As Transplants Expand To Faces And Genitals, Ethical Questions Arise

[TexasTowelie]

A badly-injured veteran who lost his genitalia after being hit by a roadside bomb in Afghanistan is the recipient of the first-ever transplant of a penis and a scrotum, according to doctors at Johns Hopkins University.

Between this groundbreaking surgery and a man’s second facial transplant earlier this month, Medical Ethicist Art Caplan says we’ve entered into an unprecedented realm of transplant surgery, with life-changing operations that come with a bundle of ethical qualms regarding the risk, cost, long-term effectiveness and rarity of such procedures.

“We have a procedure in place that says that when somebody dies, if you’re going to use their face, their penis, their uterus [or] their limb, then you need permission from the family and you try to get someone to sign a donor card — but I’m sure there are a lot of people who hadn’t thought about that aspect of organ donations,” Caplan told Boston Public Radio Wednesday. “You think kidneys, and liver and heart … but not other parts. This new world is raising some questions about giving people more choices.”

Caplan adds that organ transplants require toxic drugs that impact other body parts and eventually shorten people’s lives, even while preserving them.

Read more: https://news.wgbh.org/2018/04/25/boston-public-radio-podcast/transplants-expand-faces-and-genitals-ethical-questions-arise

[JoeOtterbein]

1. Darn! Unlike Trump's.... I was hope to make mine a bit....

....a better and bigger HEART!!!

[sarah FAILIN]

2. I guess I'm shallow.

If someone needed their scrotum or ovaries I would have a problem with that. I wouldn't want strangers having my grandchildren and possibly being mean to them. I wouldn't want them to lose their faces either. Internal organs such as heart liver and kidneys I'm ok with.

[Mariana]

3. Best not sign the donor card, then

and make sure your family know you'd rather not donate your organs if you can't pick and choose which ones you're willing to donate.

[sarah FAILIN]

8. Nobody would want my face or ovaries

I was meaning my answer for my kids, but I talked to them after seeing this. They agree. Donating what makes babies and their face is too far for our family.

[Mariana]

10. The ovaries and testicles don't appear to be going on, yet.

The scrotum that man received probably didn't include the testicles. Some people probably wouldn't mind, though. We have living people who donate sperm and eggs, and that isn't much different.

[dawg day]

51. It's a compassionate act, no matter what body part is involved

A friend of mine can see again because she got a corneal transplant. That's a great kindness from one family to another.

[MrsCoffee]

26. A face would not look the same on another skull.

It's just skin with holes in it.

[Codeine]

36. But when the poor bastard learns he

can’t grow a decent, non-patchy beard with my face he’s gonna be so pissed!

[MrsCoffee]

39. Haha!

[JI7]

5. i don't think people need ovaries to live or function in life in basic ways.

[sarah FAILIN]

9. I didn't think they needed a scrotum and penis for basic life either

Yet here we are. They did that.

I can see ovary donation being a thing for infertile women.

[LisaL]

18. Because the person who lost it wanted it done.

[dawg day]

53. If you're a 20-year-old soldier who lost his sexual organs to a bomb--

Well, it's a pretty basic part of life. I'm happy for the young man. I hope everything works!

[LisaL]

60. Well, exactly.

There are other articles about this surgery. The recipient is a young man who was facing being alone the rest of his life due to his injury. I am sure it's worth it to him.

[Ilsa]

72. That depends on age, pre- or post-menopausal, and

if hormone replacement therapy is available.

https://taylormedicalgroup.net/hormones/estrogen-and-progesterone

Hormones estrogen and progesterone, secreted by ovaries, help maintain bone density during replacement cycle, and affect other organs, keeping them functioningproperly.

[JI7]

88. ok, i understand now. i wouldn't have a problem donating

[JI7]

4. if/when i die people can take whatever they want of me if it means an improvement in their lives

Last edited Mon Apr 30, 2018, 07:02 PM - Edit history (1)

my driver's license shows i am a donor and i think it should include everything.

[uppityperson]

6. ++++++++ However..

Me too. Use whatever because it'll be doing me no good.

However, why transplant a penis and have to use anti-rejection meds? Can't they make a new one one out of skin from I don't know where?

[sarah FAILIN]

7. No

And that is the point of this article. Too many muscles involved to make one out of skin. So to take the penis, they take the things that go with it which provides the genetic material for babies.

[Mariana]

11. The article doesn't say testicles were transplanted. nt.

[sarah FAILIN]

17. The scrotum is pretty much just a package for the testes

It doesn't make sense to me that they took it without the contents.

Scrotum — The scrotum is the loose pouch-like sac of skin that hangs behind the penis. It contains the testicles (also called testes), as well as many nerves and blood vessels. The scrotum has a protective function and acts as a climate control system for the testes. For normal sperm development, the testes must be at a temperature slightly cooler than the body temperature. Special muscles in the wall of the scrotum allow it to contract (tighten) and relax, moving the testicles closer to the body for warmth and protection or farther away from the body to cool the temperature.

[SoCalNative]

47. They likely used silicone implants

for the testicles as they would be easier to work with and stretch the skin around.

This also potentially opens up avenues for transgendered individuals (specifically the female to male individuals) who really have very poor and unsatisfactory options for lower surgery for gender reassignment. And it's pretty much guaranteed that they would not be able to procreate with the transplanted organs.

[herding cats]

69. They didn't use the testes for ethical reasons.

I've read that in several articles.

Please, don't go sensational over something as important to others as this wifthout knowin the facts.

[sarah FAILIN]

73. The article posted did not say that

How else would these ethical questions arise as the articles says?

Maybe this article is more about the potential issues than a single specific case?

[herding cats]

74. It's an old argument which doesn't apply in this case.

The first penis transplant was done in China if I recall correctly, it was reversed by the patient after he and his wife had issues dealing with the fact.

A couple of years ago there was talk of helping soldiers who'd lost their penis in the line of duty. The plan was to only use the organ, not the testes. If these are successful then in a few years the recipient can actually feel and function sexually again. At a steep price, though. The very nature of a transplant means the anti-rejection drugs will be slowly killing the recipients. This isn't a fun and games surgery. It's a deadly serious situation where helping to ease life threatening depression (the most common symptom of such a loss) outweighs the extremely serious risks.

This is just more of people trying to poison the pool for those in need. Thank you for listening.

[MineralMan]

12. Oh, my.

First, the penis contains virtually no muscle tissue. Second, cosmetic penises are constructed all the time for transgender surgery. Finally, neither the penis nor the scrotum has nothing to do with generating sperm cells. It is simply a delivery system for such cells.

So far as I know, the testes are not included in these penis transplants.

It's important to understand what is actually happening, rather than guessing.

[uppityperson]

13. Thank you

[MineralMan]

14. Knowledge is Good!

I saw a sign to that effect somewhere.

[sarah FAILIN]

15. Well why bother then?

If a realistic fake penis is so easily made, why take one from a cadaver then and have to take medication for rejection?

You are wrong about the amount of muscle also. Here is a link with the anatomy spelled out with the function.

http://teachmeanatomy.info/pelvis/the-male-reproductive-system/penis/

As for the scrotum, that contains the testes. The sole purpose of the scrotum is to contain and protect the testes. Why would they need it without the contents?

Scrotum — The scrotum is the loose pouch-like sac of skin that hangs behind the penis. It contains the testicles (also called testes), as well as many nerves and blood vessels. The scrotum has a protective function and acts as a climate control system for the testes. For normal sperm development, the testes must be at a temperature slightly cooler than the body temperature. Special muscles in the wall of the scrotum allow it to contract (tighten) and relax, moving the testicles closer to the body for warmth and protection or farther away from the body to cool the temperature.

https://my.clevelandclinic.org/health/articles/9117-male-reproductive-system

[LisaL]

16. Testes were removed prior to transplant for ethical reasons.

If they weren't removed, potentially the recipient could have generated children that were not his but those of his dead donor.

[sarah FAILIN]

19. And that is my issue

I wouldn't want my grandkids being raised by someone that might be mean to them.
I did not see where it said the testes were removed in this story, just that it raised ethical issues.

[LisaL]

20. They were removed based on what has been reported.

This isn't the only story about this particular surgery.

[sarah FAILIN]

30. Sorry.

This is the only story about it that I read since it was posted here.

[Codeine]

22. Two seconds with Google answered your question.

https://www.google.com/amp/s/www.theverge.com/platform/amp/2018/4/26/17286728/penis-scrotum-transplant-surgery-us-veteran-johns-hopkins-testicles-ethics

A veteran of the US Armed Forces has a new penis and scrotum after the most extensive penis transplant yet, Johns Hopkins Hospital announced this week. Not included in the transplant? Testicles — because the testicles would continue to make the donor’s sperm in the transplant recipient’s body.

[Ms. Toad]

27. another source

The surgery, which took place over 14 hours on March 26, was performed by a team of nine plastic surgeons and two urological surgeons. The penis and scrotum (without testicles) and partial abdominal wall came from a deceased donor. The recipient is a military veteran who was injured by an improvised explosive device (IED) blast in Afghanistan and wishes to remain anonymous. The hospital said he has recovered from the surgery and will be discharged from the hospital this week.

http://time.com/5250397/penis-transplant-johns-hopkins-university/

[Hekate]

35. Such injuries have been a feature of wars since at least the dawn of explosive devices...

...and this is the first war in which there was hope for a more normal male life upon recovery.

[tblue37]

44. Anonymous? The linked article includes the recipient's name a picture. nt

[LisaL]

46. That's a different guy.

[mythology]

43. That's an odd view

The theoretical kids wouldn't really be your grandkids. You wouldn't know if they even exist. Being a parent is only a small amount about dna. It's about what someone does. There's a reason my step dad gets the call on father's day and I haven't talked to mybiological dad in nearly 20 years.

Also not to disparage your kids, you can't actually guarantee that they would be nice to your grandkids.

[dawg day]

58. Exactly. It's loving and nurturing that makes you a parent--

not sperm donation.

[sarah FAILIN]

68. It's not odd to me at all.

I was extremely close to my grandparents and even my great grandmother who lived with them till she died. I was with all of them when it was their time to go. I took my grandparents to their shopping, doctors visits and anywhere they needed to go. We lived next door and basically did everything with them.

I hope to have grandchildren of my own one day and I will spoil them rotten most likely. I would rather one of my kids have an abortion than to have a baby and give it up for adoption. I just do not like it. I don't believe in selling sperm or eggs either. Given to infertile siblings is one thing, but selling for money isn't my cup of tea. While I know adoptive parents can be wonderful parents, blood is blood to me. If I knew I had a grandchild somewhere, it would worry me that the baby was not being taken care of or even abused. No matter where that clump of cells landed, it would still be turning into someone with a connection to me and I feel like a grandparent still has a lot to give to a child.

This is the point of the article imo. Ethical questions arise when donating genitals..

[JI7]

89. do you also feel you wouldn't love an adopted grandchild as much ?

[sarah FAILIN]

90. Not what I said

I care for all children.

People here are acting like they are just extra donated tissue, not me.

[ecstatic]

63. Thanks for clearing that up. That would

have been truly creepy!

[MineralMan]

49. Those penises that are constructed from scratch

Do not function the same as a natural one. Penile function, particularly sexual function, is important for most men. Psychologically, especially. A chance to restore normal function is now possible. You ask, "Why bother?" I'd encourage you to think about it a little more.

[sarah FAILIN]

71. I was being facetious.

I know the need for this sort of thing is real, but the moral red line is taking testes or ovaries without it being specifically given, it is not part of a blanket donation to me. That is why the article is titled as it is imo.
I can see a brother or sister, mother or father donating that sort of material, but it really bothers me to think a stranger could have my grandchildren without my permission which as next of kin would be mine to give.
When an organ donor passes, the usable organs are harvested and the family is given the rest of the body for burial. The doctors don't keep a body forever to see how much tissue they can harvest.
Maybe organ donation needs to be clarified as to what is donated before we agree blindly.

[SoCalNative]

48. The cosmetic penises

may be constructed for transgender surgery, but the results are less than satisfactory and it's basically nothing more than skin from one's forearm or inner thigh stretched around a plastic tube.

[MineralMan]

50. Yes. Exactly. Not the same at all.

[dawg day]

54. A penis doesn't provide genetic material-- just delivers it

And sperm is created constantly (unlike eggs, which are there from early in life). So if the testicles are transplanted and can create sperm (which is unlikely), it's not going to be the donor's sperm.

Lots of men donate sperm anyway-- it's an act of compassion, not a theft.

[LisaL]

56. Well, that's not what the article says.

Testicles were removed because the recipient could have generated children that were the donor's and not his.

[MineralMan]

66. That's incorrect. Sperm cells would always have the donor's genes.

https://en.m.wikipedia.org/wiki/Spermatogenesis

[Codeine]

21. People are selfish and stupid.

You’re fucking dead. The notion that it’s better to let your body parts rot or be burned than to allow those parts to be used to make another life whole is sickening to me.

We’re just meat puppets — there’s nothing about you so important that it deserves to be discarded upon death just to maintain peace of mind for a mind that has ceased to exist. It’s like saying you don’t want somebody else’s car to be able to drive if it requires parts from your crashed car.

It’s all just parts. Even if it contains your genetic material, who cares? You are no longer around to use it.

[wonkwest]

23. Now I have a very weird question

I assume science would never go along with this due to ethical concerns, but you just know this question is going to arise at some point:

If someone were to get a successful testicular transplant, whose kid would that be? I don't have knowledge enough of biology to know the answer here. But, theoretically, would the DNA of the sperm be from the donor? How would that legally fly?

I know in this case it's a scrotum transplant. I assume there will be synthetic testicles inserted for aesthetic reasons.

But it's a creepy question nonetheless.

Upon reading the article, my morbid sense of humor envisioned people penis shopping. Making the best out of a horrible situation. "Ooh, an upgrade!" Yeah, there is something wrong with my brain.

[Codeine]

24. It would be the donor genes.

That’s what the testicles would produce.

[wonkwest]

25. I'm just imagining the legal clusterfark

I hope, but don't have 100% faith in, that doctors wouldn't agree to that sort of thing because of the ethicsal and legal questions that would arise.

[Ms. Toad]

28. From a legal perspective,

it would be dealt with the same way children of donor insemination are handled.

My daughter has a biological father who is not her legal father.

Not really any different.

[Codeine]

32. Exactly this.

Honestly, if you aren’t involved in the process of creation in any way (because your ass is dead) then those aren’t going to be your children in any real sense, genetics be damned.

[wonkwest]

45. Thanks for the input, but a few more questions that might arise

I just wonder if the donor's family would have to sign off on it, or if it became an actual procedure, whether or not a donor would have to sign consent for the possibility of future children having their DNA. What happens if the donor's family objects?

Those kinds of questions percolate in my head thinking on the issue.

[dawg day]

59. Hmm... do sperm donors have to get their parents' permission

DNA is nothing. Good lord. There are medical students who have donated "DNA" dozens of time. You think they are paying child support or something to all those kids? You think their parents are filing custody suits to get to see the "grandchildren"?

The parents who are staying up all night nursing a sick child are the parents. The grandparents who babysit are the grandparents. DNA is nothing compared to love.

[Ms. Toad]

75. Funny you should mention that . . .

My daughter's biological father was a medical student at the time.

Not even his wife had to sign off on his donation.

My daughter (now an adult who found him via 23 and me) has been welcomed into his family. But there are no legal ties. We don't get child support, they don't get mandatory visits.

[Ms. Toad]

77. Legally, the donor makes the decision.

As a courtesy (and to avoid litigation, even if without merit), the donor's family is typically asked to make the final sign-off.

But - legally - why would the parents of a deceased child have any more right to control where that child spreads his DNA than when he was alive?

Extending your thinking would a sperm bank that stored the donations from someone who died must seek consent from the parents for the donation made while he was living?

[Codeine]

29. I guess I just have a more utilitarian philosophy.

I just don’t feel the slightest qualm about issues like that. If body parts can benefit somebody who has been injured or harmed by disease then they should be used, full stop. The delicate sensitivities of the perpetually concerned should be of no consequence when someone can be made whole and given back some semblance of a normal life.

[wonkwest]

52. Part of my questioning is due to personal experience

A few months ago, my best friend approached me with the idea of being the sperm donor for a child. She and her husband have recessive genes that give their own biological offspring a 25% chance of contracting a fatal genetic disease.

I had to think very hard about the question. While she had no expectation of any responsibility on my end (the husband would legally adopt the child and I live across the country from them), I felt a certain responsibility. It's hard to articulate, but the idea I was responsible for bringing a life into the world weighed very heavily. I ultimately declined. Some people can do it no problem. I'd feel a burden in the back of my mind if I'd gone through with it. I'd feel responsible towards the child.

Being adopted, there's also issues of ancestry and medical history. I met my biological family and had those questions answered. That's also important for me.

But everyone is different. Some people probably wouldn't mind it in the slightest.

[LisaL]

55. This couple could do genetic embryo testing to eliminate the embryos that have the genetic defect.

It would cost a bunch of money but they can have a disease free biological child of both of them that way.

[wonkwest]

62. Money and religion are concerns

They don't have the cash for it, and they're both pretty Catholic.

Thanks for suggestion though =)

[dawg day]

57. Whose kid? The parents are the ones who raise the child

We know that. Parents who adopt children are real parents. Parents whose children came from donated sperm or eggs are parents.

Let's not fetishize a bit of DNA when a lifetime of love is what matters.

[wonkwest]

79. Oh, I'm not

I'm adopted, so I know a family is more than DNA.

I'm just curious about where issues of consent come in.

[jberryhill]

76. Parentage is not determined by whose DNA is involved

Did you know that in many states, if a married woman has a child, then the child is presumed to be that of the couple, and in time (300 days in California) that becomes a non-rebuttable presumption?

[wonkwest]

78. What do you think of the donor implications?

If someone signs the back of their license, are they tacitly agreeing to the use of their testicles/sperm in the creation of a child?

I'm just curious to know if a donor's family would have some avenue to veto it.

It's something I've never thought about, and now I'm intensely curious about where law and ethics would intersect on the question.

[jberryhill]

80. I'm just curious to know if a donor's family would have some avenue to veto it.

No. Zip. Zilch. Zero. Nada.

The testicles, and the DNA in them, belong to the owner - i.e. the recipient. The donor had the entire right to assign the entire right and interest in those body parts, fluids and future functions, to whomever was to become the recipient. That's what organ donation is all about.

That's why I was pointing out to you that legal parentage is not about DNA.

You might as well ask whether the family of someone who puts a child up for adoption has any right to "veto" it. And it is why I brought up presumed parentage.

You can go sleep with someone's wife - and KEEP your penis and testicles all your own - and if she bears a child, and she and her husband don't want it to be your child, then it is NOT your child and never will be. And it is certainly not some relative's of yours. You don't have a right to visit that child or claim parentage in any way.

We do it with living breathing children. If we are talking about sperm... no freaking way. If it makes you feel better, just consider all of the sperm to be "adopted".

[wonkwest]

81. That is really, really interesting.

I had no idea about this:

"You can go sleep with someone's wife - and KEEP your penis and testicles all your own - and if she bears a child, and she and her husband don't want it to be your child, then it is NOT your child and never will be."

I'm gay, so I'm never really going to have to deal with these issues. I was merely curious. Thanks so much for taking the time to answer and provide this information. I appreciate it.

[jberryhill]

83. I don't know why you would never have to deal with these issues

My grandchild, born to my daughter and her wife is just about two years old now.

If you mean parentage "issues" generally, then I'll give you one:

You marry your partner. Unbeknownst to you, your partner made an improperly structured sperm donation to the woman of a straight couple. Her husband, the sole breadwinner of that couple, dies during her pregnancy. At birth, she identifies you as the father, and is seeking child support from your partner. Question: to what extent is that now one of "your" problems?

[wonkwest]

85. I feel like I've read about cases where support has been awarded

I suppose the question is - and I don't know the legal answer - when does the husband legally acquire rights to the child? At conception or birth? Assuming the donation contract is void because it was improperly crafted, it feels like any legal answer will hinge on that determination. I'm going to assume there's precedent here somewhere.

[jberryhill]

86. It can depend on the state

Nobody is the parent of a child until it is born.

That's why you don't see people running around asking to see Obama's "Conception Certificate".

[wonkwest]

87. Then the answer I'd give . . .

Is that my partner would be on the hook for child support.

[Hekate]

31. When I'm done with my body, any usable spare parts may go to those in need...

That's Plan B. Plan A is I use it up myself and die at the century mark, right?

I've had a signed donor card since about 1973.

The "face" thing creeps people out, but I am sure that by the time the transplant is attached to an entirely different skull, the face will no longer be recognizable to the late donor's family and friends. What a wonderful thing for someone who has been living with a serious mutilation to be able to breathe normally, talk, eat, kiss, and to walk outside in the fresh air without being stared at. What a miracle -- equal to when they discovered the much simpler procedure of how to transplant corneas and make the blind see.

The sexual/reproductive organs are different only in kind, not degree. A usable womb -- that is, one that might carry a baby to term for a woman who had a hysterectomy at an early age, doesn't come with ovaries. The genetic material must come from elsewhere -- such as the recipient's own ovaries, or a donor. Penises get constructed for transgender men every time, though again, a man who lost his through war or accident might rather have a transplant if it can be made to function as before. That does not mean genetic material comes along with it. Men who have had testicular cancer have been known to receive a "filler" that makes their scrotal sac look normal again.

I think that if an organ donor was worried about their specific genetic materiel they could certainly carry a card that made that explicit, as people do who only want their corneas taken.

[milestogo]

40. True, the face does not look the same.

The recipient is still disfigured.

[VOX]

33. Tough to decide between the *Forrest Tucker Model* or the full *Uncle Miltie*...

It’s a tough pick between pride and overkill.

Esoteric, I know. Most boomers will probably comprehend.

[Codeine]

38. Doc, can you make sure I can go the Full Monty? nt

[VOX]

61. *Horse by name, horse by nature, eh?*

I love that movie. And yes, doc, let’s do it up right.

[X_Digger]

34. Meh, take any bit you need. I won't need it anymore. n/t

[milestogo]

37. Donating one's body means donating the whole body unless specific exclusions are made.

This is still a transitional phase between cadaver donors and parts grown in a lab.

[Codeine]

41. I want my whole body used.

Like literally, reanimate that shit like some kind of goddamned necromancer.

[misanthrope]

42. We're Elysium bound anyway

Sooner or later those of us on the bottom of society will learn to shut up and be content being farmed by our betters.

[TomSlick]

64. I'm late to the discussion but....

I was relieved of years of exquisite pain by a cornea transplant because someone signed a donor card. Donors' don't need the organ or tissue being transplanted. Transplants save and improve lives.

This question doesn't warrant navel gazing. Sign the card!

[Codeine]

65. I really hope that when I go

that my leftovers can be used to help people like yourself, and that if I need help that others will be thoughtful enough to make sure donor tissues are in supply.

I can’t understand why anyone WOULDN’T want to help in this way.

[TomSlick]

67. I agree.

I am forever grateful that someone I didn't know gave me a gift that changed my life.

I'm now old and broken down and suspect any of my leftovers would be of little benefit to anyone. Nevertheless, I'm a donor.

[Hekate]

82. I am so glad to hear that. As I said upthread, I won't need my bits when I'm gone. nt

[thucythucy]

70. My driver's license says I'm an organ donor

and I always assumed that meant "use whatever you can for whomever you can."

Although, considering the state of my body right now, it's probably not the world's most attractive offer.

Still, I'd be more than happy to know I was helping out in whatever way I could, because that's what my ethics tell me to do.

[Bucky]

84. Ooooo...! I want a wiener transplant. Make it a double! Give me a big one for the weekdays and...

a good pisser for the weekends when I go camping.