The idea came from the patient himself.
Devastated by a rare form of cancer that led to the removal of his penis in 2012, Thomas Manning asked his urologist to consider something radical and relatively untested.
“He just said, ‘Doc, if you ever do a penile transplant, I’m your man,’ ” recalled Dr. Adam S. Feldman of Massachusetts General Hospital. “I said, ‘You know, there might just be something here for you.’ ”
Earlier this month, Manning, a 64-year-old bank courier from Halifax, became the first patient in the United States to receive the delicate transplant after a team of seven surgeons, six residents, and more than 30 support staff at MGH completed an intricate 15-hour operation.
The medical milestone represented the latest advance in cutting-edge reconstructive surgery, which has seen doctors in Boston and across the world perform the first arm, hand, and face transplants over the last few decades.
Penis transplants, doctors said, could be used to restore some semblance of normalcy for catastrophic injury victims, men with penile cancer, and combat veterans who suffer from debilitating physical and psychological trauma associated with the loss of such an intimate organ.
Manning released a statement saying he hopes his transplant gives hope to wounded veterans.
“I begin a new chapter filled with personal hope and hope for others who have suffered genital injuries, particularly for our service members who put their lives on the line and suffer serious damage as a result,” he said. He thanked his medical team at Mass. General and the family of the anonymous donor, who died recently.
Penis transplants could also potentially benefit women transitioning to become men, although Dr. Dicken S.C. Ko, director of MGH’s Regional Urology Program, said that because of anatomical differences between the sexes, it would require a new set of studies to determine if that kind of transplant would be possible.
In a male transplant recipient, he said, “we’re using pre-existing wiring.”
Doctors said they are cautiously optimistic that Manning will be able to urinate normally within weeks and regain sexual function over the next several months. He is recovering well, they said, with blood flowing to the donor organ and no signs of bleeding, rejection, or infection. Still, he will have to be monitored closely and take medication to suppress his immune system and ensure that his body does not reject the new organ.
“There are multiple, multiple benchmarks before we can call this a wonderful, perfect operation,” Ko said.
Doctors in China attempted the first penis transplant in 2006, but removed the organ two weeks later after the patient and his wife suffered psychological problems. A patient in South Africa received the first successful penis transplant in 2014 and was later able to father a child with his girlfriend.
MGH doctors became interested in performing the surgery after hearing about the plight of young male combat veterans who had suffered horrific injuries to their genitals, said Dr. Curtis L. Cetrulo Jr., of the MGH Division of Plastic and Reconstructive Surgery.
“These patients are very despondent,” Cetrulo said at a press conference Monday. “They often consider taking their own lives. They don’t have much hope for intimacy going forward in their lives. And they’ve already sacrificed so much in the service of their country.”
Manning’s ordeal began four years ago when he suffered an unspecified groin injury in the mailroom at work and was rushed to the emergency room. Doctors discovered he had cancer of the penis, a rare diagnosis that affects about 2,000 men in the United States every year, Feldman said, and one that might not have been detected in Manning had it not been for the work accident. Doctors removed most of his penis in hopes of saving his life.
But Manning, who is not married, despaired that he had lost any chance of intimacy, and wanted a transplant. Three years later, the hospital’s internal review board approved the procedure, after considering the psychological and physical risks.
The New England Organ Bank located a donor and received permission from his family. On May 8 and 9, surgeons performed the operation, painstakingly connecting the intricate vascular and nerve structures of the donated organ to Manning’s body.
In completing the surgery, MGH edged out Johns Hopkins University School of Medicine, which announced last year that it was planning to perform the first penis transplant in the United States, on a veteran injured in Afghanistan.
Dr. David Cobourn Mulligan, chief of the transplantation surgery and immunology section at Yale University, said prominent medical centers across the country are competing to break barriers in the field.
“I have heard many try to clamor to be the first to do various transplants and I think, in a good way, everyone is trying to make the mark, and open that door, and light the Olympic torch that this can be done,” Mulligan said.
Still, there can be devastating setbacks: In March, the Cleveland Clinic announced that a 26-year-old woman who had received the nation’s first uterus transplant had to have the organ removed after suffering from a sudden complication.
Mulligan said the case was a reminder of the debate surrounding the transplantation of organs that may improve a patient’s quality of life, but are not necessary to survive.
“When a patient is having a life-saving organ failure, it really is easy to consider a transplant as a life-saving measure,” he said. “When it comes to these — hands, face, penis — we’re talking about a whole different ballgame, and what we’ve seen is . . . . we have to be aware of the risks.”Michael Levenson can be reached at email@example.com. Follow him on Twitter @mlevenson.