A controversial bioethical dilemma is penis transplant feasibility, balance risk-benefice and the need to maintain the patient on lifelong immunosuppressive therapy, the organ donor shortage and the high economic cost of the long process.

In May 2018, we published a comprehensive report in Bioethics Press (read HERE) on the medical and bioethical aspects of penis transplant, in which we discussed the first two cases, one in Guangzhou (China), which was unsuccessful, and a second successful transplant in Tygerberg Hospital in Cape Town, South Africa. The latter was performed in December 2014 on a 21-year-old man who had lost his penis as a result of a severe infection secondary to a circumcision carried out 3 years earlier. As mentioned, the surgery was a success, because 24 months after the transplant, the patient was able to urinate standing up and to have erections and orgasms, with normal ejaculation. His wife was even able to become pregnant and have a child.

As we said in our previous Report, and we now discuss more widely (read HERE), the second successful penis transplant was performed in May 2016 at the Massachusetts General Hospital in Boston, in a patient who had undergone subtotal penectomy for penile cancer. Seven months after the surgery, the patient could urinate standing up, had partially recovered the sensitivity of the penis and had normal erectile functions. Although he had some further complications, the patient seems satisfied with the outcome of the intervention.

In April 2017, the same team who carried out the penis transplant in Tygerberg Hospital performed another transplant, for which no further clinical information is available.

On 26 March 2018, another penis transplant took place at the Johns Hopkins Hospital in Baltimore, in a soldier who had suffered a serious amputation due to a war injury in Afghanistan (read HERE). The serious incident had affected not only his penis and scrotum but also part of the surrounding abdominopelvic and soft-tissue areas. At the present time, the patient can urinate normally in a standing position, and although not sexually active, has frequent partial and occasional complete erections. In this sense, a recent letter published in the New England Journal of Medicine confirms, more than a year later, the clinical improvement mentioned above (NEBJ, November 6, 2019).

In view of these clinical experiments, both the Tygerberg Hospital and the Johns Hopkins University Hospital are preparing special teams to perform new penis transplants.

Bioethical perspective

From a bioethical perspective, as we already said in our previous Report, “as long as the medical technique is considered safe, the bioethical judgment will have to be established based on the risk-benefit that the intervention entails. But as penis transplant, in our opinion, it is not a practice aimed at saving a life, but rather at improving its conditions, the bioethical reason to justify the transplant is that the intervention really improves the patient’s quality of life”. In the Report currently under discussion (see HERE) it is considered that, from a bioethical point of view, penis transplant poses a controversial dilemma, mainly due to the need to maintain the patient on lifelong immunosuppressive therapy, the organ donor shortage and the high economic cost of the process.

Transsexual penis transplant, gender reassignment surgery. The procedure needed has more risks and is more complex

One particular aspect of this type of surgical technique refers to transgender patients (women) who wish to undergo surgical gender reassignment. In our previous report, we commented that “a particular aspect occurs in penis transplant in the transgender community, since on this occasion the technical procedure may have more risks and be more complex than the previous cases, given that the transplant must be preceded by construction of the external urethra, construction of the scrotum and removal of the vagina. This circumstance means that the risk-benefit of this intervention must be considered more strictly.” Read offical guidline.

In the article presently discussed, when referring to the transgender population, it mentions only that this may be an additional group to whom penis transplant may be offered, but makes no medical or bioethical comment in this regard.

Justo Aznar

Bioethics Observatory – Institute of Life Sciences

A program to penis transplantation for injured soldiers

Related article but about transwoman, Gender reassignament surgery. Refashioning the male genitalia into a pseudo-vagina