lost testicles completely may still be eligible for penis transplants, but they will not be able to father biological children.

A lot more people stand to benefit if the transplant is successful

Though Johns Hopkins is only planning to offer the operation to combat veterans for now, a lot more people stand to benefit. Foremost among them are cancer survivors and transgender individuals looking to gain a functional penis.

Right now, doctors can create a penis from tissue taken from other parts of a patient’s body, but erections are not possible without an implant, and implants too often shift position, come out, or cause infection.

Other hospitals around the country have also recently gained permission to perform the surgery, and if the experiment at Johns Hopkins goes well, they will play a role in making the procedure more broadly available.

In a separate line of work, scientists have also started experimenting with growing penises using stem cells – a proposition that could eliminate complications with anti-rejection medication. At least one researcher, at Wake Forest University, has successfully attached 12 bioengineered penises onto living rabbits. Four of them even fathered offspring.

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