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Last updated: Nov 11, 2021
4 min read

Penis transplant surgery: candidates, procedure, risks

Penis transplant surgery is a rare and fairly new medical procedure where the penis and scrotum of a deceased donor are transplanted to a living recipient. A candidate for penis transplant may have lost all or part of their penis because of injury or cancer. As with most transplants, the procedure comes with serious risks.

Disclaimer

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

It may sound like fodder for a horror movie, but the penis transplant is a real procedure and has been around since 2006, where the first ever penile transplant was reportedly done in China. With that said, penis transplantation is exceedingly rare, and it’s not something that you can just pop into your local hospital to undergo. 

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The origin of penis transplant surgery

Remember how the first penis transplant happened in 2006? Well, it had to be reversed for psychological reasons. As such, it wasn’t considered to be a true success. The first successful procedure was performed in 2014 in South Africa (Bateman, 2015). And in 2016, a surgical team at Massachusetts General Hospital performed the first penis transplant in the U.S. on a 64-year-old man who had lost his penis to cancer (Cetrulo, 2018). 

The first penis and scrotum transplant occurred in 2018, when surgeons at Johns Hopkins Hospital transplanted a penis to a U.S. Army veteran who was seriously wounded after encountering an explosive device in Afghanistan. He had lost his legs and penis. Over the course of a 14-hour procedure, surgeons performed a penis and scrotum transplant from a deceased donor and repaired part of his abdominal wall (Nitkin, 2018). 

“It’s a real mind-boggling injury to suffer, it is not an easy one to accept,” said the transplant recipient, who asked to remain anonymous. “When I first woke up, I felt finally more normal… [with] a level of confidence as well. Confidence… like finally I’m OK now.” (Nitkin, 2018)

After the surgery, providers were optimistic that he would regain most of his urinary and sexual functions—and they were right. Follow-up showed that 18 months after the transplant, the veteran could urinate normally, experience ordinary sensation in the penis, have “near-normal” erections, and achieve orgasm (Redett, 2019).

Who is a candidate for a penis transplant?

Rarely, injury or trauma to the area or penile cancer can result in losing most or all of the penis. 

However, it is unclear what makes someone a suitable candidate for a transplanted penis, and the procedure is not widely performed. It will likely need to be a case-by-case evaluation involving the person and the medical team involved. 

The U.S. military reports that about 1,400 of its members experience a genitourinary injury each year, but it’s unknown how many of them would be eligible for a penile transplant (Janak, 2017).

Additionally, the standard organ-donor agreement does not include all body issues—penis transplantation is not on the list. So transplant teams have to approach the families of deceased potential donors. The Johns Hopkins patient was on a transplant waiting list for more than a year.

So, how is a penile transplant possible?

Penis transplantation is rare, expensive, and incredibly complicated. At the time of the Johns Hopkins patient’s transplant, the standard procedure to reconstruct male genitals was a phalloplasty

During this surgery, surgeons create a rolled tube of tissue, blood vessels, and nerves taken from the forearm. Or they can take a flap from the thigh, groin, or lower abdominal area and create a penis. Once the new penis has healed, you can have a penile prosthesis and testicular implant placed to achieve an “erect penis” (Schechter, 2018).

With that information, it’s not surprising that the Johns Hopkins procedure took 14-hours. And, even after the surgery is over, you are not out of the woods. After the surgery, the veteran had to get bone marrow infusions and stay on immunosuppressant therapy to keep his body from rejecting the grafted tissue (Redett, 2019). It’s a long, arduous process that involves a lot of complex factors.

Potential risks and complications

Like anyone who receives an organ transplant, people who undergo penis transplant surgery must take immunosuppressive drugs to ensure their bodies don’t mount an immune response against the foreign tissue, thus “rejecting” the transplanted organ. Long-term immunosuppression can impair the immune system’s ability to fight off serious illnesses like cancer. 

Each person needs to weigh the individual risks and benefits of getting a penis transplant. While it may not be a life-saving procedure, some would argue that it is undoubtedly a life-changing one for someone who has lost their penis. It certainly was for the Army veteran who underwent the transplant at Johns Hopkins. Over a year later, he reported an improved self-image and felt satisfied with the transplant and the changes it made to his life (Redett, 2019).

References

  1. Bateman, C. (2015). World’s first successful penis transplant at Tygerberg Hospital. South African Medical Journal, 105(4), 251–252. doi:10.7196/samj.9602. Retrieved from https://pubmed.ncbi.nlm.nih.gov/26294859/
  2. Cetrulo, C. L., Jr, Li, K., Salinas, H. M., Treiser, M. D., Schol, I., Barrisford, G. W., et al. (2018). Penis transplantation: first US experience. Annals of Surgery, 267(5), 983–988. doi: 10.1097/SLA.0000000000002241. Retrieved from https://pubmed.ncbi.nlm.nih.gov/28509699/
  3. Janak, J. C., Orman, J. A., Soderdahl, D. W., & Hudak, S. J. (2017). Epidemiology of Genitourinary injuries among male u.s. service members deployed to iraq and afghanistan: early findings from the trauma outcomes and urogenital health (TOUGH) project. The Journal of Urology, 197(2), 414–419. doi: 10.1016/j.juro.2016.08.005. Retrieved from https://pubmed.ncbi.nlm.nih.gov/27506692/.
  4. Nitkin, K. (2018). First-ever penis and scrotum transplant makes history at Johns Hopkins. Retrieved July 31, 2020 from https://www.hopkinsmedicine.org/news/articles/first-ever-penis-and-scrotum-transplant-makes-history-at-johns-hopkins
  5. Redett, R. J., 3rd, Etra, J. W., Brandacher, G., Burnett, A. L., Tuffaha, S. H., Sacks, J. M., et al. (2019). Total penis, scrotum, and lower abdominal wall transplantation. The New England Journal of Medicine, 381(19), 1876–1878. doi: 10.1056/NEJMc1907956. Retrieved from https://pubmed.ncbi.nlm.nih.gov/31693813/
  6. Schechter, L. S., & Safa, B. (2018). Introduction to phalloplasty. Clinics in Plastic Surgery, 45(3), 387–389. doi: 10.1016/j.cps.2018.03.014. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29908627/