Seventy years ago, we began transplanting human organs. With each decade, our ambitions grew. We started with kidneys, then advanced to lungs, livers, and hearts. We defied mortality. We turned death into life.
Now our ambitions are turning outward. The body parts we're replacing are more visible and less vital. Eight years ago, a man in New Zealand got a new hand. Three years ago, a patient in Vienna got a new tongue. Last year, a woman in France got a new face.
This week we crossed another line: A Chinese man has been given a new penis.
At one time or another, every middle-aged guy wishes he had the virility of a man half his age. In this case, that wish came horribly true. In what doctors call "an unfortunate traumatic accident," a 44-year-old Chinese man lost all but the last half-inch of his penis. To replace it, they offered him the 4-inch member of an anonymous 22-year-old brain-dead patient whose parents had agreed to donate the organ. The surgery was performed at Guangzhou General Hospital by—I am not making up this name—Dr. Weilie Hu.
This isn't an operation you'd undertake lightly. According to the case report, published in the Elsevier journal European Urology, the beneficiary of the new penis—I'm trying not to call him the receiving partner—was given "systemic broad-spectrum antibiotics, anticoagulation, antispasm agents, and immunosuppressants." He endured penile congestion, discoloration, "venous stasis," "lymphatic drainage," and "segmental epidermis necrosis." European Urology has pictures of the whole process, starting with the original "penile defect." It consists of a scrotum with what looks like labia where the penis should be. The necrosis is nasty. You really don't want to see the venous stasis.
You have to feel bad for this guy. He must have wanted the surgery pretty badly. And he did. He "was chosen," according to the doctors, primarily becuase of "his strong demand for recovery of his ability to void while standing and to have normal intercourse." Note the key phrase: while standing. "He could not urinate in a standing position," the doctors write. "His quality of life was affected severely."
Let's start with the tactless question: Is the inability to urinate while standing an unacceptable loss of quality of life? Is every woman entitled to a penis? Alternatively, is the inability to have normal intercourse grounds for a transplant? Should we subsidize Viagra? Is there a human right to free and fair erections?
The central picture in the case report shows the penis a day after the surgery. It has "excellent cosmetic appearance," says the caption. Indeed it does. It sure looks better than it did in the picture to the left, where it's floating in a bucket. But is cosmetic appearance our goal? In an editorial alongside the report, Dr. Jean-Michel Dubernard, who helped engineer last year's face transplant, suggests that penile replacement is a logical extension of our increasing efforts to repair "aesthetic" defects. In another editorial, Dr. Yoram Vardi, an Israeli urologist, argues that penile amputation causes "significant psychological, cosmetic, functional, and physical disabilities." Psychological disabilities? Cosmetic disabilities? If a cosmetic problem is a disability, what isn't?
In a follow-up article, Dr. Hu and his colleagues explain the shortcomings of alternatives to penile transplantation. Penile reconstruction often leads to "unsatisfactory cosmetic appearance," they write. Moreover, "Penile lengthening has a limit as to the length of penis." Being able to urinate or have sex is no longer enough. If you're not big enough or good-looking enough, you don't measure up.
But physical superficiality is only half the story. The other half is psychological complexity. The more we tinker with the surface of the body, the more deeply we affect the mind. We're altering image and self-image. According to Dr. Hu and his colleagues, "Very traditional Chinese think of the penis as a 'life-spring' to carry on the ancestral line; indeed, they regard it to be the symbol of man." This "symbolic meaning," the doctors suggest, is what ultimately justified the surgery.
It's an intriguing idea. Too bad the doctors didn't think it through. If what you're really operating on is a patient's symbolic understanding of himself, then you'd better learn about the psyche, not just the penis, before you start cutting. And that's what the Chinese surgeons failed to do.
The case report details how beautifully the surgery succeeded. Then, abruptly, it ends with the sentence: "At day 14 postoperatively because of a severe psychological problem of the recipient and his wife, the transplanted penis regretfully had to be cut off." In the follow-up article, they explain, "The patient finally decided to give up the treatment because of the wife's psychological rejection as well as the swollen shape of the transplanted penis."
In other words, the surgery failed. It passed the old tests—functionality, healing, immunosuppression—but flunked the new tests: cosmetics, aesthetics, symbolic meaning. The body didn't reject the tissue; the mind did. In their follow-up report, the doctors remain baffled. "What happened after the operation was still beyond our and the patient's imagination because this was the first attempted transplantation," they plead.
Forgive the expression, but that excuse won't cut it. Failure of imagination is exactly the problem. Maybe cosmetic surgery is progress. Maybe, after decades of giving people hearts and lungs, we're entitled to indulge in transplants that save egos rather than lives. But if that's what we're doing, we'd better learn as much about egos as we know about tongues, faces, and genitals. Until then, keep it in your pants.