According to an article published in JAMA (see HERE) in April 2016, between 2001 and 2013, more than 1300 men in the United States army who had been posted to Afghanistan or Iraq experienced urogenital trauma; 86 of these suffered severe penile injuries. According to the US administration, this group of men were 24 years old or younger when they suffered the trauma.
In view of this serious problem, Arthur L. Burnett, professor of urology at Johns Hopkins Medical School in Baltimore is preparing a penis transplantation programme.
The first attempted transplant of this organ was performed in Guangzhou General Hospital in China, but failed. The patient was a 44-year-old man who had suffered trauma to the penis, and who was transplanted with a penis harvested from a 22-year-old man who had died in an accident. However, the transplanted organ was removed after 14 days because the patient and his wife were psychologically unable to accept this type of transplant.
The first successful transplant was performed 8 years later by a team of surgeons led by André van de Merwe, of the urology department of Stellenbosch University and Tygerberg Hospital in Cape Town, South Africa (see HERE). The patient was a 21-year-old man who had had to have his penis amputated after complications following circumcision. According to a spokesperson from the University, around 250 penis amputations are performed in South Africa as a result of problems related with circumcision. The operation lasted 9 hours, was very successful, and the man recovered his sexual activity, showing no secondary psychological problems. In August that same year, Van de Merwe’s team were granted the corresponding authorisations to continue the programme.
Some ethical problems
Following the two experiments, some ethical issues were raised, especially because while it is a major injury, the transplant is not performed to save a life. In this respect, the risk-benefit of this surgical operation must be very carefully assessed, both the psychological risks, as already mentioned, and the medical risks, which include the possibility of rejection, graft-versus-host disease, cancerous problems related with immunosuppression and other lesser problems.
Additionally, since it is still an experimental intervention, the ethical problems have to be assessed in considerable detail.
In the light of this medical and human issue, Dr Burnett’s team are preparing a penis transplant programme that will include at least 60 patients. This will require protocols to be carefully drawn up; these should relate to post-surgical treatment, which will have to be similar to any microsurgery related with other types of transplants. They will also have to minimise the use of immunosuppressants, and above all, thoroughly evaluate patients who are to undergo transplant, especially as regards the psychological and medical problems that they may have.
The use of artificially bioproduced penises has also been proposed as a future possibility, as they could be an effective alternative to transplantation of natural penises. In this respect, Atala and co-workers have successfully performed penis transplants in rabbits, which were then able to effectively impregnate does. As Atala himself states, one of the advantages of this type of transplant is that the organ generated would be produced mainly using cells from the patient himself, which would reduce the likelihood of rejection.