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Johns Hopkins surgeons perform world's first male genital transplant (jhu.edu)
214 points by chmaynard 9 months ago | hide | past | web | favorite | 134 comments

The surgeons and Johns Hopkins volunteered their services, which would otherwise have cost hundreds of thousands of dollars and wouldn't have been covered by veterans benefits or insurance, they say. (because it's still experimental)

Hats off to the team of 11 surgeons involved in this (no doubt grueling) 14-hour surgery without being paid. Wow.




It's not like they aren't paid in reputation though. Because it's a novel surgery, they're now the world's leading experts on applying this surgery successfully, and that makes them the first phone call for anybody with deep pockets who wants to make it happen. Not to mention being published, talking about the surgery in conferences, etc.

The patient may not have paid in money, but they did pay in taking a very significant risk of unforeseeable complications. It's not so clear cut.

That might not do justice to a number of doctors/surgeons/scientists doing it for science and medicine. I was in the medical field and it was ripe with predators doctors. But there was really people interested in advancing science.

Also surgeons at these level are probably too well off to care about money for one operation.

This is really true. There was an interesting documentary about the docs who did the first hand transplant. The docs were really pushing to do it since they could be "first". The patient was so-so about the idea, but went ahead anyways.

Fast forward a year and the hand is slowly disintegrating since they couldn't get his immune system to accept it. The patient eventually stopped taking his drugs.

The hand was then amputated and he got a prosthetic. Patient was much more functional.

As an aside: the abandonment rate for 'normal' prosthetics is about 35% to 45% :


That being said, the doctors also took on a huge risk in performing a difficult, new surgery.

Whether or not it was good for their careers (I don't doubt it will be) doesn't negate the altruism they offered.

It also strikes me as patriotic.

I would say that depends on the risk to the patient. There have been some pretty horrendous things done in order to advance medicine in the past. These days we seem to have a bit more in the way of ethical standard though.

This is presumably true for the lead surgeons, but there's plenty of other people involved. Presumably there was a large team of surgical nurses, administrators, and other doctors like anaesthetists who can claim no such fame or fortune for taking part.

100% true, probably would have doctors running over each other to do such thing--first case, ever.

But still, we can't dismiss it like that. They did a great thing and they deserve our kudos. Plenty of doctors take charity cases, some even go to Africa or poor areas in USA.

the one time "do it for the exposure" is justified

This is often the case. Building a website for someone's portfolio for free is nonsense. But things like this come up all the time, and demanding payment in the form of money is often very stupid.

I got the chance to film alongside ESPN using experimental cameras and technology that I've pioneered, and didn't request payment (just all expenses covered). Gaining networking contacts at ESPN and on-air mentions of the tech are worth far more than I could reasonably bill, and in the case of billing them, you lose out on extracting favors for doing it for "free."

Being a good business operator requires not relying on platitudes you hear from the freelancing community.

I can't help but think of the series Grey's Anatomy, where most surgeons would be more than happy to scrub in on a chance like this, maybe even pay for the privilege.

That is just the surgery itself, prep was hundreds of additional hours.

“Hundreds of thousands of dollars” probably includes the prep work.

Um, this was in the USA. Not kidding, I doubt a six-figure sum would cover the entire process.

I imagine that they spent a hefty multiple of those 14 hours preparing for the operation.

I hope it works out well for the patient, enabling the hoped-for quality of life.

That they did not bill does not mean they were not paid. Papers came from this. Lectures will be given. They did not take pay cuts from day jobs when they committed hours to this project. Doing experimental things like this is part of being a top doc.

Shameful veterans benefits doesn’t cover this. Clearly, if enough of these surgeries are done, the cost then will come down.

Any kind of health insurance or health system has to draw the line somewhere.

Not covering novel, risky and expensive "elective" surgeries is relatively easy to justify, compared to other stupidities in American health care.

I spoke to several of my friends about this. People of both genders I discussed the surgery with have said they'd seriously consider suicide if their genitals were destroyed.

I'm not saying this to make light of the situation; my point is that I would expect the risk of suicide caused by this kind of injury to make such a surgery of medical importance. Compare, for example, that several governing bodies consider gender reassignment surgery to be of medical necessity for transgender individuals who want to transition because of the dramatic reduction in suicide.

I'd consider gender reassignment surgery to be less elective, less expensive and less risky. There is a condition called gender dysphoria, and for a lot of patients hormones and living their gender identity doesn't alleviate it. I'm "cis", so I can't fully understand the situation transgender people are in, but I would hope that we can get to a point where genitalia matter less for gender identity. Easier said than done, probably.

It also depends on how much of your sense of self worth or identity is entangled with your sexual "functioning". I believe I wouldn't opt for such a surgery. Of course, I'm not in this terrible situation. And I can imagine other people having enough of a problem with these parts missing.

Speaking just about the costs, intensive psychiatric and therapeutic care should be more cost effective, and it's necessary in most cases, anyway.

> self worth or identity

Wow, that's rich. Is it really beyond your comprehension that someone might be deeply hurt by losing the capability to engage in sexual relations with their significant other? I know you say you 'can imagine other people having enough of a problem' but I'm not sure you really do when you word it that way. I agree that it's more expensive and more risky than gender reassignment but I don't understand why someone trying to return to a fully functioning body is considered "elective".

From the emotion in your response I gather you interpreted my words to be derogatory. Far from it, I see self worth and identity as important, and I don't want to judge those who involve their sexual functioning or their appearance in their sense of self worth. I certainly do, to some extent... I just think (or hope) my sense of self worth would survive without it.

I think the big issue is that this is an experimental and previously unproven remedy.

Speaking of gender reassignment surgery, is there any reason a penis couldn’t be transplanted onto a trans man?

I'm not an expert. But in this case, I believe there was some part of the penis left, making things a lot easier.

As far as I understand it, "reconstructive" methods using the female organs/tissue to provide part of the function is easier and less prone to complications. Keep in mind: A trans man can have sex with a partner before reassignment surgery. He just can't perform it in one particular way.

Finding a suitable donor, high change of rejection, etc., are the main reasons.

Then there's the price of it and the issues of finding surgeons who would be able to.

Right now, the option is pretty much a (huge) cosmetic surgery, so you can get it done "easily". Doing a full transplant would mean a much more complicated operation.

As long as it is an experimental surgery, it may be quite simple to find a donor, considering no competition.

I don't know if the donor or his family has to consent specifically to donating an organ which is normally not donated and where the procedure has a much lower chance of succeeding.

If a country with the resources of the US or most other developed nations wants to send people off to war, the deal should be that those men and women will be made as whole as possible again when they come back.

There are serious shortcomings in veterans' care when returning from combat, and we shouldn't regard any of it as "elective". Spending significantly more resources on veteran care might also help some countries reconsider the costs of war before engaging in it.

For a good book on the subject, read "What It Is Like To Go To War", by Karl Marlantes.

This is what "support the troops" should mean.

It's not just about the resources, but also about the ethics of experimental surgery. You'd essentially have a state paying for someone to harm himself. That has to be debated thoroughly, at least.

In my opinion, this is not a matter of health insurance. This is more comparable to a workplace injury. If I worked as a construction worker for instance, and suffered a debilitating injury or Asbestos poisoning because of the work, in a just society I would expect compensation from the employer, that covered the costs of fixing or mitigating it to the best of medical capability.

That surgery seems to be just beyond the best of medical capability. Or a lot worse, considering that the risks must be rather high.

Off the top of my head, my recollection is that lung transplants cost a cool half million on average in the year they occur, plus add ongoing expenses to care for the rest of your life.

An article I googled earlier suggests similar costs for other transplant surgeries: http://www.nationalkidneycenter.org/treatment-options/transp...

The figures given in this article don't appear particularly more than or out of line with other, more established transplant surgeries.

No it's not shameful. Better to pay veterans more and let them decide how they want to spend the money, including any health insurances.

As a vet who knows a couple of guys who've suffered injuries to their genitals I'm really happy to hear this news. There's a huge stigma around not having a dick anymore and I can acutely remember thinking, before stepping out on patrol, that I'd rather die than have that happen to me.

Hopefully this is just one step in a larger journey toward being able to replace damaged/destroyed genitalia with functioning replacements (ie re-growing new appendages using stem cells and patient DNA, etc).

The NYTimes article (https://nytimes.com/2018/04/23/health/soldier-penis-transpla...) adds a lot of context that this press release didn't go into. Along the lines of what you're saying:

He felt isolated, even in the hospital among other wounded soldiers.

“There were times you’d be hanging out and guys would be talking about getting hurt, and that’s one of the first things when they get blown up, to check down there, and they would say things like, ‘If I lost mine I’d just kill myself,’” he said. “And I’m sitting there. They didn’t know, and I know they didn’t mean any offense, but it kind of hits you in the gut.”

He struggled with thoughts of suicide, he said: “When I would actually think about killing myself, I would think, ‘Am I really just gonna kill myself over a penis?’”

I read this comment as, 'Why would a veterinarian have a relevant anecdotes to.. ooooooh'.

Thank you for your service sir, you are a braver soul than I.

I've read the suicide rate among vets with genital injuries is over 25%.


Not to downplay the vast significance of such an injury, but seems to me the far greater tragedy is that our society/culture places so much emphasis on sexual function that a 25% rate of suicide in such cases 'makes sense'.

There's a lot more to life than sex - this is basically saying that 1 in 4 males don't think the rest of it is worthwhile otherwise..

People aren’t just formless masses of pure reason floating through the world. We’re animals, and one of the most primal drives is to reproduce. That’s not society and culture that says sex is that big of a deal; it’s billions of years of evolution.

Even at an academic level, far too many people feel entitled to attribute absolutely every human outcome to society and culture.

Not only do we have philosophical, logical, and biological contributors affecting this, but "society" and "culture" can have logical and biological components as well. From a purely philosophical standpoint, what if I had come to the conclusion that a part of myself would live on through my children, and I am in despair at the lost opportunity to do do so? From a biological standpoint, I have lost access to one of life's greatest pleasures, but am also subject to the same physical drives without any release.

Now to expand that to "society," what fault is it of a partner who similarly has a philosophical drive towards procreation, or a biological desire for certain pleasure?

Some things just are blamelessly tragic, I'm sorry to let you know.

Is it society and culture or the single most important biological imperative our DNA can express, something hardwired into the parts of our brains older than life on land?

Certainly it isn't hardwired in any relevant manner, and people are in fact just fine not reproducing, see vasectomy.

Don't just repeat platitudes. People are killing themselves over not being able to have sex, or rather not being able to prove they're proper functional men. It has at least as much to do with social status as with actual sex.

Knowing you aren't held in respect by your peers doesn't cause depression because of culture or society - every single living organism with some sort of higher brain function gets "depressed" when its peers hold it as less valuable.

This isn't platitudes, this is science, and shows the solution likely isn't down the path of telling people 'losing your junk" jokes are harmful. Choosing to not have kids are far different than having that choice taken from you, and the most viable solution is likely chemical intervention.

For the record I agree with you (in contrast to some of these other commenters); sex is criminally over rated. There's a reason why we have a distinction between people and animals guys (though even many animals can live a eudaimonic existence without sex, see neutered dogs).

“sex is criminally overrated” is certainly a statement borne of the sort of careful, even-handed consideration i would expect from someone asserting people aren’t animals

Out of interest whats the normal rate for vets? I imagine it could be relatively high as you hear a lot about PTSD.

So, just to clarify here; the first successful penis transplant was in 2014 in South Africa [1] (the same team again performed a successful transplant in 2017 [2]).

The article posted however is the first penis and scrotum (without testicles for perhaps obvious reasons) transplant.

[1] http://www.sun.ac.za/english/Lists/news/DispForm.aspx?ID=232... [2] https://www.health24.com/News/Public-Health/see-sa-doctors-p...

Does anyone have an idea as to why the testicles weren't included in the transplant?

My best guess is that the testosterone produced wouldn't be "compatible" with the recipient and they would want to avoid an immune system rejection?

Additionally, I suppose that if sperm is still being produced, you could effectively impregnate a woman with someone else's DNA. That would be... strange. I can see how that might be unwanted by both parties.

The testes are immunoprivileged. Transplanting testes would probably result in dead nubs of fibrous tissue after a couple years or severe immunosuppression requirements. Even autologous testicular tissue transplant has had only a 1 in 7 success rate (https://www.newscientist.com/article/dn1851-man-fathers-chil...)

Additionally the testes derive their blood supply from the testicular arteries that branch off the aorta all the way up in the abdomen. I would imagine that 'hooking them up' would be a much more complicated surgery since the vessels would have to be passed through the pelvis into the scrotum.

Oh man it’s like having to pass props all the way down through my react components. No wonder the surgeon closed as #wontfix.

Just need the context API for blood... Somehow.


Nominated for comment of the year,

Well, there are plenty of big arteries in the pelvis the surgeon could anastamose with, and you can harvest the donor artery as far up as you want (it supplies nothing else), so I'm not sure the arterial supply is really the problem. Venous drainage could be a problem.

The other thing: they may actually plan to do those transplants down the line, but there's no sense in doing them if the scrotum fails to take.

Fun fact: this is because they start out the same place as ovaries during fetal development and then migrate down and out of the abdomen leaving a trail of vasculature and nerve endings. This is why you get nauseated after testicular trauma.

But why do I get nauseated when I witness somebody else's testicular trauma?

Everyone's balls are connected in the 4th dimension

That explains so much about the human race

The article I read earlier specifically said there were ethical concerns with him potentially being able to father children with the donor's genetic code. Which is a weird ethical concern I'd be intrigued to read more about.

That creates an interesting twist: since DNA test is legally acceptable as fatherhood proof the recipient could create a lot of trouble for the donor.

I'd assume that the donor in every case (as in this case) would be diseased, so I'm not certain how that could be an issue for the donor.

There have been lawsuits about children born to deceased fathers and inheritance.

So it's a real issue.

For example: https://www.cbsnews.com/news/can-kids-inherit-sperm-donors-f...


I assume you mean “donor deceased”. Even if I were dead I would not necessarily want people using my DNA to father children.

I wouldn’t necessarily be against it, either, but I would feel I had some interest in how sperm were used in a different way from other organs. I’d also feel differently about something physically identifying like a face, and even more so about the brain/cognition (if there were a way to do a partial brain transplant which carried memories or something but didn’t transfer consciousness — seems unlikely given what we know of the brain today, but I wouldn’t count it out since we don’t really know all that much.)

(if there were a way to do a partial brain transplant which carried memories

Years ago, I saw an interview with a woman on TV. IIRC, she was the first recipient of a heart and lung transplant.

She was asked a question shortly after surgery in which her reply was something like "I'd love to have a beer!" though she did not drink. The young male donor who died in a motorcycle accident did drink. She also reported having dreams and other experiences in line with having somehow inherited some piece of his consciousness. Over time, they faded.

If anyone is curious to read more, this might be her book:

A Change of Heart: A Memoir by Claire Sylvia

That's sounds like an urban legend / exaggerated story.

I hope it is urban legend or exaggerated, because that is terrifying.

Or it's wishful thinking / placebo. The mind is very good at deceiving itself.

Or the subconscious memories could have been transferred through other methods, e.g. socialising with people who knew the donor.

Well, the heart apparently has 40,000 neurons, which is cracking on for the same number as a fruit fly. Although one would assume that they're not arranged for the sort of thing which would make a person crave a beer.

Yeah, more of a "Keep pumping even if the brain upstairs talking to me" would probably the answer to that. I doubt it cares much for beer.

I wonder if it's a less romantic statistic if you look at neurons in, say, the left butt cheek or something.

Well, apparently there's something called Gluteal Amnesia...?

Perhaps it would be possible (ethical?) to set up a system to provide organs from post-operative female-to-male transgender patients to potential recipients.

Did you mean male-to-female patients (assuming that you're trying to provide penises)? My understanding is that most of the structure of the penis is used to craft various structures of the newly constructed female genitals (shaft for the vagina, glans for the clitoris, and so on).

Oh dear, I did mean male-to-female. <embarrassed face>

Thank you, also, for clarifying that male-to-female gender reassignment surgery wouldn't result in an organ that could be donated.

assuming that even worked, i wouldn't expect a lot of living donors, and the timing of decease and birth should clear most everything else up.

and yet uniqueness of DNA is 'irrelevant' in cases of new life..

'medicine' will decide what it wants.

I imagine divorces involving sperm and embryos would be a good source of material.

And those are situations where there is a relationship instead of anonymous posthumous donation.

I guess lots of people don't think it's weird to assert some right of control over their genetic material.

The testes don't provide a useful or vital enough function for the recipient to warrant the additional risks and effort.

Really, the only thing a male body normally needs its rocks is to produce some hormones. Those are easily substituted. Simple silicone implants will satisfy aesthetic properties. The tactile nerve endings aren't vital to recreative copulation.

As trans people, post-menopausal women, and diabetics can tell you, your body doesn't care where the hormones came from as long as it's the same substance.

They did transplant the scrotum. I wonder if they included some cosmetic testicles just to make the patient look more "fully equipped".

My kneejerk reaction is that I imagine appearances are a low priority here compared to regaining basic functionality.

I say that as someone who was quite vain about my looks when I was young, but chronic health problems have drastically changed my priorities.

That's not intended as dismissive. I just kind of feel like it's a detail likely to be a low priority at this stage, what with it being groundbreaking surgery to begin with, etc.

This article indicates he's also missing his lower legs:


No indication if they made the scrotum look like there are testes.

If they don't add cosmetic testicles, it's a constant reminder that testicles are missing, which causes psychological stress.

Cosmetic testicles would be tremendously simple, too, compared to the operations complexity.

Google tells me that "testicular prostheses have been used for 50 years to replace missing or removed testes"...

I would speculate that they would be a relatively simple addition to the surgery itself, but at the very least it would be very simple to do as an additional operation once the transplant stabilized.

At the same time, it isn’t uncommon for breast cancer survivors to get implants after a mastectomy. I just wonder why they bothered with the scrotum otherwise?

pet owners have been doing that for years. [0]

[0]: https://www.neuticles.com/

Why not just keep the testes?


Two intratesticular or intraepididymal shots are far cheaper and so much less invasive than two surgeries.

I like how the picture in the article almost looks like an access panel on the side of an insulated appliance, seeming to imply that it was as easy as connecting a few wires and pipes... if only[1]! The unrealistic "cleanliness" of these sorts of detailed medical illustrations continues to fascinate and slightly amuse me.

[1] https://cdn2.tmbi.com/TFH/Step-By-Step/display/FH12JUN_WATHE...

Yeah. Another reason for being an organ donor. Remember, even when you are dead, you best friend could still be working :-)

I'm surprised they were able to reattach the nerves as well. Isn't that something that can't be reattached after being severed.

If nerve reattachment now is possible, can't we cure quadriplegics?

The first transplant was actually in South Africa, in Dec 2014.

This is the first total penis transplant vs partial penis transplant. Previous transplants just attached to an existing "stub".


without the testes. he would be able to function sexually and orgasm? will it not be like castration

While sperm is produced by the testes, most of the semen is produced by the prostate gland which is inside the body - not in the testes.

Wrong. The semen is produced by the testicles. The ejaculate is produced by approximately three different glands:

1) Testes - produces the semen (1% of the total volume) 2) Prostate - Sugars, etc (30%) 3) Cowper's Gland - mucoproteins, etc...

Sperm are produced by the testes, but sperm are a minority of the semen.

He's probably undergoing hormone replacement therapy, as well.

Orgasm is something that's generated entirely within the nervous system. As long as the nerves of the transplanted penis are properly hooked up to the right pathways, you can orgasm, though it will take some healing time for the nerves to come fully online.

You don't need to have an erection or be able to ejaculate semen in order to orgasm. Most men associate orgasm with both, but neither is strictly necessary.

Speaking of erections (probably the only time I will ever write these words on HN), they too are not dependent on having testes. Erection is a vascular response within the penis: much of the internal structure of the penis consists of sponge-like tissue that stiffens when filled with blood. Assuming the relevant blood vessels and nerves are properly hooked up, erection should be possible. Of course, you need to take into account healing time and the surgeons doing a perfect job hooking everything up. Testosterone plays a role in signalling for an erection, but you don't need testes for that either: the adrenal glands produce a small amount of testosterone, and exogenous testosterone such as from an injection, a patch, or a gel works just as well (and I would be very much shocked if this guy wasn't on exogenous T already). And in the absence of testosterone entirely, there's always Viagra. And some people can still achieve erections in the absence of testosterone even without Viagra, but this is extremely YMMV.

He might even be able to ejaculate if everything is hooked up right, but it'll be watery seminal fluid without sperm.

Though that does bring up one difference between this guy and a guy with testes: he's still going to have to take exogenous testosterone for the rest of his life for the sake of his mental health, body shape, and bones. And he'll never be able to conceive, of course.

They've been able to put penises in women for a while, but only just now they've been able to put them in men?

What am I missing?

In construction of simulation organs the person's own tissues are used.

Got it, thank you.


> Also note: attractive people have more girls. If you’re a rich OG with a young model, she’s likely going to water-birth girls. That’s just scientific fact.


That's what I said. After I picked myself up off the floor from laughing so hard.

But then I goggled it and apparently there is some basis. Ya, I was surprised also.


Ha! “The scientific fundamentalist”? I’d look for a second opinion.

I was gonna say "fundamentalism does not always imply religion," but I read a few of his posts and he's definitely a nutbar.

E.g. "The females of all mammalian species, including humans, always have more power than the males, and, in every human society, women are slightly better off than men are." (Based solely on longevity and reproductive success, "the only two biologically meaningful measures of welfare.") It sounds like he's one of those "women are better off than men because they can get laid whenever they want and I can't" guys.


This is Hacker News, not Reddit.

I was going to make one about "Johns Thomas surgeons" but it needs a punchline transplant.


Take this garbage back to reddit. The recipient was a young Afghanistan vet who lost his urinary as well as sexual function. Have some empathy without resorting to some cheap internet laugh.

I want to say +100 to what you said but as a Redditor, don't even bring it to Reddit...it's not welcome there either.

I can't really sympathize. At least to me, the risks involved in foreign transplants, and the drug regimen with all its effects, seem to outweigh the benefits.

For others it may be different.

Serious question, not wanting to be crass, but does it “work”? That would be a huge breakthrough over reconstruction options that often require an implanted device to mimic an erection. It also, I imagine, requires a great deal of accuracy regarding the surgically connected plumbing in order not cause rupture and internal bleeding as a result of blood pressure.

Did you read the article, or just the headline?

Yes I read the article. My question was not answered in it.

> "We are hopeful that this transplant will help restore near-normal urinary and sexual functions for this young man." - W.P. Andrew Lee Director, plastic and reconstructive surgery

“We are hopeful” did not indicate success or failure.

"They transplanted from a deceased donor the entire penis"

Is there any research on the statistics of people signing up for organ donation, wealth, death rate etc. to objectively measure if people are ... left to die if the resulting organs are more profitable? A macabre thought indeed.

"It's a real mind-boggling injury to suffer; it is not an easy one to accept," the recipient says. "When I first woke up, I felt finally more normal … [with] a level of confidence as well. Confidence … like finally I'm OK now."

^ this is exactly what worries me on the subjects of sex-change, -transplantation etc. : without even any time to recover, time to repeatedly re-assess the new condition, without anonimity (or rather a pseudonym signed by say the government, so that they can prove they actually underwent such an operation, without giving up their identity) how do we know they tell the truth? how can he already be happy without trying his new dick out? or is he really just being happy about officially having a dick again ? how do we prevent people who are fantasizing about a sex change from deciding something they will come to regret, especially if their only source of information is people who 1) did not provably undergo such an operation 2) are no longer anonymous to be able to speak freely how they feel about it?

>is he really just being happy about officially having a dick again ?

Yes that's probably exactly it. It's very easy for people who don't experience these things to say "well logically it's not that bad so why are you so unhappy?", but these kind of issues can cause constant psychological stress, and even purely cosmetic changes can make a huge difference to people's quality of life.

>how do we prevent people who are fantasizing about a sex change from deciding something they will come to regret

You can't absolutely prevent it, but it's vanishingly rare in practice, and these kind of overblown concerns end up causing far more harm by making it difficult for trans people to get surgery than they do by saving hypothetical confused cis people.

Also, for trans people who do opt for sex change surgery, it's usually driven by persistent discomfort caused by the body they currently have, not just "fantasizing" about the body they want.

There are several Internet communities where transgenders can talk pseudonimously.

Indeed, I think part of the problem is that the only interactions a lot of people have with trans people is with political advocacy, where people are too busy trying to deal with rampant misinformation to ever get into nuance. And people then assume this is the only form of discourse that trans people ever engage in.

Much as people like to deride "safe spaces" as echo chambers, actual safe space trans communities are far more open to discussing conflicting feelings, doubts, regrets etc. because they know people won't use those admissions to judge or invalidate them. Which is of course, exactly the point of a safe space.

(PS: The preferred term is "transgender people" or more commonly just "trans people".)

I think part of the problem is that the only interactions a lot of people have with trans people is with political advocacy,

I've personally been attacked a few times on HN as transphobic for trying to talk about women's issues and my personal problems as a woman in a man's world. My experience suggests the trans community frequently takes approaches that are openly and unnecessarily hostile.

I also spent 9 months being very supportive of a MTF trans youth met through HN whose life was in serious crisis at the time. Several other members of HN are well aware of the support I provided her. None of them ever stepped forward in my defense during the time when I was being repeatedly randomly attacked as supposedly transphobic.

The MTF individual in question was incredibly ugly to me during the months that I was supportive. Every single personal problem I had as a divorced single mom, problems very typical of divorced single moms, was dismissed as me being incompetent, not wanting success badly enough, etc.

I got badly burned for being sympathetic and supportive. I have reason to believe this individual still has the ear of powerful people and there is evidence they are still telling lies about me and dragging my name through the mud.

If my experience is at all representative, then your description of the problem space doesn't begin to capture the issue.

>If my experience is at all representative

I don't really see any reason to think that your interactions with one trans woman would be representative?

You are glossing over large parts of my comment. This is hardly limited to interactions with one individual.

The part of the comment about trans people is an off-topic derail. Sex reassignment surgery is not free for the asking. There is substantial prep work preceding it, including psychological exams. You have to convince a bunch of people this is merited and appropriate in order to get such surgery.

None of this would apply if it was e.g. a hand transplant, would it?

both my complaints would still apply:

I still want a provable control mechanism to measure the influence of organ donor status (donating or not, rich or poor, etc) on donor death rate (if this is happening this would typically not be just for one organ, but for multiple; and the value of the organs would have to exceed the costs from the perpetrator perspective: value from acceptors, from research on tissues, from educational value of the body parts, saved future costs of the donor on the health care system, ...).

Think of it this way: if there was a mathematically provable mechanism in play to prevent this in an open, reproducible and public fashion, there would be more people open to donating their organs after death.

Just as for the genital case, if a person had a hand transplant and exclaimed the finality of his joy without first assessing the result (do I still have the same dexterity? if my sensation is measured with an ABX test, do I provably feel as finely details in texture of objects? do I have full motor control?) then yes I would make the exact same complaint.

I don't think your concerns are invalid.

I can't source it and it is not a study/statistics, but I did see a piece once on a Black American with a brain injury in a coma who was declared dead and then their organs were promptly harvested. The article suggested the patient could have recovered from their brain injury with proper care and that a well off white person with the same injury would have gotten the care they needed to recover instead of being declared dead and then essentially parted out.

It's a pretty macabre scenario. It's a question most people don't want to ask. Organ transplants get hyped a lot as miraculous and entirely positive events.

I used to belong to a number of cystic fibrosis lists. CF accounts for about a third of adult lung transplants and about half of all pediatric lung transplants in the US. I have seen plenty of discussions by family members, recipients or other concerned parties about things like being listed and waiting for a donor, as well as stories of people dying slowly from rejection.

So I have thought long and hard about this and I have my misgivings about "heroic medicine," such as insanely expensive drugs (one new-ish CF drug costs about $250k-$300k annually) and organ transplants.

The patient who received a new penis may not have gone through this, but one of the things that horrifies me about transplants is that, once you are listed, you essentially sit around hoping that a young, healthy person who is a tissue match dies tragically in the prime of their life in an accident so that you get a second shot at life. If your condition is deadly, you have been listed because you are basically dying. So you sit there hoping someone dies fairly soon. I can't imagine what that does to someone psychologically.

However, my father and my ex were both career army. The military has a very long association with experimental medicine and this relationship is more responsible for medical advances than people realize. I'm extremely sympathetic to this story in part because he's a veteran.

Returning to the question of studies, I do recall a blurb about Puerto Rico being a major source of organs for transplant. The article went into some of the reasons for that, though I don't recall any of the details. You could try looking for info on that angle and see where it leads you.

> ... one of the things that horrifies me about transplants is that, once you are listed, you essentially sit around hoping that a young, healthy person who is a tissue match dies tragically in the prime of their life in an accident so that you get a second shot at life.

I've thought about this some, because I carry a donor card.

I have read an account of someone who had been waiting for transplant (kidney, if I recall correctly). The call comes, she and her husband are driving two hours to where the operation will be, they're all happy... and then it hits her: Someone had to die for her to get that kidney.

But from my (abstract) perspective as a (potential) donor, I'm dead anyway. You might as well take my parts, because I don't need them any more. Whoever I am, I'm already gone, and I'm not coming back. So take my parts with my blessing, and don't feel guilty about it. Use them in good health and long life.

I have seriously thought about writing a letter to organ recipients, stating all this, but I don't know if my family would be allowed to give it to them...

Without getting this too far afield into religion, philosophy and psychology, some people believe that prayer et al can influence outcomes and many people feel incredibly guilt ridden about hoping for certain kinds of outcomes, no matter how irrational you may feel that is.

Thank you for being a donor. I am not against organ transplants. I just wish there was more emphasis placed on more prosaic, less "heroic" solutions to certain problems.

Edit: Please look into whether or not they would be willing to give such a letter to a recipient and, if so, how that could be arranged.

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