The United States is following in the footsteps of South Africa as surgeons are preparing to perform a penile transplant, which is expected to take place soon.
They are getting pointers from Professor Andre van der Merwe, the head of Stellenbosch University's division of urology, who led the groundbreaking procedure that was performed at Tygerberg Hospital in Cape Town.
An overwhelming response
"I am inundated with requests for penile transplant from across the world," he told Health24. He said in most cases the requested related to penile cancer, but also included traumatic loss of penis and congenital aphallia, which is the term for when a male is born without a penis.
"I have to disappoint all of them sadly as we only do this as part of a pilot study on South African citizens."
Read: Penis transplant – what the real focus should be on
However, Prof Van de Merwe has been sharing some pointers on penis transplants with his counterparts abroad. "Many surgeons wanted technical details, which I happily provided," he said.
"They wanted to replicate our process and all the steps needed to perform the transplant. A US centre has made good progress and I expect they should soon follow."
A penis donor from the US
Prof Van de Merwe noted that he even referred a potential donor to them from the US who wanted to donate a penis to South Africa.
He added that the 21-year-old male, who became the first person to have a successful penile transplant, continues to do well. He lost his penis after a traditional circumcision.
View: This graph illustrates how the penis was transplanted
As part of the study, nine more patients, who suffered the same fate, will receive penile transplants, but only after costing estimates are done.
"Cost analysis is in an advanced stage. Hopefully it's not to long before we can do the next one, but we need to learn all the lessons possible from the first case – who continues to do well." he said.
Prof Van de Merwe mentioned two aspects of many and this related to technical issues such as cooling the organ for preservation and which blood vessels to avoid at implantation.
Focusing on donors
He said a firm plan is also in place to recruit donors and this includes successfully counselling potential donor families.
"Men who wish to become organ donors can now consider to include organs such as the penis", said Dr Dimitri Erasmus, the chief executive officer of Tygerberg Hospital.
He explained to Health24 that they and their families can be reassured that their dignity will be maintained since part of the harvesting procedure includes the fashioning of a prosthetic penis.
Watch: Three key takeout points about the breakthrough transplant procedure
Dr Erasmus and Prof Van de Merwe also expressed appreciation for the praise the team received from the National Assembly in a congratulatory letter in March.
"The acknowledgement by the National Assembly is warmly welcomed," Dr Erasmus said.
Prof Van de Merwe added: "I feel it confirms that Stellenbosch University and Tygerberg Hospital are doing research of national relevance."
The planning and preparation for the study in South Africa started in 2010 and the procedure in December 2014 was the second time that a penile transplant was attempted. The first procedure was performed in China in 2006.
What was done differently this time?
What the South African team did differently from the Chinese, according to Prof van de Merwe, was to ensure that the penis was provided with a good blood supply.
"It appears the Chinese transplant had an infrared lamp postoperative to warm the penis," he said. "The fact that the penis needed to be warmed indicated that the blood supply was not very good."
He explained that this increased the metabolic requirements without supplying sufficient oxygen to tissue. This led to the skin becoming necrotic and making the organ look offensive – which the partner of the recipient couldn't bear and insisted that it be removed.
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