Are Penis Transplants Ethical?

Are Penis Transplants Ethical?
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Earlier this year, a young American veteran of the War in Afghanistan became the first person to receive a successful total penis and scrotum transplant. A medical team at Johns Hopkins Hospital performed the complicated, 14-hour procedure.

To date, five individuals have received penis transplants, one in China, two in South Africa, and two in the United States. Each event is vigorously reported in the popular press, but as is typical, the coverage often contains more cheerleading than context.

In a recent article published to the journal European Urology, Johns Hopkins University urologist Hiten D. Patel provides that missing context, along with some skepticism.

"In the wake of the world's fifth human penile allotransplantation, an important question resurfaces—what in the world are we doing?" he writes.

Patel believes that penile transplantation is a case where pushing the envelope is overshadowing ethics and clear consideration of the ramifications.

A glaring issue is that, unlike other organ transplants, which are physically needed for survival, a penis transplant is not.

"Ethicists have rightly challenged the audacity of performing non life-saving transplantations with a goal for vanity and appearance rather than preservation of life itself," admitted the team of surgeons at Harvard Medical School that was behind the first penis transplant in the U.S.

This point is made starker by the fact that reconstructive phalloplasty, in which a penis is surgically built from skin grafts, has advanced considerably over the decades. The procedure creates a highly functional member with complete urinary function, good tactile sensation, and even satisfactory intercourse and orgasm.

Moreover, phalloplasty avoids the lifelong administration of immunosuppressant drugs required by transplantation to ensure that the donor penis isn't rejected by the body's immune system. The costly regimen usually involves taking six to twelve powerful medications every day.

Still, phalloplasty falls short in one key respect: sex. True erections are not possible, and some sort of prosthesis is required for intercourse. This prosthesis can take the form of an inserted, malleable rod, which the owner of the constructed penis can bend up or down, or an inflatable implant inside the shaft controlled by a pump concealed in the scrotum.  On the other hand, penile transplantation offers the hope for full sexual function, although the hope hasn't yet come to public fruition.

"Of the five patients who underwent transplantations, only one patient is reported to have successfully engaged in intercourse thus far," Patel notes. "It is likely that men who are unable to achieve a sufficient erection after transplantation will ultimately require a penile prosthesis for sexual penetration."

Contradicting Patel's criticism are self-reports from the few patients who have received penile transplants. Per published reports, four of the five recipients expressed optimism and improvements to their mental health. However, the other patient did elect to have his donated penis removed. The small sample size and relatively short time for follow-up makes it difficult to draw any conclusions about penile transplantation thus far, and leaves the door open for criticism.

"[Penile transplantation] does not appear to be justified as a medical priority despite several planned procedures in the next few years," Patel argues. "The intended population is exceedingly small with less than five veterans in the US experiencing complete penile loss over 13 years. Men with pre-existing erectile dysfunction would derive no benefit, and young healthy men may not recover sufficient function for intercourse. Therefore, penile transplantation lacks both life-saving and life-enhancing properties when compared to a readily available alternative in phalloplasty with a penile prosthesis."

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