A veteran of the US Armed Forces UU He has a new penis and scrotum after the most extensive penis transplant to date, the Johns Hopkins Hospital announced this week. Not included in the transplant? Testicles: because the testicles would continue to produce the sperm of the donor in the body of the recipient of the transplant.
The patient, who asked Johns Hopkins not to reveal his name, suffered a devastating injury to the penis, testicles, part of the lower abdomen and legs in Afghanistan when an improvised explosive device exploded,  reports from the New York Times . A team of 11 surgeons replaced the injured flesh of their genitals and the lower abdomen with tissue from a deceased donor during a 14-hour surgery at the end of March, and the patient is recovering well, according to a press report on Monday. . But the transplant did not include the testicles, something the Johns Hopkins team decided from the start was off the table, says Damon Cooney, a professor of plastic and reconstructive surgery at the Johns Hopkins University School of Medicine.
Although Cooney was unable to discuss the details of the situation due to confidentiality, he said that people who lose their testicles usually choose to take testosterone to replace the hormones and receive testicular prostheses to restore appearance. Technically, a testicular transplant is possible, says Cooney, and would allow recipients to abandon hormone replacement therapy.
But the problem is that the transplanted organ could produce the genetic offspring of the donor. And without the consent of the deceased donor, that raises an ethical complication that Johns Hopkins wanted to avoid from the beginning. "If I had to transplant testes, that would make the donor not only a donor of body parts, but also a sperm donor," says Jeffrey Kahn, director of the Johns Hopkins Berman Bioethics Institute. "It's effectively a donation of sperm without consent, and that should not happen."
To understand how it is possible, it is useful to know a little about the testicle tubing. Early during the development of an embryo, the germ cells, which are basically cellular grandparents or great-grandparents of sperm, travel to the nascent gonads. These germ cells then divide to form stem cells that can produce more of themselves, and more of the cells that, through a series of divisions, produce sperm. Therefore, even if those testicles are transplanted into a new body, they will continue to produce sperm that carry the donor's DNA, explains Michael Eisenberg, a urologist at Stanford University.
"If someone who uses donated testes was able to conceive a child, the genetic material would be from the donor," says Cooney. "You can see why that raises ethical issues."
Ensuring that donor expectations align with reality is another reason why testicular transplants are off the table, at least for now. Most people who think about organ donation "think about donating their own tissues," says Cooney. "They do not think about donating genetic material that can be used to transmit genes to the next generation."
The American Society for Reproductive Medicine has clear guidelines on this, explains Valarie Blake, an associate professor of law at West Virginia University. "They basically say do not take reproductive material from a corpse unless they have your consent," she says. If the donor did not spell the written permission while he was still alive, the ASRM says that only the surviving spouse or partner can request that the sperm or eggs be collected after death.
So without the donor's permission during his life, taking his testicles would have been especially frightening, says Kahn. "You've turned that dead person into a sperm donor without their knowing it, so they could not have allowed it," he says. "You would cross a line: it is not just about restoring function: sexual and urinary function: you have given a person the ability to reproduce, but with the gonads of another person."