Everything You Need to Know About the Upcoming Penis Transplant

Surgery photo via Shutterstock

The Internet is aflutter with news that doctors in Baltimore will soon perform the first penis transplant in the U.S., to help a wounded veteran. To date, only two such procedures have been documented, one in China and one in South Africa, and the results have been mixed.

Given the buzz, we caught up with Robert Hartman, the former urology resident at Brigham and Women’s Hospital whose brief case study on a broken penis went viral. Hartman, who is not involved with the upcoming transplant, talked us through the nitty-gritty of the procedure.

On paper, this doesn’t seem like an incredibly challenging surgical task. How difficult is this surgery?

At its most basic element, the surgery involves connecting three tubes, as well as a couple of veins and a couple of arteries from the donor to the recipient. But you have to consider that these blood vessels are no bigger than about a millimeter in diameter, and the sutures used in the procedure are finer than a strand of hair. So you can begin to appreciate the complexity, and then you throw in the fact that the recipient is actively trying to kill the foreign tissue and the transplanted penis is trying to die.

Is there a time frame the team will have to get the penis off the donor and match it to the recipient?

There absolutely is. There are, however, special solutions of fluid that are designed entirely to preserve organs, including a penis, and optimize the quality of the tissue for transplantation.

There’s research that says the organ can last up to 18 hours in transport and preparation for a procedure. I believe in the case of Lorena Bobbitt [a woman who cut off her husband’s penis in 1993] that penis was in the tall weeds for about 12 hours before it was reattached.

That’s not a transplant, but did the guy return to functionality in terms of mechanics and sensation?

He did. He went on to have a very prolific pornographic career.

Was the Bobbit case a benchmark of any sort, or was it just the first time the public heard about a penis being reattached?

I think it put a very bright light on the nether region and made something that was probably well known to a small urologic community well known to the world at large.

As an organ donor, is my penis fair game? Or is this something that needs special consent?

You have to give consent to be an organ donor, and you’re presuming that your heart and lungs and kidneys and things like that are fair game. One does not necessarily consider a face, or arms, or in this case, a penis, fair game. Just as important as counseling the patient prior to surgery, you have to counsel the potential families of donors about what is being considered for organ donation. I would say this is not necessarily fair game and it does in fact need special consent.

Would they screen the donor penis for latex allergies?

Yes—latex allergies among many, many other types of screenings for tissue types, blood types, and other genetic indicators that may not only precipitate an immediate reaction, but perhaps a long-term chronic rejection.

Why have there only been two penis transplants performed so far? 

This topic has been addressed or considered in the past 20 years—actually, since Lorena Bobbit widely publicized that a penis could be removed and then replaced. But really, the nuances of reattaching a severed penis have been documented in urologic literature long before Lorena Bobbitt. The latest twist is that it’s a donor penis rather than the patient’s own severed penis.

Before even considering a transplant, most candidate patients undergo extensive genital reconstruction procedures with their own tissues. And that affords some very good outcomes, and very good functional results. Given the obvious ethical and psychological concerns, reconstruction will likely remain the first consideration.

Given the experimental nature of the upcoming penis transplant, what’s a good outcome for the patient?

Well, it’s probably a subjective answer. A good outcome is probably one in which the patient has an improved sense of self, be it aesthetically or functionally—hopefully both. In the case in South Africa, the patient was sexually active just weeks after the procedure. That’s incredible, and probably as close to as perfect an outcome as one could expect.

But realistically, if the patient is able to use the transplanted penis to simply empty his bladder, and do so without any psychological issues, that would be a good outcome. And if the patient happens to have an improved body image or any sort of sexual function, I think that’d be considered an excellent outcome.

Would the medical team take things like size and color of the donor penis into consideration?

I would believe so. When face transplants or arm transplants are considered, those elements, while not primary, are certainly considered.

The Guardian previously reported that the first penis transplant in China had to be removed due to “a severe psychological problem of the recipient and his wife.”

It’s an evolving science. The patients undergoing these radical transplants are also undergoing extensive preoperative counseling and postoperative counseling. The case in China 10 years ago, that patient went from having a 1-centimeter penile stump to immediately having a 10-centimeter penis. Surgically, everything, per Chinese reports, went perfectly. It’s just that the patient and his wife had difficulty coping with the fact that this was a dead man’s much larger penis.

Are there ethical issues that we may project onto this procedure that we wouldn’t necessarily project onto a heart or lung transplant?

The penis is not a vital organ—it’s not a heart or kidney or lung. So I think it’s inappropriate to consider using that ethical framework. Similarly, it could be argued that a face or arms are technically not vital either. But I think any reasonable person would consider that the social and functional utilities of these transplants justify the potential risks.