Injured Veterans Approved for Penis Transplants: The Life-Changing Surgery No One Wants to Talk About

What do wounded veterans, South Africans, and transgender men have in common? All of them could stand to benefit from penis transplants.

The Journal of the American Medical Association (JAMA) announced Wednesday that Johns Hopkins Medicine plans to conduct 60 penis transplants on male veterans, over 1,300 of whom suffered urogenital injuries from 2001 to 2013. Eighty-six of those injuries were severe. If these experimental operations are as successful as the first viable penis transplant in 2014, doctors will consider opening up the procedure to more candidates.

For now, however, servicemen are the top priority. As JAMA notes, part of the ethical justification for selecting veterans is to repay them for their service. The surgery comes with risks of rejection—penis recipients will have to take immunosuppressant drugs for the rest of their lives—but transplants could help injured veterans start or grow families.

“You have a person who sacrificed part of their life for our society,” Dr. Craig Klugman, a DePaul University bioethicist, told JAMA. “That is one reason to go ahead.”

If these transplants become routine, there are plenty of other populations who need penises as well.

Botched circumcision rituals in South Africa took the lives of almost 500 young men from 2006 to 2014 in one province alone. Many men who survive the coming-of-age ritual lose their penis or must have it amputated due to unsanitary conditions. For instance, a young South African man interviewed by the Associated Press in 2014 was circumcised with the same spear that was used on over 12 other men. His penis became gangrenous and he had to be hospitalized as a result. JAMA notes that up to 250 similar cases come out of the country annually.

In fact, the first successful penis transplant was performed on a South African patient. As Kent Sepkowitz reported for The Daily Beast, a 21-year-old man lost his penis when the surgeon for his “initiation ceremony” accidentally cut off his entire penis instead of his foreskin. A team of surgeons, led by Dr. André van der Merwe, operated on him three years later for a staggering nine hours. It was a total success. The recipient has chosen to remain anonymous but he has full sexual and urinary function. He reportedly tells his surgeon, “I am happy again.”

For some transgender men, too, penis transplants may be preferable to the complex phalloplasty procedures that are currently available. Dr. Loren Schechter, a surgeon who performs such operations for transgender men told Out that complications from such surgeries can arise in 30 to 50 percent of cases. To surgically construct a penis, skin must be taken from other areas of the body and the urethra must be lengthened. Erections are possible with the help of a pump.

“We are thinking about how to move forward [with sex reassignment surgeries]; …that requires more discussions,” Johns Hopkins urology professor Dr. Arthur Burnett told JAMA.

But there’s reason to believe that if penis transplants were commonplace for injured soldiers, transgender men would quickly follow suit. Most recently, as Military Times reports, veterans who have lost their penises have received a radial forearm free flap phalloplasty, in which forearm skin and other tissue are used to construct a penis. This is also the most common type of phalloplasty for transgender men.

As JAMA notes, the surgical technology for a penis transplant is still in an experimental stage. The risks of such a procedure must be carefully considered and weighed against the benefits. And with new advancements in regenerative medicine—laboratory-grown vaginas are already a reality—the penis transplant may prove to be a stepping stone on the way to a more refined technique. But in the short-term, penis transplants could be life-altering for a diverse range of marginalized groups.