Table of ContentsView AllTable of ContentsSuccessful Penis TransplantsCandidatesTypes of TransplantsDonor MatchingSurgerical ProcedureRecoverySupport and Coping
Table of ContentsView All
View All
Table of Contents
Successful Penis Transplants
Candidates
Types of Transplants
Donor Matching
Surgerical Procedure
Recovery
Support and Coping
Apenistransplant is a rare and complex procedure, with just five successful penis transplants worldwide as of 2023.There are additional cases of successful surgical reattachments after a traumatic injury, but these replantations are not the same as transplants from a donor.
Surgeons are developing techniques and policies for penis transplant. The Baltimore Criteria require recipients to be adults with loss due to trauma or cancer, or who were born with atypical genitalia. It is currently not available totransgendermales, though the possibility is under study.
This article explains the history of the penis transplants, who is a candidate, what to expect from surgery, and information about recovery.
David Sacks / Getty Images
The first successful penis transplant was performed in South Africa in 2014, involving a 21-year-old recipient who lost his penis due to a failed circumcision. It followed a failed attempt in China, in which the transplant was removed two weeks later. Other successes occurred at:
The Baltimore case involved a 30-year-old Afghanistan veteran who lost both legs and the penis due to an improvised explosive device (IED) attack and later received a donated penis andscrotumin a successful 14-hour operation at Johns Hopkins Medical Center.
Organ Transplants
Who Is a Candidate for a Penis Transplant?
So far, successful penis transplants have occurred in young males as well as a 64-year-old man who lost part of his penis to cancer.The criteria may vary depending on the facility. At Johns Hopkins, wounded veterans are considered if they have more than 75% genital loss from combat injuries.
The Johns Hopkins Medical Center program requires that a candidate has lost the penis due to trauma or cancer, or has atypical genitalia (likemicropenis). They should be:
The Baltimore Criteria, developed at Johns Hopkins, also require that candidates must have passed clinical, physical, and psychological assessments.
Other experts have weighed in on the criteria and suggested modifications moving forward. They include:
As the science evolves, it’s likely that further changes will be recommended and adopted.
HLA Typing: Purpose, Genetics, Procedure, Interpretation
Psychological Evaluation
A recipient of a penis transplant must be considered stable mentally, and be deemed stable in the following categories:
The partner must also be evaluated if the candidate is married or in a relationship. These evaluations can include tests like theMini-Mental Status Exam, and assessments to ensure informed consent.
Penis Transplants and Transgender RecipientsResearchers have demonstrated that a cadaver penis transplant from a male donor to a person with a female pelvis, including the urethra, blood vessels, and nerves, was successful. Though not yet available, penis transplant study groups continue to weigh the benefits and risks for potential transgender candidates.Advances in the surgery may make it possible.
Penis Transplants and Transgender Recipients
Researchers have demonstrated that a cadaver penis transplant from a male donor to a person with a female pelvis, including the urethra, blood vessels, and nerves, was successful. Though not yet available, penis transplant study groups continue to weigh the benefits and risks for potential transgender candidates.Advances in the surgery may make it possible.
What Is Gender Transitioning?
Types of Penis Transplant Procedures
Penis transplants are a type of procedure called vascularized composite allotransplantation (VCA). This means the transplant is done as a complete unit, with all of the skin, muscle, and other tissue. This can include the nerves and blood vessels grafted to the recipient.
For example, in the 2018 procedure at Johns Hopkins, the penis, scrotum, and part of the abdominal wall were transplanted together. Each case will be different: In the case in China, the recipient had his own vascular structures intact, while the IED explosion obliterated them in the soldier’s case.
The techniques also may need to be revisited. In one of the Cape Town cases, rejection of part of the transplant occurred after 32 months but it was again restored withskin graftreconstruction.
Donor Matching for a Penis Transplant
Those waiting for a penis donor can expect it to take weeks or months. The donor must be a match in several categories including:
Once the donor is located—utilizing a computerized organ donor matching system—the surgery can be scheduled. A person waiting for a penis donor may be called into surgery at a moment’s notice.
Organ Donation and GovernanceThe United Network for Organ Sharing is a nonprofit organization that manages nationwide organ donation for the United States government.
Organ Donation and Governance
The United Network for Organ Sharing is a nonprofit organization that manages nationwide organ donation for the United States government.
Donating Your Organs or Body to Science
What Happens During a Penis Transplant Surgery
Before a person undergoes a penis transplant procedure, a very rigorous screening process is performed.
The process includes lab testing and in-depth psychological evaluations, as well as comprehensive imaging to evaluate the person’s physical anatomy (such as the blood vessels and nerves) before surgery.Preoperative lab tests may include:
A penis transplant procedure is much more complex than many other types of transplants. Experienced surgeons, trained to perform microsurgery, work to transplant skin, muscles, and tendons, while connecting a vast network of very small blood vessels and nerves.
A team of specialists participate in planning and completing a penis transplant, including a urologist, cardiologist, infectious disease specialist, and more.
A recent discovery in the Baltimore transplant procedure involves taking a bone marrow sample from the donor and, before the procedure, infusing it (along with a low dose of immunosuppression medication) into the recipient’s body. This procedure lowers the risk of rejections of the new organ being transplanted.
Testicles and the Penis TransplantTesticles were not included as part of the penis and scrotum transplant in Baltimore. This was because, according to the experts, the sperm-generating tissue in the donor’s testicles would possibly cause the recipient’s reproduction system to involve genetic material from the donor.This could result in a possible pregnancy involving the donor as the biological father of future offspring. To avoid the ethical complications involved, the testicles were not transplanted.
Testicles and the Penis Transplant
Testicles were not included as part of the penis and scrotum transplant in Baltimore. This was because, according to the experts, the sperm-generating tissue in the donor’s testicles would possibly cause the recipient’s reproduction system to involve genetic material from the donor.This could result in a possible pregnancy involving the donor as the biological father of future offspring. To avoid the ethical complications involved, the testicles were not transplanted.
Testes Anatomy, Function, and Associated Conditions
Recovery from a Penis Transplant
Few penis transplants have been completed, but it appears recovery time can take up to six months, or longer. Even after recovery, transplant recipients will need to be monitored throughout their lives. They may need:
Questionnaires to evaluate the function of the GU (genitourinary system including the organs of the reproductive and urinary system). Experts look for:
Because of the limited number of penis transplant procedures that have been performed, there are no statistics on the long-term prognosis of the procedure yet. Results in the Boston and Baltimore cases have been excellent, however.
Organ RejectionPerhaps the most common and serious complication from a penile transplant is organ rejection, with the immune system attacking the transplanted tissue as a foreign threat, like a virus. A recipient is given immunosuppressant medications to fight this risk, but they become more vulnerable to infection.
Organ Rejection
Perhaps the most common and serious complication from a penile transplant is organ rejection, with the immune system attacking the transplanted tissue as a foreign threat, like a virus. A recipient is given immunosuppressant medications to fight this risk, but they become more vulnerable to infection.
Perhaps more than other types of transplant surgery, the emotional and psychological burden of having a penis transplant can be significant. The risk of transplant failure and rejection is considerable. A recipient can benefit from:
The recipient’s romantic partner or spouse should also be involved in professional counseling, and peer support groups are highly advisable.
Summary
Penis transplant is still rare, with just five successful cases in the world. But the science continues to mature, and it is emerging as a viable treatment option for penis loss due to trauma, cancer, or a congenital condition. Transgender people are not yet eligible but may be in the future.
A penis transplant is a complex procedure. Candidates need to go through extensive testing, including their psychological profile, and wait for a donor match. Organ rejection is a lifelong risk and requires maintenance medications. Your healthcare provider can discuss the option with you.
6 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.de Haseth KB, Gehrels AM, Widdershoven G, Bouman MB, van de Grift TC.Ethical considerations regarding penis transplantation surgery in transgender men-an empirical ethics study.Sex Med. 2023 Sep 14;11(4):qfad041. doi: 10.1093/sexmed/qfad041Tran AA, Machado BLC, Kuykendall KH, Spencer HJ, Scherzer ND, Almajed WS,et al.The Revised PENIS Score and proposal of the PACKAGE Checklist: a meta-epidemiologic study on penile amputation and replantation.Sex Med Rev. 2023 Jun 27;11(3):278-290. doi: 10.1093/sxmrev/qead005.Lopez CD, Girard AO, Lake IV, Oh BC, Brandacher G, Cooney DS,et al.Lessons learned from the first 15 years of penile transplantation and updates to the Baltimore Criteria.Nat Rev Urol. 2023 May;20(5):294-307. doi: 10.1038/s41585-022-00699-7.Szafran AA, Redett R, Burnett AL.Penile transplantation: the US experience and institutional program set-up.Transl Androl Urol. 2018;7(4):639-645. doi:10.21037/tau.2018.03.14Johns Hopkins Medicine.Penis Transplant Program.Nitkin K.First-ever penis and scrotum transplant makes history at Johns Hopkins.Dome. March/April 2018.
6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.de Haseth KB, Gehrels AM, Widdershoven G, Bouman MB, van de Grift TC.Ethical considerations regarding penis transplantation surgery in transgender men-an empirical ethics study.Sex Med. 2023 Sep 14;11(4):qfad041. doi: 10.1093/sexmed/qfad041Tran AA, Machado BLC, Kuykendall KH, Spencer HJ, Scherzer ND, Almajed WS,et al.The Revised PENIS Score and proposal of the PACKAGE Checklist: a meta-epidemiologic study on penile amputation and replantation.Sex Med Rev. 2023 Jun 27;11(3):278-290. doi: 10.1093/sxmrev/qead005.Lopez CD, Girard AO, Lake IV, Oh BC, Brandacher G, Cooney DS,et al.Lessons learned from the first 15 years of penile transplantation and updates to the Baltimore Criteria.Nat Rev Urol. 2023 May;20(5):294-307. doi: 10.1038/s41585-022-00699-7.Szafran AA, Redett R, Burnett AL.Penile transplantation: the US experience and institutional program set-up.Transl Androl Urol. 2018;7(4):639-645. doi:10.21037/tau.2018.03.14Johns Hopkins Medicine.Penis Transplant Program.Nitkin K.First-ever penis and scrotum transplant makes history at Johns Hopkins.Dome. March/April 2018.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
de Haseth KB, Gehrels AM, Widdershoven G, Bouman MB, van de Grift TC.Ethical considerations regarding penis transplantation surgery in transgender men-an empirical ethics study.Sex Med. 2023 Sep 14;11(4):qfad041. doi: 10.1093/sexmed/qfad041Tran AA, Machado BLC, Kuykendall KH, Spencer HJ, Scherzer ND, Almajed WS,et al.The Revised PENIS Score and proposal of the PACKAGE Checklist: a meta-epidemiologic study on penile amputation and replantation.Sex Med Rev. 2023 Jun 27;11(3):278-290. doi: 10.1093/sxmrev/qead005.Lopez CD, Girard AO, Lake IV, Oh BC, Brandacher G, Cooney DS,et al.Lessons learned from the first 15 years of penile transplantation and updates to the Baltimore Criteria.Nat Rev Urol. 2023 May;20(5):294-307. doi: 10.1038/s41585-022-00699-7.Szafran AA, Redett R, Burnett AL.Penile transplantation: the US experience and institutional program set-up.Transl Androl Urol. 2018;7(4):639-645. doi:10.21037/tau.2018.03.14Johns Hopkins Medicine.Penis Transplant Program.Nitkin K.First-ever penis and scrotum transplant makes history at Johns Hopkins.Dome. March/April 2018.
de Haseth KB, Gehrels AM, Widdershoven G, Bouman MB, van de Grift TC.Ethical considerations regarding penis transplantation surgery in transgender men-an empirical ethics study.Sex Med. 2023 Sep 14;11(4):qfad041. doi: 10.1093/sexmed/qfad041
Tran AA, Machado BLC, Kuykendall KH, Spencer HJ, Scherzer ND, Almajed WS,et al.The Revised PENIS Score and proposal of the PACKAGE Checklist: a meta-epidemiologic study on penile amputation and replantation.Sex Med Rev. 2023 Jun 27;11(3):278-290. doi: 10.1093/sxmrev/qead005.
Lopez CD, Girard AO, Lake IV, Oh BC, Brandacher G, Cooney DS,et al.Lessons learned from the first 15 years of penile transplantation and updates to the Baltimore Criteria.Nat Rev Urol. 2023 May;20(5):294-307. doi: 10.1038/s41585-022-00699-7.
Szafran AA, Redett R, Burnett AL.Penile transplantation: the US experience and institutional program set-up.Transl Androl Urol. 2018;7(4):639-645. doi:10.21037/tau.2018.03.14
Johns Hopkins Medicine.Penis Transplant Program.
Nitkin K.First-ever penis and scrotum transplant makes history at Johns Hopkins.Dome. March/April 2018.
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