This post has been updated.
In the United States, circumcision after infancy (and the injuries that often come with it) is admittedly less common. But that doesn't mean there isn't a need for penis transplants: The Department of Defense Trauma Registry reports that 1,367 military servicemen sustained injuries to the genitals between 2011 and 2013 in Iraq and Afghanistan alone.
Carisa Cooney, clinical research manager of the Johns Hopkins Department of Plastic and Reconstructive Surgery, told The Post that the university had been approached by "quite a few servicemen" and military leaders with requests for the experimental surgery. Around July 2013, the plastic surgery team started the arduous process of getting approval — first from their own internal review board, and then from those of the organ procurement organization.
"We were very concerned about getting the acceptability of the general public," Cooney told The Post.
It's true that one doesn't require a penis to live a long and productive life, so the process of asking a bereaved family to donate a seemingly unnecessary organ — not to mention the physical toll on the recipient, who may have to take daily immunosuppressant drugs for the rest of his life to avoid organ rejection — can seem like overkill. But because male genitals are so strongly associated with a sense of masculinity and identity in our culture, the sudden loss can be debilitating. Reconstruction using skin from other parts of the body or prosthetics can help, but it doesn't restore natural function. Only a complete organ taken from a deceased donor — and attached in a highly experimental surgery — can do that.
"These are very important in terms of giving back a sense of self," Cooney said.
“Our young male patients would rather lose both legs and an arm than have a urogenital injury,” Scott E. Skiles, the polytrauma social work supervisor at the Veterans Affairs Palo Alto Health Care System, told the Times.
It's possible that the surgery, once developed, could help people with congenital deficiencies or even be adapted for transgender individuals seeking sex reassignment. For now, Cooney said, Johns Hopkins is emphasizing the fact that these recipients are veterans injured in the line of duty — men who are ineligible for less drastic surgical fixes, eager to participate and who understand the risks.
In addition to working with potential recipients to make sure they and their partners are ready for the physical and psychological toll the surgery will take, the team has worked on figuring out sensitive ways of asking a potential donor's next-of-kin. It's clearly a touchy topic: The organ for the South African surgery could only be procured after doctors agreed to fashion an ersatz penis for the donor to be buried with.
"We were concerned that making a request like this might have a negative impact on organ donation," Cooney said. "We wanted to make sure we'd have a very sensitive way of approaching it, so it wasn't distasteful to them. We want donor families to know -- we'll treat them with respect once the donation is made."
The procedure itself is no easy feat, with Johns Hopkins doctors estimating a 12-hour surgical marathon. Dr. W. P. Andrew Lee, chairman of the department of plastic reconstructive surgery, told The Post that his team has prepared for the procedure using cadavers.
"We've been doing multiple rehearsals to get familiar with the anatomy," Lee said. "We've done that on multiple occasions, and I think we're pretty close to being ready to perform the surgery. We're optimistic that significant function can return."
Even if everything works physically, the psychological trauma can sometimes be too much to bear. That's what happened to the Chinese patient who could have been the first successful recipient of a penis transplant: In 2006, 10 days after a physically successful surgery, the man asked doctors to remove his new organ.
One day scientists may be able to grow new organs for these patients in the lab, using their own site-specific stem cells. Until then, the potential psychological implications of waking up with a stranger's genitals are a major concern — so it's important that these injured vets go in with realistic expectations. But in the one case that's worked, the results have been tremendous: In June, South African surgeons reported that their patient had impregnated his girlfriend just six months after his experimental transplant.
"Of course we had hoped we'd beat them to the punch, but we were very excited to hear of the success," Cooney said of the South African surgery. "We knew it would only help us in terms of acceptability."
This post has been updated.