Andre Van der Merwe The man behind the world's first penis transplant (Part 1)

The Professor has been caught slightly off-guard by all the attention focused on him.

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Professor Andre Van der Merwe play

Professor Andre Van der Merwe

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Written by Liesl Venter

The professor has been inundated with calls from around the world following the world's first successful penis transplant – academics, doctors, journalists, patients, all queuing for a piece of Africa’s latest medical superstar.

But he is not one for fanfare, and speaks frankly and to the point. While he makes it clear that he doesn’t have much time – he is doing hospital rounds at 2pm – he does not rush through our questions.

He approaches them with quiet reserve, not to mention a fair amount of modesty.

Van der Merwe admits he had no idea there would be so much international attention. And no, he did not expect any acclaim. He knew there would be interest, of course, but not to this extent.

In fact, he says, the entire project nearly didn't happen, as resistance has been the one constant he has had to deal with since embarking on this path more than four years ago.

“The hype of the operation is a reflection on us [as a society] rather than a reflection on the operation,” he has said.

“I think we are finding out about ourselves. We haven’t spoken about issues below the belt that often.”

That’s an understatement, judging by the plethora of jokes doing the rounds about the transplant, some even about him.

Van der Merwe is well aware of this, and at face value he doesn’t seem to care. His intentions are far removed from crude jokes. They are simply about changing the lives of damaged young men.

“If this has started a conversation around what it means to lose a penis at 18, then so be it,” he says.

“For years I have been meeting these young men in hospital wards, not being able to help them at all. For the first time we have a solution,” he says earnestly.

For all the publicity surrounding him since he did this operation, there has been little change to his life.

As head of the University of Stellenbosch’s urology department he goes about his days as he always has.

He is a familiar site in his white coat at Tygerberg Hospital, where the operation was performed in December last year.

During a grueling nine-hour procedure, Van der Merwe and his team transplanted a penis from a deceased man onto a 21-year-old who had lost his during a botched tribal circumcision three years earlier.

He talks matter-of-factly about the procedure and the surgical team, which is the same group he uses when doing kidney transplants.

“We work well together and know each other. I did, however, make one change, and that was to ask Prof Frank Graewe, head of the division of Plastic Reconstructive Surgery at Stellenbosch University, to come on board for the microscope work.”

It was Graewe's job to find the nerves and tiny blood vessels and reconnect them all.

It is meticulous work. “Because of the infection our patient had that led to the amputation of his penis, just about everything one could work with had been destroyed. It’s not an easy operation by any account,” he says.

In preparation, the team used cadaver studies to identify key blood vessels, nerves and other structures in the penis that had to be connected to ensure normal function.

During the harvesting of the donor penis it was dissected entirely over about six hours, keeping blood vessels, nerves and other connecting structures intact. These were then marked to be connected to the recipient’s correlating tissue.

It turned out to be a little more complicated than that.

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The operation

“We were unable to use one of the recipient’s major blood vessels. We only realised this when he was on the operating table," Graewe reveals.

"This vessel was also destroyed by the same infection that caused him to lose his penis. We then had to reroute the blood vessel from the patient’s lower abdomen to the perineum, where we connected it to the new penis.”

According to Van der Merwe, the operation was slow going .

“It is very delicate surgery using microscopes. While I am able to do this and have done it before, I felt more at ease with Frank there as he does a lot of microsurgery as a plastic surgeon.”

The surgeons connected three blood vessels – all between 1mm and 2mm in diameter. This was to ensure blood flow to the transplanted penis.

Two dorsal nerves, also between 1mm and 2mm in diameter, were connected to restore sensation, as well as the urethra, which enables the recipient to urinate through the penis, and the corpus cavernosum, the tissue into which blood flows to enable an erection.

“He was then moved to the theatre high-care unit. where we monitored him for two days, after which he was in isolation in the transplant high-care ward for a month,” says Van der Merwe.

“But we grew lots of grey hair. We had to rush him back into theatre after one of the major arteries blocked and the penis nearly died. We also had to deal with drainage of a hematoma, and we had to repair a small fistula of the urethra.”

Within weeks the young man, whose identity has been protected for ethical reasons, had shown remarkable recovery and was discharged. Soon after, he was reportedly having sexual intercourse.

This has only added to the hype surrounding the procedure.

“Our anticipation for full recovery was around two years. We were very surprised that he was doing so well only weeks after the transplant, including the early sexual recovery,” says Van der Merwe, who sees the patient often.

“He is confident, happy. He is back at work, living his life. He has full use of the transplanted organ, regularly having intercourse with his partner.”

Van der Merwe says they knew very early on that the operation was a success because of the complete acceptance of the new organ.

“A lot of it is psychological, and he identified with it as his penis from the very beginning. If you add an organ like this it can be a big shock to the self-system.

"If you are dealing with someone who has any slight personality disorder it will all be exacerbated, while the immuno-suppression would add further risk.”

The psychology of it plays a big role. In 2006, doctors in China transplanted a penis onto a 44-year-old man who had lost his in an accident.

The operation was not considered successful as the man asked for the organ to be removed two weeks after receiving it – he is said to have been unable to psychologically adapt to it.

Van der Merwe says they were fairly confident this would not happen in their case, and they were proved right with the young man in question referring to the organ as his from the first moment he saw it.

“He is completely at ease with the transplant. This is his penis. He has no psychological after effects. It is very clear that this procedure has changed his life.

"His experience alone has made this project worthwhile.”

Physical rejection also seems off the cards. He remains, of course, on a hefty dose of immune suppression medication that is being monitored by Professor Rafique Moosa, head of the department of medicine at Stellenbosch University.

“Immuno-suppression is a key component of a successful organ transplant,” says Moosa. ”As soon as you put a foreign object into a person, the natural instinct of the body is to reject it. The immuno-suppression helps to prevent the body from rejecting it.”

With no previous guidelines to follow, the team based their treatment on other composite-tissue transplants such as hand and face transplants.

Transplants where several types of cells are involved require stronger immuno-suppression treatment.

Van der Merwe says that the patient is coping well on the drugs.

“He is still on a bulky regime of medicine. Over time it will be reduced.”

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