Man Receives First Penis Transplant in the United States

A man whose penis was removed because of cancer has received the first penis transplant in the United States, at Massachusetts General Hospital in Boston.
Thomas Manning, 64, a bank courier from Halifax, Mass., underwent the 15-hour transplant operation on May 8 and 9. The organ came from

a deceased donor.
“I want to go back to being who I was,” Mr. Manning said on Friday in an interview in his hospital room. Sitting up in a chair, happy to be out of bed for the first time since the operation, he said he felt well and had experienced hardly any pain.
“We’re cautiously optimistic,” said Dr. Curtis L. Cetrulo, a plastic and reconstructive surgeon and a leader of the surgical team. “It’s uncharted waters for us.”
The surgery is experimental, part of a research program with the ultimate goal of helping combat veterans with severe pelvic injuries, as well as cancer patients and accident victims.
If all goes as planned, normal urination should be possible for Mr. Manning within a few weeks, and sexual function in weeks to months, Dr. Cetrulo said.
Mr. Manning welcomed questions and said he wanted to speak out publicly to help dispel the shame and stigma associated with genital cancers and injuries, and to let other men know there was hope of having normal anatomy restored.
“Don’t hide behind a rock,” he said.
He said he was not quite ready to take a close look at his transplant.
He will have to take several anti-rejection drugs for the rest of his life. One of them, tacrolimus, seems to speed nerve regeneration and may help restore function to the transplant, Dr. Cetrulo said.
Another patient, his penis destroyed by burns in a car accident, will receive a transplant as soon as a matching donor becomes available, Dr. Cetrulo said.
Surgeons at the Johns Hopkins University School of Medicine are also planning to perform penis transplants, and have had a combat veteran, injured in Afghanistan, on the waiting list for several months.
Dr. Cetrulo estimated the cost at $50,000 to $75,000. Both hospitals are paying for the procedures, and the doctors are donating their time.
Worldwide, only two other penis transplants have been reported: a failed one in China in 2006 and a successful one in South Africa in 2014, in which the recipient later fathered a child.
Veterans are a major focus of transplant programs in the United States because suicide rates are exceptionally high in soldiers with severe damage to the genitals and urinary tract, Dr. Cetrulo said. “They’re 18- to 20-year-old guys, and they feel they have no hope of intimacy or a sexual life,” he said. “They can’t even go to the bathroom standing up.”
Given the psychological toll, he said, a penis transplant can be lifesaving.
Dr. Cetrulo said the team would most likely perfect its techniques on civilian patients and then move on to injured veterans. It will also train military surgeons to perform the transplants. The Department of Defense, he said in an email, “does not like to have wounded warriors undergo unproven techniques — i.e., they do not want them to be ‘guinea pigs,’ as they have already sacrificed so much.”
His team is working on ways to minimize or even eliminate the need for anti-rejection medicines, which transplant patients typically have to take. That research is especially important for veterans, he said, because many are young and will risk serious adverse effects, like cancer and kidney damage , if they have to take the drugs for decades.
From 2001 to 2013, 1,367 men in the military suffered so-called genitourinary injuries in Iraq or Afghanistan, according to the Department of Defense Trauma Registry. Nearly all were under 35 and had been hurt by homemade bombs, commonly called improvised explosive devices, or I.E.D.s. Some lost part or all of their penises.

The Massachusetts General team spent three years preparing for the penis transplants. The team did meticulous dissections in a cadaver lab to map out anatomy, and operated on five or six dead donors to practice removing the tissue needed for the transplants. Mr. Manning’s operation involved about a dozen surgeons and 30 other health care workers.
Dr. Dicken Ko, a team leader and the director of the hospital’s regional urology program, said the team had not planned a set number of transplants. Instead, he said, the hospital would evaluate candidates one at a time and decide whether to allow surgery. For now, he said, the transplants will be limited to cancer and trauma patients, and will not be offered to transgender people.
An accident at work in 2012 brought Mr. Manning to the hospital, and ultimately to the transplant team. Heavy equipment had fallen on him, causing severe injuries. The doctors treating him saw an abnormal growth on his penis that he had not noticed.
Tests revealed an aggressive and potentially fatal cancer.
Penile cancer is rare, with about 2,030 new cases and 340 deaths expected in the United States this year.
If not for the accident, Mr. Manning said, “I would’ve been in the ground two years ago.”
Doctors said that to save his life, they would have to remove most of his penis, in an operation called a partial penectomy. Mr. Manning’s urologic oncologist, Dr. Adam S. Feldman, estimated that a few hundred men a year needed full or partial penectomies because of cancer.
Mr. Manning was left with a stump about an inch long. He had to sit to urinate. Intimacy was out of the picture. He was single and was not involved with anyone when the cancer was found. After the amputation, new relationships were unthinkable. “I wouldn’t go near anybody,” he said.
He continued: “I couldn’t have a relationship with anybody. You can’t tell a woman, ‘I had a penis amputation.’”
Some people close to him urged him to keep the operation a secret, but he refused, saying that was like lying, and he had nothing to be ashamed of.
“I didn’t advertise, but if people asked, I told them the truth,” he said, adding that a few male friends made “guy talk” jokes at his expense, but that it toughened him up.
“Men judge their masculinity with their bodies,” he said.
Before he had even left the hospital after the amputation, he began asking Dr. Feldman about a transplant. No one at the hospital was considering the idea yet, and Dr. Feldman admits that he thought it was a bit outlandish.
But Mr. Manning never gave up hope. “I kept my eye on the prize,” he said.
Soon Dr. Cetrulo and Dr. Ko began talking about transplants. About three years later, Dr. Feldman called Mr. Manning to ask if he still wanted the operation.
After a battery of medical tests, interviews and psychological grilling — typical for transplant candidates, to make sure they understand the risks and will take anti-rejection medicine — Mr. Manning was on the waiting list. Two weeks later, a donor with the right blood type and skin tone became available.
Mr. Manning was stunned that it had happened so fast. Dr. Cetrulo credits the New England Organ Bank, which asks families of some dying patients to consider organ donation. The organ bank said the donor’s family wished to remain anonymous but had extended a message to Mr. Manning saying they felt blessed and were delighted his recovery was going well.
Organ banks do not assume that families who donate internal organs like kidneys and livers will also be willing to give visible, intimate parts like a face, hands or a penis. Those requests are made separately. Several families have agreed to allow the penis to be removed, and none have declined, said Jill Stinebring, the organ bank’s regional director of organ donation services.
So far, Mr. Manning has had one serious complication. The day after his surgery, he began to hemorrhage and was rushed back to the operating room.
Since then, his recovery has been smoother, he said. He has no regrets. He looks forward to going back to work and hopes to eventually have a love life again.
“If I’m lucky, I get 75 percent of what I used to be,” he said. “Before the surgery I was 10 percent. But they made no promises. That was part of the deal.”