U.S. cancer patient Thomas Manning, 64, is the second man in the world to have received a penis transplant successfully. The procedure involved 12 surgeons, 30 other medical personnel, 15 hours on the table, three years of planning, five or six practice cadavers and, last but not least, one anonymous (deceased) donor. The team, operating out of Massachusetts General Hospital, is cautiously optimistic that the patient will see most of his functionality restored.
As the above video explains, this is more than just a salacious headline. It's been only a little more than 60 years since doctors conducted the world's first-ever successful organ transplant surgery (a kidney), and only 10 years since the world's first-ever penis transplant failed.
Penile cancer is a relatively rare disease, but according to one urologic oncologist's estimate, it causes hundreds of men in the U.S. alone to undergo a penectomy every year. That can be anything from a partial to a total removal of the penis.
And of course, cancer isn't the only thing that can necessitate a penectomy. In other cases around the world, the surgery is lifesaving after severe injuries and infections due to ritual adult circumcision gone wrong, traumatic accidents or warfare — experienced, for example, by an estimated 1,300 U.S. combat veterans.
Unsurprisingly, men who undergo partial or total penectomies sometimes experience what the scientific community terms poor psychological outcomes, including lowered rates of sexual satisfaction and withdrawal from social activities. According to one of Massachusetts General's surgical team leaders, Dr. Curtis L. Cetrulo, suicide rates are high in soldiers with severe pelvic damage.
“They're 18- to 20-year-old guys, and they feel they have no hope of intimacy or a sexual life,” Cetrulo told The New York Times in an interview. In one study of 30 patients with penile cancer, seven reported that in retrospect, they would have chosen a treatment with the risk of a decreased life span if it might have meant keeping their sexual function. (Others reported being satisfied; it depends on the case and patient in question.)
There are options for reconstruction after a penectomy: Skin and muscle taken from a patient's thigh or forearm can be fitted with a prosthesis to approximate sexual function, and researchers are working to create lab-grown penises for transplant. The former is reportedly cumbersome and prone to urologic dysfunction, and the latter is still in testing. Opening up the possibility of transplants from organ donors gives patients who want reconstruction a new option, though this procedure has difficulties, as well.
Any transplantation surgery is a massive physical undertaking: making cuts that don't damage tissue, preserving the organ to be transplanted and preventing the recipient's immune system from rejecting the organ. Psychological aspects also have to be managed for both the donor's survivors and the organ recipient. While preparing for what would become the world's first successful penis transplant, the South African medical team spent a year-and-a-half searching for an organ donor whose family would agree to the unusual request. And the reason that the first-attempted penis transplant failed was psychological: The surgery itself was without complication, but the recipient and his wife requested that the transplant be removed two weeks afterward, reporting high levels of distress.
Perhaps more important (if less scientific) than the current surgery's good physical outcomes, the patient seems to be in good spirits.