A veteran who received the world’s first penis transplant after losing his legs during an explosion in Afghanistan has revealed it was the ‘best decision he ever made’.
The US Navy corpsman, known only as Ray, was tending to wounded soldiers during an ambush by the Taliban when he stepped on a roadside bomb in 2010.
Ray, who is in his 30s, lost both his legs, genitals, and part of his abdominal wall and was forced to learn how to walk on prosthetic legs after the tragic accident.
The soldier revealed his life-changing injury – which he kept a secret except from loved ones – had even made him contemplate suicide.
But a year-and-a-half after the mammoth 14-hour surgery, Ray has almost regained full sensation in his new penis, and is able to get an erection and urinate.
The US Navy corpsman, known only as Ray (pictured after his operation in 2018), was tending to wounded soldiers during an ambush by the Taliban when he stepped on a roadside bomb in 2010
But in 2018, medics performed a groundbreaking 14-hour surgical procedure in the first of it’s kind ever performed at Johns Hopkins Medicine in Baltimore (pictured in 2018)
‘It was one of those injuries that really stresses you out and you think, “Why would I keep going?”,’ Ray said in an interview with MIT Technology Review. ‘I guess I always just kept this real hope that there’s an answer out there.’
But in 2018, medics performed a groundbreaking 14-hour surgical procedure in the first of it’s kind ever completed at Johns Hopkins Medicine in Baltimore.
‘This was actually something that could fix me,’ says Ray said. ‘I could go back to being normal again.’
‘I don’t regret it,’ he said. ‘It was one of the best decisions I ever made.’
Ray revealed he was walking his dog eight years after the accident when he received a call from his doctor who told him they had found a donor.
The infantryman raced into action while medics boarded a charted jet from Maryland to meet the donor – a brain-dead man – before transporting the penis on ice to the hospital to begin the 25-surgeon operation at 2am.
The complex surgery also involved transplanting the donor’s skin, muscles, tendons, nerves, bone and blood vessels
Surgeons had to stitch nerves, arteries, veins and blood vessels finer than human hairs from the transplant penis to Ray (pictured). It also involved some abdominal wall
In 2013, the veteran met with a plastic surgeon, Dr Richard Redett (see left) of Johns Hopkins Medicine in Baltimore, who said he was the perfect candidate for a penile transplant
The veteran’s transplant was the fourth in the world and the first involving a scrotum
Grafting a donor penis involves many different kinds of tissue, and requires using threads thinner than a hair to stitch nerves and blood vessels smaller than 2 millimeters wide.
‘We felt very confident we could do it, but we had never done it,’ said Dr. Richard Redett. ‘If you’re not anxious for something like that, you’re not thinking hard enough.’
They transplanted an entire penis, scrotum and part of the abdominal wall from a deceased donor. The donor’s testicles were removed for ethical reasons to avoid the risk of the patient having his babies.
The complex surgery also involved transplanting the donor’s skin, muscles, tendons, nerves, bone and blood vessels.
‘For him, it was almost either you do this transplant, or you live the rest of your life with your defect,’ said Redett.
Ray had to wait two days after surgery before he saw his transplant for this first time, describing it as ‘swollen’ and needing to heal.
‘In the back of your mind, you know this is a transplant, and you wonder if it’s going to be too much for you to handle. Once I went through with the surgery, all of those concerns just went away,’ he said.
The move is groundbreaking, and paves the way for the many other soldiers who have sustained genital injuries during combat.
‘We are hopeful that this transplant will help restore near-normal urinary and sexual functions for this young man,’ Andrew Lee, M.D., professor and director of plastic and reconstructive surgery at the Johns Hopkins University School of Medicine, in Baltimore, Maryland, said in 2018.
The team has been working towards this milestone for years. It is part of a major program to give 60 soldiers penis transplants.
There have been two penis transplants in the world to date. The first in China in 2006 was unsuccessful, while the second in South Africa in 2014 was a success. The South African patient, who is now 24, even fathered a child in 2016.
However, this is the first time a team has performed a total penis and scrotum transplant.
The patient started working with the Johns Hopkins team in 2012 as he refused to believe the military doctor who said there was no way back, according to the New York Times.
As with any transplant surgery, tissue rejection is a concern. The patient is on a regimen of immunosuppressive drugs to prevent this.
The team has developed an immune modulation protocol aimed at minimizing the number of these drugs needed to prevent rejection.
Ray was able to urinate again within just a few months after the operation, after the nerve endings started to grow.
DOCTORS REVEAL WHAT PENIS TRANSPLANT SURGERY ENTAILS
In 2016, Dr Richard Redett, director of pediatric plastic and reconstructive surgery at Johns Hopkins Hospital, and Dr Carissa Cooney, the department’s clinical research manager, explained what the penis transpant operation would entail.
How will the team identify a suitable donor?
Dr Redett said the organ will come from a deceased person, but added the person’s family will have to consent before the procedure can go ahead.
He said: ‘Many people might think that organ donation means unquestioned consent of all organs.
‘That’s not the case with the face, hand or penis.’
He added that once found, the donor tissue is evaluated on a variety of factors, inclidong blood type, age – within five to 10 years – and skin tone.
How do you identify which patients need a penis transplant?
Dr Cooney said as with other transplant operations, the patient has to be in good physical and mental shape,
She said psychiatric evaluations can take up to a year before a patient will be approved to have the operation.
‘There’s a significant loss with the initial injury that the patient has to overcome emotionally.
‘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 before the donor penis will be fully functioning?
Dr Redett said the first priority is to ensure the transplanted tissue has adequate blood supply, to prevent immediate rejection.
He said that should be apparent within a few days to weeks.
‘The next priority will be to regain function,’ he said.
‘Nerves grow at a rate of one millimeter per day, about one inch per month.
‘We anticipate that acheiving function, including urinary and sexual function, could take between six to 12 months.
‘If the patient’s testes are still present, he may even be able to father children.’
What precations are taken to try and prevent the risk of rejection?
Dr Cooney said the patient will be given immunosuppressive drugs follwing the procedure.
Ten to 14 days later he will receive 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 life, down to one pill twice a day,’ she explained.
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