Thomas Manning, who had 15-hour penis transplant surgery last week, is expected to regain normal urination and sexual functions.KAYANA SZYMCZAK/The New York Times
A 64-year-old cancer patient has received the United States' first penis transplant, a groundbreaking operation that may also help accident victims and some of the many U.S. veterans maimed by roadside bombs.
In a case that represents the latest frontier in the growing field of reconstructive transplants, Thomas Manning of Halifax, Mass., is faring well after the 15-hour operation last week, Massachusetts General Hospital said Monday.
His doctors said they are cautiously optimistic that Manning eventually will be able to urinate normally and function sexually again for the first time since aggressive penile cancer led to the amputation of the former bank courier's genitals in 2012. They said his psychological state will play a big role in his recovery.
"Emotionally, he's doing amazing. I'm really impressed with how he's handling things. He's just a positive person," Dr. Curtis Cetrulo, who was among the lead surgeons on a team of more than 50, said at a news conference. "He wants to be whole again. He does not want to be in the shadows."
Manning, who is single and has no children, did not appear at the news conference but said in a statement: "Today I begin a new chapter filled with personal hope and hope for others who have suffered genital injuries. In sharing this success with all of you, it is my hope we can usher in a bright future for this type of transplantation."
The identity of the deceased donor was not released.
The operation is highly experimental – only one other patient, in South Africa, has a transplanted penis. But four additional hospitals around the country have permission from the United Network for Organ Sharing, which oversees the country's transplant system, to attempt the delicate surgery.
The loss of a penis, whether from cancer, accident or war injury, is emotionally traumatic, affecting urination, sexual intimacy and the ability to conceive a child. Many patients suffer in silence because of the stigma their injuries sometimes carry; Cetrulo said many become isolated and despondent.
Unlike traditional life-saving transplants of hearts, kidneys or livers, reconstructive transplants are done to improve quality of life. And while a penis transplant may sound radical, it follows transplants of faces, hands and even the uterus.
"This is a logical next step," said Dr. W. P. Andrew Lee, chairman of plastic and reconstructive surgery at Johns Hopkins University School of Medicine.
His hospital is preparing for a penis transplant in a wounded veteran soon, and Lee said this new field is important for "people who want to feel whole again after the loss of important body parts."
Still, candidates face some serious risks: rejection of the tissue, and side effects from the anti-rejection drugs that must be taken for life. Doctors are working to reduce the medication needed.
Penis transplants have generated intense interest among veterans from Iraq and Afghanistan, but they will require more extensive surgery since their injuries, often from roadside bombs, tend to be more extensive, with damage to blood vessels, nerves and pelvic tissue that also will need repair, Lee noted.
The Department of Defence Trauma Registry has recorded 1,367 male service members who survived with genitourinary injuries between 2001 and 2013. It's not clear how many victims lost all or part of the penis.
A man in China received a penis transplant in 2005. But doctors said he asked them to remove his new organ two weeks later because he and his wife were having psychological problems.
In December, 2014, a 21-year-old man in South Africa whose penis had been amputated following complications from circumcision in his late teens received a transplant.
Dr. Andre van der Merwe of the University of Stellenbosch said that the man is healthy, has normal sexual function and was able to conceive, although the baby was stillborn. But his recovery was difficult, with blood clots and infections, the doctor said.
For congenital abnormalities or transgender surgery, doctors can fashion the form of a penis from a patient's own skin, using implants to achieve erection. But transplanting a functional penis requires connecting tiny blood vessels and nerves.
A bigger challenge than the surgery itself is finding donor organs.
"People are still reluctant to donate," van der Merwe said. "There are huge psychological issues about donating your relative's penis."
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Penis operation highlights past, future of organ transplants
Add one remarkable case to the 30,000-plus organ transplants expected to be performed across the United States this year: A cancer patient who received a donor penis.
Worldwide, there have been faces, tongues, hands, legs, uteruses – and now the third penis transplant, a first in the United States. Could any body part be left to transplant? Research is continuing for eyeballs, and one Italian doctor has raised eyebrows with talk of a brain transplant.
Still, the vast majority of operations involve more conventional organs.
Since the United States' first successful human organ transplant in 1954, involving a kidney, more than 700,000 organ transplants have been done nationwide. Kidneys are the most commonly transplanted (almost 18,000 U.S. operations were done last year) followed by livers (7,000) and hearts (nearly 3,000), according to the United Network for Organ Sharing.
Some of the more rare transplants.
Face
Since the world's first face transplant in France in 2005 on a woman mauled by a family dog, about 30 more have been done. These include a 26-hour operation last August at New York University's Langone Medical Center on a Mississippi firefighter whose face was charred in a fire. Other U.S. cases include a Connecticut woman who got a new face after a 2009 attack by a friend's chimpanzee.
Uterus
The first U.S. uterus transplant failed shortly after the Feb. 24 operation at the Cleveland Clinic, but others are planned. About 14 have been done worldwide, said Dr. Vijay Gorantla, medical director of the University of Pittsburgh reconstructive transplant program. These include a 2013 operation in Sweden resulting in the first reported live birth from a transplanted uterus.
Hand and arm
Hand and/or arm transplants have been done in more than 85 people globally, according to Johns Hopkins Medicine, a leading transplant centre. Its patients include the first U.S. soldier to survive losing all four limbs in the Iraq War, who had a double-arm transplant in 2013.
Gorantla said the first U.S. patient, a New Jersey man injured in a firecracker accident, still has total use of his donor hand 17 years after his operation.
Leg
Only three total leg-foot operations have been done worldwide, Gorantla said, but the operations are still experimental. U.S. centres researching the procedure include Brigham and Women's Hospital in Boston, where doctors say potential candidates could include amputees injured in the 2013 Boston Marathon bombings.
Future
Gorantla and his team have a $1-million-plus military grant to establish the country's first whole eyeball transplant program, with injured veterans among the potential candidates.
A doctor in Italy has talked of attempting human head and brain transplants but that raises complicated ethical issues and many mainstream scientists are skeptical.
– Lindsey Tanner, Associated Press