Penis Transplantation
Penile Allotransplantation, Vascularized Composite Allograft Reconstruction
Evidence grade 2 of 5, Thin. Read how the Atlas grades evidence.
The written rationale for this grade is still being prepared.
- FDA
- Investigational (small number of cases at specialized centers)
Reference only. Not medical advice.
What can go wrong
The procedure carries the risks of major microsurgery (thrombosis, hematoma, skin necrosis, graft failure) plus those of lifelong immunosuppression: infection, drug-related organ injury (including kidney injury), and increased malignancy risk. Acute rejection of the antigenic composite tissue is a constant threat. Psychological and ethical considerations are significant. It is an experimental procedure available only at specialized centers after rigorous evaluation.
This is something to take to a clinician. The Atlas can tell you what is known about penis transplantation in general. It cannot tell you what is happening in your body, and the difference matters most for exactly the symptoms that bring people to this page.
Penile transplantation is an experimental vascularized composite allotransplantation in which a deceased donor's penis is microsurgically transplanted to a recipient with catastrophic penile loss (from trauma, war injury, cancer, or complications of ritual circumcision). Only a small number have been performed worldwide. The first successful transplant was reported in South Africa in 2014; Massachusetts General Hospital performed a US transplant in 2016; and Johns Hopkins performed the first total penis-and-scrotum transplant on a wounded veteran in 2018. Reported outcomes include return of urinary and, in some cases, sexual function, but the procedure requires lifelong immunosuppression with its attendant risks, raises complex ethical and psychological considerations, and remains confined to specialized centers.
An experimental microsurgical transplant for catastrophic penile loss, a handful of cases worldwide, requiring lifelong immunosuppression.
What people take it for
These are the reasons people give for taking it. They are not effects it has been shown to have.
- Catastrophic penile loss
- Considered for traumatic amputation (including combat injury), complications of ritual circumcision, and oncologic resection where autologous reconstruction is inadequate.
- Specialized-center care
- Performed only at a few centers with vascularized composite allotransplantation expertise, extensive screening, and multidisciplinary teams.
- Comparison with phalloplasty
- Offers native anatomy and potential natural sensation/erection but requires donor tissue and lifelong immunosuppression; phalloplasty avoids immunosuppression but uses non-native tissue and typically an implant.
How it is supposed to work
The transplanted graft restores native penile anatomy that autologous reconstruction cannot fully replicate. Microvascular anastomosis re-establishes blood flow; nerve coaptation aims to restore protective and erogenous sensation and, over time, potentially natural erectile function through the transplanted erectile bodies. Immunosuppression (typically multi-drug regimens) prevents rejection of the antigenic composite tissue. This differs fundamentally from phalloplasty, which builds a phallus from the patient's own tissue and usually requires a penile implant for rigidity.
The graft is a vascularized composite allograft containing skin, the corpora cavernosa and spongiosum, urethra, and the dorsal neurovascular structures. Success requires microvascular anastomosis of the dorsal arteries and deep dorsal vein, coaptation of the dorsal nerves for sensory and potentially erectile recovery, urethral continuity, and corporal alignment. As a composite of multiple highly antigenic tissues (especially skin), it is prone to acute rejection and demands potent immunosuppression, unlike non-vascularized reconstruction with the patient's own tissue (phalloplasty).
Safety in detail
Penile transplantation is an experimental vascularized composite allotransplant performed at very few specialized centers and requires lifelong immunosuppression with serious documented risks. It is appropriate only after rigorous multidisciplinary evaluation; it is not a routine or widely available procedure.
What people get wrong
Often saidPenis transplants are a routine, widely available option
ActuallyOnly a handful have been performed worldwide. The procedure is experimental and confined to a few specialized centers with rigorous selection.
Often saidA transplant is the same as phalloplasty
ActuallyTransplantation uses donor tissue and restores native anatomy but requires lifelong immunosuppression; phalloplasty uses the patient's own tissue and an implant and avoids immunosuppression. They are different reconstructions.
Often saidThere are no major downsides if the surgery works
ActuallyLifelong immunosuppression carries real risks (infection, kidney injury, malignancy), and the procedure involves significant ethical and psychological considerations, including donor-tissue acceptance.
Who profits, and who pushes back
Nobody is named here yet, because we have not done that work on this entry. Read that as unfinished. Somebody almost certainly sells this, and somebody almost certainly disputes it. Assume both until we have checked.
How we got here
An early attempted penile transplant in China in 2006 was removed after about two weeks, reportedly for psychological and social reasons despite reasonable graft viability. The first clearly successful case came in South Africa in 2014, a setting with a high burden of ritual-circumcision injuries. Massachusetts General Hospital performed a US transplant in 2016, and Johns Hopkins extended the field with the first total penis-and-scrotum transplant for a wounded veteran in 2018. The field remains small, experimental, and ethically scrutinized.
- 2006Early attempted transplant in China removed after about two weeks
- 2014First successful penile transplant reported in South Africa
- 2016US transplant performed at Massachusetts General Hospital
- 2018First total penis-and-scrotum transplant at Johns Hopkins
At a glance
- Procedure type
- Vascularized composite allotransplantation (donor organ)
- First success
- South Africa, 2014
- US first
- Massachusetts General Hospital, 2016
- First penis-and-scrotum transplant
- Johns Hopkins, 2018 (wounded veteran)
- Requirement
- Lifelong immunosuppression
- Status
- Experimental; very few cases worldwide
What this entry does not yet cover
What follows is unfinished work on our side, not a finding about Penis Transplantation. A short entry is not a safe entry.
- Cost and market. We have not documented what it sells for or who sells it.
- Supply chain. We have not mapped where it is made.
- Who uses it. We have not documented the user groups.
- What could change. No forward-looking summary yet.
- How it compares. We have not set it against the alternatives.
- Children and teenagers. We have not checked what is known about younger people.
- Where we land. We have not taken a position on this yet.
Sources
The studies below are named and described, but not linked. You cannot open them from here and check our reading against them, which means this page is our summary of the literature rather than a document you can verify. Weigh it accordingly until the links exist.
The studies that matter
South African penile allotransplant report2014 to 2017
The first successful penile transplant restored urinary and sexual function in a young man who had lost his penis to ritual-circumcision complications; a second South African case followed, establishing feasibility.
Johns Hopkins total penis-and-scrotum transplant report2018
The first total penis-and-scrotum transplant in a combat-injured veteran restored urinary function with anticipated sexual recovery; reported complications included an arterial thrombus, infected hematoma, skin necrosis, and a later episode of immunosuppression-related kidney injury that was managed.