Penis allotransplantation reviewed

Penile allotransplantation (PA) offers hope to those who lost their penis and are often ostracised and withdraw from society. Four long-term successful cases are described following lessons learned from an unsuccessful case from China in 2005. The need for lifelong immunosuppression hampers penile transplantation. In addition, many see the operation as non-lifesaving. From the four successful cases, the essence of success seems to be Ethical conduct, critical inclusion criteria for the PA program, least possible immunosuppression, donor bone marrow infusion if possible, extra-anatomical blood supply and nerve anastomosis and fastidious follow-up. PA also offers hope to gender dysphoria patients, but the immunosuppression needs currently make this not possible.