Hats off to the team of 11 surgeons involved in this (no doubt grueling) 14-hour surgery without being paid. Wow.
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.
Also surgeons at these level are probably too well off to care about money for one operation.
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.
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.
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.
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.
Not covering novel, risky and expensive "elective" surgeries is relatively easy to justify, compared to other stupidities in American health care.
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.
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.
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".
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.
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.
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.
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.
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.
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).
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?’”
Thank you for your service sir, you are a braver soul than I.
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..
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.
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.
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.
The article posted however is the first penis and scrotum (without testicles for perhaps obvious reasons) 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 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.
So it's a real issue.
For example: https://www.cbsnews.com/news/can-kids-inherit-sperm-donors-f...
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.)
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
I wonder if it's a less romantic statistic if you look at neurons in, say, the left butt cheek or something.
Thank you, also, for clarifying that male-to-female gender reassignment surgery wouldn't result in an organ that could be donated.
'medicine' will decide what it wants.
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.
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.
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.
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.
Two intratesticular or intraepididymal shots are far cheaper and so much less invasive than two surgeries.
If nerve reattachment now is possible, can't we cure quadriplegics?
1) Testes - produces the semen (1% of the total volume)
2) Prostate - Sugars, etc (30%)
3) Cowper's Gland - mucoproteins, etc...
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.
What am I missing?
But then I goggled it and apparently there is some basis. Ya, I was surprised also.
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.
For others it may be different.
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?
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.
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'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.
I don't really see any reason to think that your interactions with one trans woman would be representative?
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 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.
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...
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.