Penile transplantation: an emerging option for genitourinary reconstruction

Abstract

Penile transplantation is an emerging option for patients with severe genital defects not amenable to traditional reconstructive options. In this article, we discuss the burgeoning problem of severe male genitourinary trauma in the military, the limitations of traditional reconstructive options in addressing these problems, and the potential for penile transplantation to provide improved outcomes. We also review the preclinical research and limited worldwide experience with penile transplantation to date, including lessons learned, and discuss the many important technical, logistical, and ethical considerations pertaining to penile transplantation that must be addressed to maximize the likelihood of successful implementation.

The Baltimore Criteria for an ethical approach to penile transplantation: a clinical guideline

“…Over the course of six months, the group held several discussions to refine these considerations. Then, using the Montreal Criteria for Ethical Feasibility in Uterus Transplantation as a model, we created the Baltimore Criteria for an Ethical Approach to Penile Transplantation, which builds upon the foundation laid by prior recommendations while incorporating the current approach developed and used at Johns Hopkins.…”

“…Preliminary recommendations to help navigate such difficult issues have been previously proposed . These include recommendations regarding candidate selection, balancing benefits and risks, informed consent of the donor and recipient, use of a patient advocate and the funding implications of penile transplantation as a standard of care.…”

“…However, a lack of reconstructive options is not alone an indication for penile transplant. Previous recommendations emphasized penile transplantation as a last resort , following failed conventional reconstruction. Yet some have questioned the prudence of amassing failed reconstructive attempts before transplantation .…”

“…Although living donation is a medically and ethically accepted practice for certain life‐saving and life‐enhancing transplants , the use of such donors is not generally considered appropriate in penile transplantation due to the associated unacceptable loss of function suffered by the donor. Indeed, past recommendations have only discussed use of a deceased donor . Nevertheless, gender reassignment surgery offers a potential source of living donors.…”

“…For example, a research protocol has been developed that delineates the technical and logistical aspects of the procedure . In addition, some ethics protections have been employed for early penile transplants and recommendations regarding them have been offered . However, a more comprehensive ethical framework, akin to that which is available for uterus transplant that is often referred to as the “Montreal Criteria”, is not currently available for penile transplantation .…”