Be Well, Marsha 2/16/16

Another transplant frontier

By Marsha Bonhart

Modern medicine is miraculous and its use is nothing short of marvelous. The more the medical community learns and experiments, the longer we live productive lives. One of those therapies is organ transplantation and a recent endeavor in that area is helping severely injured military servicemen return to their families, whole.

In this country, it will be used specifically for soldiers who have suffered enormous injuries from bomb blasts in the Middle East. We have become used to seeing our soldiers with missing limbs, but now there is attention focused on a nearly unmentionable—restoring the use of a damaged or missing penis. Penis transplants have not yet been performed in the United States, but some doctors at Johns Hopkins School of Medicine in Baltimore say they are preparing to train for the delicate, intricate operation.

New York Times reporter Denise Grady writes that in a few months, medical specialists will begin figuring out how to give the surgically transferred penis urinary function, sensation and the ability to have sex. We know that from 2001 to 2013, nearly 14 hundred of our military men serving in Iraq or Afghanistan suffered wounds to their genitalia because of IEDs, or improvised explosive devices.

“To be missing the penis and parts of the scrotum is devastating,” says Dr. Richard Redett in the NYT article. He is in charge of the Johns Hopkins pediatric reconstructive surgery. “These guys have given everything they have.” Doctors also agree these kinds of injuries are not always physical. They make up what is considered the hidden, psychological wounds that are connected to perceived male self worth. Sgt. First Class Aaron Causey was stationed in Afghanistan when he lost both legs, a testicle and part of another to an IED explosion. He did not lose his penis in the warfare, but said to Denise Grady, “I don’t care who you are—military or civilian, you have an injury like this, and it’s more than a physical injury.” In fact, wives of military men who had urogenital injuries interviewed at a conference last year, that the health status eroded their husbands’ sense of manhood and identity. But given that psychological trauma, how can the injured man consider how his most intimate part belonged to another man?

A recently deceased organ donor, with the permission of family, will have his penis removed. The urethra, as well as major blood vessels and nerves have to be intact and will be connected together, using a microscope.  The nerves are expected to grow from the recipient at about one inch per month and that depends on the extent of the injury. A successful operation will be marked by full sexual function. The testes will not be transplanted. That leaves room for the recipient to be able to father a child who is genetically connected to him. Because sperm are produced in the testes, the men who have lost them will not be able to father children but will be able to have a penis transplanted.

Johns Hopkins’ Dr. W.P. Andrew Lee was quoted in the article as saying, “these genitourinary injuries are not things we hear or read about very often. I think anyone would agree it is as devastating as anything that our wounded men suffer, for a young man to come home in his early 20s with the pelvic area completely destroyed.”

One such transplant was tried and failed in China several years ago; there was a successful one in South Africa, recently. Reporter Grady reveals the recipient of the penis in the China surgery apparently psychologically rejected the transplant after photographs showed patches of dead skin which indicated a blood flow problem.  But the South Africa patient has become a father.  “Our young male patients would rather lose both legs than have a urogenital injury.” That comment is from the poly-trauma social work department supervisor at a veteran’s medical facility in northern California. In fact, doctors who treat these injured men say they wake from surgery and want to first know if their genitals are there—no matter what their other injuries are.

The Johns Hopkins surgeons have permission to try 60 of the operations at first. One of several problems associated with the risk of this surgery is bleeding, infection and the possibility that the anti-rejection meds will hike the chance of cancer.

Right now, the experiment is reserved for men injured in combat. But doctors expect it will be the next level asked for in gender re-assignment. In fact, a similar surgery is being performed on transgender men. That process takes tissue from the patient’s own body, but in this case, erections aren’t possible without an implant. Doctors say those implants shift position and cause infection.

So far, Johns Hopkins has a few men being evaluated for the surgery with only one ready to actually move forward. The hospital will cover the finances for that operation. Each operation is estimated to cost between 200 and 400 thousand dollars, taking about 12 hours to perform.

Detractors say transplants should be reserved to save lives. But doctors can argue the unchallenged necessity for hand transplants. The question is whether function is equally as important as a patient’s psychological need to feel whole.

Be well,

Marsha

Marsha Bonhart is a freelance writer and public relations/marketing consultant in the Dayton area. She can be reached at MarshaBonhart@DaytonCityPaper.com.    

 

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