AB002. Human penile allotransplantation: an emerging option for major genital loss

Reconstruction of complex functional structures is increasingly being performed with vascularized composite allotransplantation. This reconstructive approach has been used successfully to replace complex functional tissues including the face, hands and limbs. At this time, penile transplantation is under consideration for vascularized composite allotransplantation. Indications for penile transplantation include severe penile tissue loss and congenital penile malformations. Additionally, although traditionally not considered an indication for penile transplantation, its role in gender reassignment surgery has been increasingly considered. Penile transplantation offers an alternative to autogenous reconstruction, particularly when the latter option is disadvantageous on the basis of limited donor tissue availability as well as complexity of surgical revision that commonly is associated with autogenous reconstruction. It is recognized that phalloplasty techniques should achieve such goals as a normal appearing phallus, a mode for successful urinary transport and natural erection ability with sensation. Penile transplantation may offer an alternative for complex genitourinary reconstruction meeting objectives of phalloplasty. However, consideration must be given to various challenges, including ethical and psychosocial considerations as well as concerns of immunosuppression and surgical anatomical complexity. A multidisciplinary approach involving urologic and plastic surgeons, mental health specialists, bioethicists and perioperative clinical providers is essential for establishing a clinical program that offers this therapy.