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Soldier wounded in Afghanistan receives historic penis transplant

More than 1,300 U.S. men fighting in Iraq and Afghanistan have suffered devastating injuries to the genitals, affecting self-esteem and identity. Now surgeons in Baltimore say they have performed a transplant of a penis, scrotum and part of the abdominal wall on an anonymous wounded soldier. Jeffrey Brown talks to Dr. Richard Redett of the Johns Hopkins University School of Medicine.

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  • Amna Nawaz:

    Now, a historic transplant for a soldier who was injured in Afghanistan and one that could potentially transform his life in important ways.

    Jeffrey Brown speaks with a key member of the team behind the surgery about its potential impact.

    A note for some viewers – our conversation is focused on sensitive issues involving the male anatomy.

  • Jeffrey Brown:

    They are horrific physical injuries that affect self-esteem and identity and are rarely even discussed. Between 2001 and 2013, more than 1,300 men fighting in Iraq and Afghanistan suffered devastating injuries to the genitals from bomb blasts.

    Now surgeons at the Johns Hopkins School of Medicine in Baltimore have announced the most complex transplant to date of a penis, scrotum and part of the abdominal wall from a deceased donor to a wounded soldier who has chosen to remain anonymous.

    The surgery was performed in March and involved 11 surgeons.

    One of them, Dr. Richard Redett, joins us now.

    And welcome to you.

    Doctor, first, why did you and your team feel this was important to do?

  • Dr. Richard Redett:

    Well, you know, we met our patient for the first time about five years ago.

    When we evaluated him and examined him, we realized that the losses of tissue was very significant. It involved part of his abdominal wall, his entire penis and his scrotum. And he had other neighboring injuries which really made conventional reconstruction almost impossible for him.

    At the about same time, we had started doing a penis transplant. He’s a great candidate, and a great person, and it all just made sense.

  • Jeffrey Brown:

    These kinds of transplants have been tried and done before, but what has been done and what made this one unique?

  • Dr. Richard Redett:

    There have been three prior penis transplants that we know about, two in South Africa, one in Boston. And those were partial or complete penis transplants.

    But what makes this so unique is that it involves the entire penis, the scrotum and part of his abdominal wall. And when these soldiers sustain these type of IED injuries, they get a big blast to the pelvis and they lose a lot of tissue.

    And we were able to replace exactly what he had lost with the donated tissue.

  • Jeffrey Brown:

    And I was reading connecting artery, veins, nerves. He’s expected, I understand, to be released from the hospital later this week. Is the hope of a return to urinary and sexual functions?

  • Dr. Richard Redett:

    We are confident that he will be able to urinate like he normally would and resume normal sexual function eventually.

  • Jeffrey Brown:

    And what — so, what is his status now?

  • Dr. Richard Redett:

    He’s in the hospital. He’s doing well. He’s up walking. We’re monitoring him for signs of infection or rejection, none of which he has.

    We’re sorting out his medications that he will take for his immunosuppression. He’s in good spirits. He’s doing really well.

  • Jeffrey Brown:

    You mentioned the immunosuppression, because that’s one of the big issues, isn’t it, whether the body will reject the transplant?

  • Dr. Richard Redett:

    Correct.

  • Jeffrey Brown:

    But explain that, because I think that means he is going to have to go through therapy for a long time, which also, I think, went to some of the ethical issues that were raised here.

  • Dr. Richard Redett:

    Right.

    When we started looking at this about five years ago, one of the common questions we would get is, how can you consider doing a penis transplant and placing a young man on immunosuppression?

    But until you meet one of these guys, and you realize what they have given to their country, what they have lost, it doesn’t make sense, but when you meet him and you sit down with him and you talk with him, it all makes sense. You know it’s the right thing to do.

    So, one of the things we have done here is, when we procure the graft from the donor, we also take the vertebral column, the bones that make up the spine. We grind that up. We extract the bone marrow cells and the stem cells, and we infuse that into our patient about two weeks after surgery.

    And that allows us to reduce pretty significantly the amount of immunosuppression that he will be on for the rest of his life. So, it’s our plan to send him home not on three medications, but only on one medication.

  • Jeffrey Brown:

    I gather there are other questions, ethical questions that came up about the cost, about the necessity of something like this.

    The hospital covered the cost in this case. How far ahead are you and your colleagues thinking about this kind of procedure, how routine it might become one day?

  • Dr. Richard Redett:

    Well, you know, I think the thing that holds us back right now is the immunosuppression.

    And I think, as we do more of these — and we’re seeing this with hand transplants and face transplants — it will become more acceptable, considered less experimental and a little more mainstream.

  • Jeffrey Brown:

    And the donor, we should say, wasn’t identified, nor was his cause of death.

    But the family issued a statement in praise and saying in his honor of what happened. Explain what you know of that.

  • Dr. Richard Redett:

    Well, you know, I think the family has some military connections. And when they heard that we were doing this on a soldier that gave so much for his country, I think it was a little easier for them to do it.

    Because there haven’t been many penis transplants done in the United States, it’s a difficult ask when you approach the donor family.

  • Jeffrey Brown:

    And just finally, I mentioned the more than 1,300 men in various cases like this. Can you see a wider — wider procedures?

  • Dr. Richard Redett:

    I can. I can see doing more of these in wounded warriors, servicemen that have been injured overseas.

    But I think, eventually, we will expand our indications to include people with other conditions as well. The Boston group did it on a patient that had removal of his penis for cancer. There are a lot of men that have significant birth defects that may benefit from this.

    So, I think, as we get more experience, we will expand the indications.

  • Jeffrey Brown:

    Dr. Richard Redett of the Johns Hopkins School — University School of Medicine, thank you very much.

  • Dr. Richard Redett:

    Thank you.

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