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The Ethics of Penile Transplantation: Preliminary Recommendations

Caplan, Arthur L. PhD1; Kimberly, Laura L. MSW, MBE2; Parent, Brendan JD1; Sosin, Michael MD3; Rodriguez, Eduardo D. MD, DDS3

doi: 10.1097/TP.0000000000001352
Original Clinical Science—General: Donor and Recipient Factors

Background For men with significant genitourinary injury, penile transplantation is being considered as an option when reconstruction is not feasible or proves unacceptable to the injured patient.

Methods A review of the literature was conducted to assess the current state of penile reconstruction and transplantation options, as well as to evaluate scholarly research addressing the ethical dimensions of penile transplantation.

Results The state of penile transplantation is elementary. If reconstruction is not a possibility, proceeding ethically with research on penile vascularized composite allotransplantation will require the articulation of guidelines. To date, very little has been published in the scholarly literature assessing the ethics of penile transplantation.

Conclusions Guidelines should be developed to address penile transplantation and must cover the donation of tissue, consent, subject selection, qualifications of the surgical team, and management of both failure and patient dissatisfaction. Unless guidelines are established and disseminated, penile transplants should not be undertaken. The preliminary recommendations suggested in this article may help to inform development of guidelines.

Penile transplantation could be an option for increasing severe penile injuries in the era of modern warfare. Great care must be taken to assess risks and benefits of highly experimental penile transplantation, and patient-oriented medical and ethical guidelines are mandatory.

1 Division of Medical Ethics, NYU Langone Medical Center, New York, NY.

2 School of Social Work, Columbia University, New York, NY.

3 Department of Plastic Surgery, NYU Langone Medical Center, New York, NY.

Received 30 December 2015. Revision received 17 May 2016.

Accepted 20 May 2016.

The authors declare no funding or conflicts of interest.

A.C. wrote the initial draft of this article, with substantial assistance from L.K., A.C., and L.K. were responsible for subsequent revisions, with extensive contributions from B.P. and M.S. who also provided important structural revisions. E.R. contributed to the design and to revisions of the article.

Correspondence: Laura L. Kimberly, Columbia University School of Social Work, 1255 Amsterdam Avenue, 9th Floor, New York, NY 10027. (LK2583@columbia.edu).

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