Many soldiers returning from combat bear visible
scars, or even lost limbs, caused by blasts from
improvised explosive devises, or IEDs. However, some
servicemen also return with debilitating hidden
injuries — the loss of all or part of their
genitals.
Now, Richard Redett, director of pediatric plastic
and reconstructive surgery, and Carisa Cooney, the
department’s clinical research manager, the
Johns Hopkins reconstructive surgery team that once
performed the hospital’s first bilateral arm
transplant will attempt the first penis transplant
in the United States.
While it’s possible to reconstruct a penis using
tissue from other parts of the body, there is no
possibility for a spontaneous erection with that
approach.
A prosthesis implant can be used to achieve an
erection, but that comes with a much higher rate of
infection.
Additionally, due to other injuries, servicemen
often don’t have enough viable tissue from other
parts of their bodies to work with.
How will the team identify a donor for the
transplantation?
Redett: The tissue will come from a deceased person
whose family agrees to the donation. Many people
might think that organ donation means unquestioned
consent for donation of all organs. That's not the
case with the face, hand or penis.
All organ donations have to be done specifically
through an organ procurement organization (OPO). In
this case, we are working with The Living Legacy
Foundation. Unlike with donation of the heart,
kidneys, liver or lungs, a request for donation of
the hands, arms, face or penis is made separately.
The family has to specifically consent to such a
donation. Once the local OPO finds a family who is
willing to donate, we are notified and make a
decision if the donor will fit our criteria.
The donor tissue is evaluated based on a variety of
factors specific to the recipient, including blood
type, age (within five to 10 years) and skin tone.
How do you identify a good candidate for penile
transplantation?
Cooney: As with reconstructive transplants of the
hand, arm or face, the patient has to be a good
candidate physically and mentally. Psychiatric
evaluations for patients can take up to a year.
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.
If the patient has a significant other when he
begins working with our team, we also work to
educate that person on what to expect. We can’t
guarantee the outcome or the extent of urinary
function, erection, and ability to have sexual
intercourse or have children.
How long do you anticipate it will be before the
donor penis is fully functioning?
Redett: The first concern will be that the
transplanted tissue has an adequate blood supply and
is not immediately rejected. That is generally known
within a few days to weeks. The next priority will
be to regain function. Nerves grow at a rate of 1
millimeter per day, about 1 inch per month. We
anticipate that achieving function, including
urinary and sexual functioning, could take between
six to 12 months. If the patient’s testes are still
present, he may even be able to father children.
What precautions are taken to ward against potential
rejection?
Cooney: To minimize the risk of rejection, we will
give one immunosuppressive medication to the patient
at the time of the transplant. After about 10 to 14
days, they will get a bone marrow infusion from the
donor. By doing that, we have been able to reduce
the number of anti-rejection medications the patient
will have to take for the rest of his or her life
down to one pill twice a day.
What is the scope of the genital transplant program?
Redett: The Johns Hopkins Genital Transplant Program
is initially focusing on post-traumatic deformities,
such as battlefield injuries in wounded warriors, as
many of these men have other injuries which make
conventional penile reconstruction not feasible.
The Johns Hopkins University will fund the first
penile transplant, which could happen within weeks
to months, depending on the availability of a donor.
The university has approved a total of 60 surgeries
for this project.
The penile transplant project is considered a
clinical trial and is made possible because of
contributions from a team of specialists, including
psychiatrists, psychologists, urologists, plastic
surgeons, anesthesiologists, a nurse transplant
coordinator, hematologists, infectious disease
specialists, immunosuppressive therapy experts,
dermatopathologists and bioethicists.
For more information
Johns Hopkins Medicine
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