Most Complex Penis Transplant Ever Performed on Bomb Victim

Doctors at Johns Hopkins Hospital in Baltimore have performed the most extensive penile transplant to date, on a military veteran who was maimed by an improvised explosive device -- an operation that, while performed on a cisgender man, raises hopes for transgender men as well as questions about whether the surgery would be available to them.

The patient, whose name is being kept confidential, lost his genitals and both legs above the knee in the blast. In a 14-hour operation last month, doctors transplanted "a penis, scrotum and portion of the abdominal wall, taken from a deceased organ donor," The New York Times reports.

There had previously been successful penis transplants in 2014 in South Africa and 2016 in Massachusetts, "but they involved only the organ itself, not the scrotum or surrounding flesh," the Times notes.

Johns Hopkins is covering the costs of the surgery, estimated at $300,000 to $400,000, and the 11 surgeons involved worked for free, the Times reports. The Department of Defense did fund some of the research that led to the operation, and the doctors hope for additional grants from the department for future surgeries. They would also like to see insurers cover it, which they currently don't.

The doctors are optimistic that the man will regain urinary and sexual functions, including the ability to have an erection spontaneously and achieve orgasm, as nerves regrow in the transplanted tissue. He will not be able to father children, as testes were not part of the transplant. If the donor's testes had been transplanted, he would be the biological father of any children, and doctors said ethical considerations prevented them from including his testes in the operation.

Transgender men who decide to undergo a phalloplasty -- not all do -- have a penis constructed from their own skin and need implants to achieve an erection. This is also the procedure generally used on patients born with genital anomalies, notes an Associated Press/CBS News report.

The transplant surgery is obviously a boon to those who have suffered traumatic injuries or genital cancers, and undoubtedly some transgender men would like to have access to it as well. But the experimental nature of the procedure and the difficulty in finding a donor match -- the Johns Hopkins patient waited a year -- mean it won't be widely available any time soon.

The cost is also a barrier and raises questions about double standards in treatment for cisgender and transgender men. Politicians and activists who oppose allowing transgender people to serve in the military have cited, among other justifications for their position, the cost of gender-confirmation procedures, usually giving estimates far above those of neutral researchers. Studies from The New England Journal of Medicine and the Rand Corp. have projected the cost would be between $24 million and $84 million over 10 years, while right-wing groups have estimated it at $3.7 billion over the same period.

Advocate contributor Amanda Kerri, who is a transgender woman, weighed in on Twitter: