Ethical stakes of penile transplantation: A literature review

Abstract

Background: Vascularized composite allotransplantation has become an alternative reconstruction technique for patients with a severe loss of substance. Today, five human penile transplantations have been reported. The objective of this literature review is to offer an updated overview of the technical and ethical questions surrounding penile transplantation compared with conventional phalloplasty.

Material and methods: A systematic review was conducted of the literature from 2000 to 2020. A search of PubMed was performed using the keywords: "penile transplantation," "penis transplantation," and "penile vascularized composite allotransplantation." The criteria for the analysis were the type of study, surgical techniques, and ethical concerns.

Results: Thirty-six articles were selected. These articles include reviews, case report, editorials, and preclinical studies. The first article was published in 2003, but the number of articles has increased after the second human transplantation in South Africa in 2014. Surgical techniques and the medication management specific to each team were successful in the 5 transplant cases, but several complications were noted.

Conclusion: Two decades of successful penile transplantations have proven the technique to be a viable solution to treat a penile amputation, allowing for a better esthetic and sensitive outcome paired with the possibility of natural urinary and erectile functions. Psychological impact of penile transplantation, selection of patients, complications of immunosuppressive therapies, and surgical technicity are the biggest penile transplantation challenges. Further experimental studies are necessary to produce standardized protocols to safely include penile transplantation in the conventional treatment of a penile amputation.

Keywords: Ethics; Penile transplantation; Vascularized composite allotransplantation.