Mass General urologist Dicken S.C. Ko, a member of Manning's surgical team, told The Washington Post that he and his colleagues saw a real need for penile transplants among their patients with genital amputations and injuries.
"These patients ended up with catheters, they lost all sexual function, and ultimately they kind of lost a sense of who they were as individuals," Ko said. They and others hoped that advances in vascularized composite allotransplantation (VCA) — complex surgeries that connect multiple types of tissue, as is the case with hand and face transplants — could provide a better solution.
"Helping them be able to get up and go to the bathroom every morning by giving them a catheter is one thing," Ko said. "But it isn't necessarily the best we can do for them. If we can help them look in the mirror and say, 'Yeah, I'm doing all right,' that's what we want to do."
In South Africa, where the first successful surgery was performed (and resulted in a healthy baby last year), surgeons found a large pool of potential recipients injured by a common form of ritual adult circumcision. In the United States, it's presumed that troops — increasingly suffering from devastating genital injuries in explosions — will be the main patient base. Johns Hopkins University had announced intentions to perform the country's first surgery on a soldier this year and has a long list of veterans waiting for the procedure.
Manning isn't a soldier — he lost most of his penis to cancer several years ago. Curtis L. Cetrulo, who co-led the surgical team with Ko, said his group will avoid veterans as a patient base until its techniques are perfected.
"It's a very different procedure," W.P. Andrew Lee, chairman of the department of plastic reconstructive surgery at Johns Hopkins, told The Post after praising the Mass General surgeons for their accomplishment. Lee's team is focused on perfecting techniques for patients with less remaining tissue than Manning had — the kind of surgery someone who survived a violent explosion might need. Then they'll work backward and expand their patient base to include cancer survivors, those with congenital malformations of the penis and civilians with less-traumatic injuries.
As the technique continues to improve, it could even be used to give transgender males more natural urinary and sexual function. But the teams from Mass General and Johns Hopkins have cautioned that this won't be attempted until the surgery has proved safe and effective for injured cisgender men.
“Today I begin a new chapter filled with personal hope and hope for others who have suffered genital injuries, particularly for our service members who put their lives on the line and suffer serious damage as a result,” Manning wrote in a statement. “In sharing this success with all of you, it’s my hope we can usher in a bright future for this type of transplantation.”
At a news conference Monday, Cetrulo said that the undertaking — which was preceded by 3½ years of research and practice — was "a huge group effort." There were 30 people in the operating room at any given time, including seven surgeons and seven residents.
Certrulo said he was "cautiously optimistic" about Manning's results. “We hope that this will be a common part of reconstructive surgery going forward," he added.
Manning is doing well, but the medical team's work is far from over: As with any organ transplant, the recipient faces a potentially lifelong regimen of drugs designed to keep his body from rejecting the donation as a foreign object, and lots can go wrong. This was apparent in the recent failure of the country's first uterine transplant — such a procedure would allow a woman without a uterus to carry a baby to term (and has done so in Sweden). Just days after going public, the recipient of the transplant suffered complications and had to have the organ removed.
When asked how soon another penile transplant would be attempted at Mass General, Ko said that Manning's recovery will set the pace.
"I think this will take some time," he said, adding that doctors will have to keep tabs on the appearance and functionality of Manning's new organ for several months before they can consider the surgery a true success. There are many arteries and veins that need to maintain healthy blood flow to keep the donated tissue alive, and it could take months to know whether there are complications in the newly connected urinary system or whether Manning can achieve normal sexual functions.
Penis transplants carry an added psychological risk, as well: What would have been the first successful penis transplant — a technically successful operation performed in China — ended with the recipient asking doctors to remove the organ because of his discomfort with the unfamiliar body part.
But Ko is optimistic that Manning will recover well and that his success will give hope to men suffering in silence.
"These patients, because of the location of their injury and their loss, they really have suffered alone, because it’s not really visible to the outside world," he said. "Hopefully we can give them better options in the future."
This post has been updated.