An Afghanistan war veteran who had his genitals blown off by a roadside bomb is the recipient of a donated penis and scrotum that doctors hope will restore his ability to function normally, after a 14-hour surgery that doctors hailed as a medical first.
The veteran, who asked to remain anonymous for privacy-related reasons, received the tissue transplant from a team of 11 doctors - nine plastic surgeons and two urological surgeons - at Johns Hopkins Hospital in Baltimore in March. The procedure was the result of years of research, studies and cadaver work, giving doctors hope that if it proves successful, it could be used for injured veterans and other men with severe injuries to their genital regions.
"While extremity amputations are visible and resultant disability obvious, some war injuries are hidden and their impact not widely appreciated by others," Dr. W.P. Andrew Lee told reporters, speaking of the "devastating impact" that injuries had on mens' identity, self-esteem and intimate relationships.
Doctors said they hoped that the patient, who is expected to be released from the hospital this week, would regain "near-normal" urinary and sexual functions as he recovers and his nerves heal over the coming months.
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"It's a real mind-boggling injury to suffer; it is not an easy one to accept," the patient said in a release. "When I first woke up, I felt finally more normal."
The transplant included an entire penis, scrotum and partial abdominal wall from a donor, which made it distinct from the four other penis transplants, which only included the organ. Only a couple of the procedures have been successful.
For the transplant, the donor's testes were first removed because of what the doctors said were complicated ethical issues, in particular the potential ability to father children with another man's genetic material.
"There were too many unanswered ethical questions with that kind of transplant," Dr. Damon Cooney told reporters.
Another man, who lost his penis to cancer, was the recipient of more limited transplant in Massachusetts two years ago, but he has yet to regain full sexual functioning, Curtis Cetrulo, who runs the reconstructive transplantation program at Massachusetts General, told USA Today.
The transplant that Johns Hopkins doctors did in March involved connecting blood vessels and nerves from the patient to the tissue material, including three arteries, four veins and two nerves "to provide complete blood transfusion and sensation," Dr. Richard Redett said.
The procedure, which was not covered by the patient's insurance, was estimated to have cost between $300,000 to $400,000, the majority of which was covered by the hospital.
Little information has been released about the donor, who was from New England, or his cause of death, though his family released a statement through New England Donor Services about the transplant.
"We are all very proud that our loved one was able to help a young man that served this country. We are so thankful to say that our loved one would be proud and honored to know he provided such a special gift to you," the family said. "Please know that this is truly a heartfelt statement, as we have several veterans in the family. We hope you can return to better health very soon and we continue to wish you a speedy recovery."
The patient was given a transfusion of bone marrow from the donor and will also require immunosuppressive drugs to prevent his body from rejecting the donated organ.
Doctors noted that it was one of many groundbreaking procedures to emerge from the combat casualties suffered by soldiers at war. U.S. Army Sgt. Brandan Marrocco, a quadruple amputee veteran of the Iraq War, received a double arm transplant at Johns Hopkins about five years ago.
About 1,367 male military members suffered genitourinary injuries from 2001 to 2013, according to data from the Department of Defense Trauma Registry cited by the Baltimore Sun.
Dr. Elspeth Cameron Ritchie, a former Army psychiatrist and author of a book about intimacy and injury, told the Sun that one of the first questions soldiers ask after a severe injury is whether their genitals were unharmed.
The patient's injury in Afghanistan also necessitated the amputation of both of his legs above the knee. He said that he kept the extent of his injury a secret.
"That injury, I felt like it banished me from a relationship," he told the New York Times. "Like, 'that's it, you're done, you're by yourself for the rest of your life.' I struggled with even viewing myself as a man for a long time."
Doctors said they had no plans to use the procedure for gender reassignment surgeries at the moment.