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Q&A: Penile Transplantation

Johns Hopkins experts Richard Redett and Carisa Cooney discuss their attempt at the first penis transplant in the U.S.

carisa cooney and richard redett

Many soldiers returning from combat bear visible scars, or even lost limbs, caused by blasts from improvised explosive devises, or IEDs. However, some servicemen also return with debilitating hidden injuries — the loss of all or part of their genitals. Now, within weeks to months, the Johns Hopkins reconstructive surgery team that once performed the hospital’s first bilateral arm transplant will attempt the first penis transplant in the United States.

While it’s possible to reconstruct a penis using tissue from other parts of the body, there is no possibility for a spontaneous erection with that approach. A prosthesis implant can be used to achieve an erection, but that comes with a much higher rate of infection. Additionally, due to other injuries, servicemen often don’t have enough viable tissue from other parts of their bodies to work with.

To learn more about the procedure, we sat down with Richard Redett, director of pediatric plastic and reconstructive surgery, and Carisa Cooney, the department’s clinical research manager.

How will the team identify a donor for the transplantation?

Redett: The tissue will come from a deceased person whose family agrees to the donation. Many people might think that organ donation means unquestioned consent for donation of all organs. That's not the case with the face, hand or penis.
All organ donations have to be done specifically through an organ procurement organization (OPO). In this case, we are working with The Living Legacy Foundation. Unlike with donation of the heart, kidneys, liver or lungs, a request for donation of the hands, arms, face or penis is made separately. The family has to specifically consent to such a donation. Once the local OPO finds a family who is willing to donate, we are notified and make a decision if the donor will fit our criteria.
The donor tissue is evaluated based on a variety of factors specific to the recipient, including blood type, age (within five to 10 years) and skin tone.

How do you identify a good candidate for penile transplantation?

Cooney: As with reconstructive transplants of the hand, arm or face, the patient has to be a good candidate physically and mentally. Psychiatric evaluations for patients can take up to a year.
There’s a significant loss with the initial injury that the patient has to overcome emotionally, so we make sure to have a psychiatrist, who is also an expert in psychosexual disorders, on the team.
If the patient has a significant other when he begins working with our team, we also work to educate that person on what to expect. We can’t guarantee the outcome or the extent of urinary function, erection, and ability to have sexual intercourse or have children.

How long do you anticipate it will be before the donor penis is fully functioning?

Redett: The first concern will be that the transplanted tissue has an adequate blood supply and is not immediately rejected. That is generally known within a few days to weeks. The next priority will be to regain function. Nerves grow at a rate of 1 millimeter per day, about 1 inch per month. We anticipate that achieving function, including urinary and sexual functioning, could take between six to 12 months. If the patient’s testes are still present, he may even be able to father children.

What precautions are taken to ward against potential rejection?

Cooney: To minimize the risk of rejection, we will give one immunosuppressive medication to the patient at the time of the transplant. After about 10 to 14 days, they will get a bone marrow infusion from the donor. By doing that, we have been able to reduce the number of anti-rejection medications the patient will have to take for the rest of his or her life down to one pill twice a day.

What is the scope of the genital transplant program?

Redett: The Johns Hopkins Genital Transplant Program is initially focusing on post-traumatic deformities, such as battlefield injuries in wounded warriors, as many of these men have other injuries which make conventional penile reconstruction not feasible.

The Johns Hopkins University will fund the first penile transplant, which could happen within weeks to months, depending on the availability of a donor. The university has approved a total of 60 surgeries for this project.

To request an appointment and learn more about penile transplantation, contact us at 443-997-1583.

The penile transplant project is considered a clinical trial and is made possible because of contributions from a team of specialists, including psychiatrists, psychologists, urologists, plastic surgeons, anesthesiologists, a nurse transplant coordinator, hematologists, infectious disease specialists, immunosuppressive therapy experts, dermatopathologists and bioethicists. (IRB#NA_00089306)

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