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Published On January 18, 2017

CLINICAL RESEARCH

Towards a Complex Transplant

These medical breakthroughs made a penis transplant possible.

1954: The First Organ

The era of human transplantation began when surgeons at Peter Bent Brigham Hospital in Boston removed a kidney from Ronald Herrick and implanted it in his identical twin, Richard, saving Richard’s life.

Because the two men were genetically alike, Richard’s body accepted the donor organ. That didn’t answer the question of how to avoid immune system rejection of an allograft—tissue donated from someone less closely related.

The problem was later solved by using total-body irradiation and bone-marrow replacement, procedures that stripped the body of its normal immune defenses, before the transplant of a kidney in a fraternal twin. The process was flawed, however, and many other surgeries failed.

1964: Noble Failures

The introduction of the immunosuppressive drugs azathioprine and prednisone in the early 1960s made it possible to transplant kidneys in unrelated recipients and was another vital step towards an eventual penile transplant.

In 1964, surgeon Robert Gilbert transplanted a cadaver hand onto a patient who had lost both hands. Despite treatment with these drugs, however, the recipient’s body rejected the hand and it had to be amputated three weeks later.

The failure of this procedure, and several animal experiments involving skin-bearing structures, led to the theory that these parts of the body were excessively prone to rejection. Interest in transplanting hands and other such body parts waned for several decades.

1977: Tiny Vessels

More than 100 men were documented as having had their own severed penises reattached—the first in 1929. But for much of the 20th century, surgeons could only stitch together the penis’s major structures—the corpora cavernosa, urethra and skin.

In successfully reattaching a severed thumb in 1965, however, Japanese surgeons used microvascular techniques. They used microscopes and extremely fine sutures to connect blood vessels as small as a millimeter in diameter, which allowed blood to flow again.

In 1977, two teams, including a group from MGH, reported cases in which they employed microsuturing to reattach severed penises, restoring blood flow, sensitivity and function.

1998: Better Protocols

Once microsurgical techniques and effective immunosuppressive drugs were available, surgeons began transplanting limbs in rats and pigs to learn more about complex transplants.

French doctors performed the first human hand transplant in 1998, transferring the right forearm of a man who had been declared brain dead onto a 48-year-old patient. While the operation was a technical success, the patient failed to regularly take needed immunosuppressing medicines and skipped physical therapy sessions. His body rejected the new hand, which doctors removed after 29 months.

This pioneering attempt at VCA transplantation ended in disappointment, but it underscored the importance of conducting a thorough psychiatric evaluation when identifying candidates for surgery.