Skip to main content

Lessons learned from the world’s first successful penis allotransplantation


We performed a successful penis allotransplantation on 11 December 2014. Sharing the lessons learned might help more patients in need to be treated this way. We divided the project into manageable segments that was each overseen by an expert. The ethical review and conduct paved the way for a publically acceptable and successful project. Screening for a psychological stable recipient is important. The most difficult part of the project was finding a donor penis. This was successfully negotiated with the family of a brain dead donor by creating a neo-phallus for the donor, thereby maintaining the dignity of the donor. Working with transplant coordinators that are sympathetic to aphallic men is crucial. Surgeons versed in microvascular techniques is a critical part of the team. Transplant immunologists have to adapt to treat composite tissue transplantation patients.

Graphical Abstract

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2


  1. Bramstedt KA. Increasing donation opportunities for vascularized composite allografts: an analysis of worldwide donor registries and procurement organization web content (VOLAR Study). Prog Transplant 2016. (Epub ahead of print) doi:10.1177/1526924816664080

  2. Hu W, Lu J, Zhang L, Wu W, Nie H, Zhu Y, et al. A preliminary report of penile transplantation. Eur Urol. 2006;50(4):851–3. Oct

    Article  Google Scholar 

  3. Clark PA. Face transplantation: part II-an ethical perspective. Med Sci Monit. 2005;11(2):RA41–RA47.

    Google Scholar 

  4. Wendler D, Grady C. What should research participants understand to understand they are participants in research?. Bioethics. 2008;22(4):203–8.

    Article  Google Scholar 

  5. Basch SH. Damaged self-esteem and depression in organ transplantation. Transplant Proc. 1973;5(2):1125–7.

    Google Scholar 

  6. Castelnuovo-Tedesco P. Organ transplant, body image, psychosis. Psychoanal Q. 1973;42(3):349–63.

    Google Scholar 

  7. Castelnuovo-Tedesco P. Ego vicissitudes in response to replacement or loss of body parts. Certain analogies to events during psychoanalytic treatment. Psychoanal Q. 1978;47(3):381–97.

    Google Scholar 

  8. Rome HP, Braceland FJ. The role of ACTH, cortisone and hydrocortisone in the provocation of certain psychologic responses. Res Publ Assoc Res Nerv Ment Dis. 1953;31:273–9.

    Google Scholar 

  9. Tuffaha SH, Sacks JM, Shores JT, Brandacher G, Lee WP, Cooney DS, et al. Using the dorsal, cavernosal, and external pudendal arteries for penile transplantation: technical considerations and perfusion territories. Plast Reconstr Surg. 2014;134(1):111e–9e.

    Article  Google Scholar 

  10. Tuffaha SH, Budihardjo JD, Sarhane KA, Azoury SC, Redett RJ. Expect skin necrosis following penile replantation. Plast Reconstr Surg. 2014;134(6):1000e–4e.

    Article  Google Scholar 

  11. Hui-Chou HG, Nam AJ, Rodriguez ED. Clinical facial composite tissue allotransplantation: a review of the first four global experiences and future implications. Plast Reconstr Surg. 2010;125(2):538–46.

    Article  Google Scholar 

  12. Petruzzo P, Dubernard JM. The international registry on hand and composite tissue allotransplantation. Clin Transpl 2011;247–253.

  13. Siemionow MZ, Kulahci Y, Bozkurt M. Composite tissue allotransplantation. Plast Reconstr Surg. 2009;124(6S):327–339.

  14. Lee WPA, Yaremchuk MJ, Pan YC, Randolph MA, Tan CM, Weiland AJ. Relative antigenicity of components of a vascularized limb allograft. Plast Reconstr Surg. 1991;87(3):401–11.

    Article  Google Scholar 

  15. Gander B, Brown CS, Vasilic D, Furr A, Banis JC, Cunningham M, et al. Composite tissue allotransplantation of the hand and face: a new frontier in transplant and reconstructive surgery. Transplant Int. 2006;19(11):868–80.

    Article  Google Scholar 

  16. Hsu CC, Chang SS, Lee PC, Chao SC. Cutaneous alternariosis in a renal transplant recipient: a case report and literature review. Asian J Surg. 2015;38(1):47–57.

    Article  Google Scholar 

  17. Gilaberte M, Bartralot R, Torres JM, Reus FS, Rodriguez V, Alomar A, et al. Cutaneous alternariosis in transplant recipients: clinicopathologic review of 9 cases. J Am Acad Dermatol. 2005;52(4):653–9.

    Article  Google Scholar 

  18. Nankivell BJ, P’Ng CH, O’Connell PJ, Chapman JR. Calcineurin inhibitor nephrotoxicity through the lens of longitudinal histology: comparison of cyclosporine and tacrolimus eras. Transplantation. 2016;100(8):1723–31.

    Article  Google Scholar 

  19. Naesens M, Lerut E. Calcineurin inhibitor nephrotoxicity in the era of antibody-mediated rejection. Transplantation. 2016;100(8):1599–600.

    Article  Google Scholar 

  20. Ojo AO, Held PJ, Port FK, Wolfe RA, Leichtman AB, Young EW, et al. Chronic renal failure after transplantation of a nonrenal organ. N Engl J Med. 2003;349(10):931–40.

    Article  Google Scholar 

  21. Lim WH, Eris J, Kanellis J, Pussell B, Wiid Z, Witcombe D, et al. A systematic review of conversion from calcineurin inhibitor to mammalian target of rapamycin inhibitors for maintenance immunosuppression in kidney transplant recipients. Am J Transplant. 2014;14(9):2106–19.

    Article  Google Scholar 

  22. Morris PJ, Bradley JA, Doyal L, Earley M, Hagan P, Milling M, et al. Facial transplantation: a working party report from the Royal College of Surgeons of England. Transplantation. 2004;77(3):330–38.

  23. Agich GJ, Siemionow M. Facing the ethical questions in facial transplantation. Am J Bioeth. 2004;4(3):25–7.

    Article  Google Scholar 

  24. Siemionow M. Ethical considerations in face transplantation: ethical issues related to inclusion criteria for face transplant candidates. Arch Immunol Ther Exp (Warsz). 2011;59(3):157–9.

    Article  Google Scholar 

Download references


We thank hospital management at Tygerberg Academic Hospital, Cape Town, South Africa in particular Drs Dimitri Erasmus, our CEO, and Andre Muller for their support. Prof Ian Vlok form the Division of Neurosurgery is thanked for recruiting the donor to our transplant coordinator Sr Bertha Bailey. Sr Bailey is thanked for her major role as the “mother” of the males rendered aphallic and on our waiting list.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Andre van der Merwe.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interest.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Merwe, A., Zarrabi, A., Zühlke, A. et al. Lessons learned from the world’s first successful penis allotransplantation. J Mater Sci: Mater Med 28, 27 (2017).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI:


  • Acute Rejection
  • Calcineurin Inhibitor
  • Corpus Spongiosum
  • Phaeohyphomycosis
  • Composite Tissue