Friday, May 20, 2016

First penile transplant in the nation

Manning with Heather Parker, NP, of MGH Plastic Surgery
PATH TO RECOVERY: Manning with Heather Parker, NP, of MGH Plastic Surgery

“Today, 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,” says Thomas Manning, 64, who, earlier this month, received the 
nation’s first penis transplant at the MGH. “If you tell the truth, you have 
nothing to worry about. I’m not ashamed at all.”

The genitourinary vascularized composite allograft (GUVCA) transplant surgery was performed by team of more than 30 MGH staff, led by surgeons Curtis L. Cetrulo, Jr., MDdivision of Plastic and Reconstructive Surgery and the Transplant Center, and Dicken S.C. Ko, MD, director of the MGH Urology Regional Program. The 15-hour operation involved surgically grafting the complex microscopic vascular and neural structures of a donor organ onto the comparable structures of the recipient. 

"Vascular Composite Allograft transplantation - at its core - relies upon a donor family with the strength to look past their own grief at the loss of a loved one and see the ability to provide hope to someone in need. In this case, too, a family experiencing a deep personal loss was able to say ‘yes’ to this donation and give health and well-being to another person. There are not words to adequately thank a family for the selfless gift of donation that forever changes the lives of strangers."

- Statement from the New England Organ Bank

The procedure represents the culmination of more than 3½ years of research and collaboration across multiple departments and divisions within the MGH – including Plastic and Reconstructive Surgery, Urology, Psychiatry, Infectious Disease, Nursing and Social Work – all of which are part of the MGH Transplant Center. Cetrulo and Ko together began researching the possibility of performing a GUVCA transplant in 2012, shortly after an MGH team led by Cetrulo completed its first hand transplant. Working closely with the New England Organ Bank, both surgeons developed key strategic surgical approaches aimed at helping patients with devastating genitourinary injuries.

At about the same time in 2012, Manning, a bank courier from Halifax, Massachusetts, experienced a devastating accident while at his job which crushed his genitalia. Subsequent follow-up after the accident revealed penile cancer, necessitating a curative partial penectomy – or amputation of the penis.

His physicians say Manning is recovering well, with blood flow established to the donor organ and no signs of bleeding, rejection or infection. While he is still early in the post-surgical healing process, his physicians say they are cautiously optimistic he will regain function.


Ko and Cetrulo
Ko and Cetrulo

“We are hopeful that these reconstructive techniques will allow us to alleviate the suffering and despair of those who have experienced devastating genitourinary injuries and are often so despondent they consider taking their own lives,” says Cetrulo. “The entire transplant team has worked tirelessly to ensure that our patient is on the path to recovery, thanks in part to the gift of organ donation.”

While individuals who have lost their penises to disease or who have suffered genitourinary injuries in combat or through a traumatic event can live without an intact organ, the psychological aspects of such an injury can be overwhelming, the surgeons say. The ability to offer a more acceptable long-term solution has been the motivation driving this research.   

These proof-of-principle cases will help establish the techniques used in this procedure and will forge the path to future treatment of patients with significant pelvic and genitourinary tissue loss related to cancer, trauma or infection,” says Ko.“We are delighted to have taken the first steps to help those patients who have suffered silently for far too long.”

Manning says he hopes to lend support to other victims of penile cancer, as well as veterans who have suffered genital injuries. “I want to thank the extraordinary medical team here at the MGH, who helped not only make this possible, but quite literally saved my life. I would also like to sincerely thank the family of the donor, whose wonderful gift has truly give me the second chance I never thought possible. In sharing this success, it’s my hope we can usher in a bright future for this type of transplantation.”

Read more articles from the 05/20/16 Hotline issue.

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