More than a year and a half after surgeons at Johns Hopkins Hospital performed a complex genital transplant on a soldier who also lost his legs in a bomb blast in Afghanistan, the man says he has normal functions and is “feeling whole.”
The man, who chose to remain anonymous, received a donated penis, scrotum and part of an abdominal wall during a 14-hour surgery in April 2018.
The progress report came Thursday in a letter to the editor of the New England Journal of Medicine from about two dozen doctors, mostly from Johns Hopkins School of Medicine, but also from Cooper University Health Care in Camden, New Jersey, and Duke University School of Medicine in Durham, North Carolina.
The letter says the man has “near-normal erections and the ability to achieve orgasm,” and can urinate “while standing, without straining, frequency, or urgency, with the urine discharged in a strong stream.”
“The patient has returned to school full time and continues to live independently using leg prostheses," the letter says. "He reports an improved self-image and ‘feeling whole’ again and states that he is very satisfied with the transplant and the implications it carries for his future.”
The surgery marked a milestone in transplant science. There had only been a handful of similar transplants performed at hospitals in Massachusetts, South Africa and China, but they involved only a penis.
Doctors and mental health professionals said at the time of the surgery that while not directly lifesaving, they considered the transplants necessary because of the psychological toll of such an amputation. Service members have said it can be far worse than the toll of losing limbs.
The patient had been identified in 2012 for reconstruction using skin from other parts of the body, but he opted to wait until a penis transplant would be possible.
A trauma registry kept by the Department of Defense listed 1,367 male service members between 2001 and 2013 with so-called genitourinary injuries that include injuries to the genitals.
The transplants remain difficult because they require a willing donor who is a match medically as well as in age and skin tone. The family of the donor to the soldier specifically consented, saying in a statement they wanted to support the man for serving his country.
Hopkins covered the $300,000 to $400,000 cost of the procedure and doctors donated their time. The hospital approved up to 60 more such procedures for service members, though not for transgender individuals or those born with defects.
“We are currently evaluating several patients for penile transplant," said Dr. Richard Redett, lead author of the journal letter, in a statement to The Baltimore Sun.
The screening process is lengthy, said Redett, interim director of plastic and reconstructive surgery, and professor of plastic and reconstructive surgery at Hopkins School of Medicine. It involves a series of blood tests, examinations and radiographs. Interviews with different doctors and specialists help the team decide if the patient is an appropriate candidate and education helps the patient decide whether he wants to proceed.
“This is a life-enhancing and not lifesaving transplant,” Redett said, "so we are very careful about evaluating the risks and benefits and safety of the procedure.”