Photos reveal the donor penis and scrotum doctors transplanted onto the body of a US Navy veteran, known as 'Ray' last year in a case report published Wednesday.
Ray, a Navy Corpsman, told doctors that, thanks to the transplant he 'feels whole again' and is able to achieve a nearly normal erection and even orgasm, according to the new New England Journal of Medicine report.
His was the fourth and most complex penis transplant every performed, after explosion in Afghanistan blew off most of his lower body.
In order to restore Ray's sex organs, a surgical team at Johns Hopkins University had to invent new techniques to route some of the 30-something-year-old's arteries together so that blood could flow into his new penis keeping it alive, and erect.
But the 14-hour surgery was a success, that Ray has called 'the best decision' he's ever made.
More than a year out from the life-changing operation, Ray's doctors relayed that their patient has sensation in his new penis, an 'improved self-image' and is now in school full time and fully independent.
A computer reconstruction of Ray's body shows the damage that left him with just a 1.5cm piece of penis tissue, no scrotum and a chunk of his abdomen missing (Pictured from the front, on the left, and side, on the right)
On the day of the surgery, the donor abdomen, penis and scrotum (pictured) lay in the operating room, awaiting transplantation onto Ray's body
Ray was tending to wounded soldiers during an ambush by the Taliban when he stepped on a roadside bomb in 2010.
He lost both his legs, genitals, and part of his abdominal wall and was forced to learn how to walk on prosthetic legs after the tragic accident.
Speaking for the first time since his 2018 surgery, the soldier revealed Monday night that his life-changing injury - which he kept a secret except from loved ones - had even made him contemplate suicide.
A team of doctors at Johns Hopkins University in Baltimore successfully grafted a new penis and scrotum from a deceased donor onto Ray's body, making him the fourth patient in the world to receive such a transplant - and his was by far the most extensive ever done.
Speaking in October about his life-changing procedure, Ray said he's 'close' to regaining full sensation in his new penis and is able to get an erection and urinate standing up.
Eight days after surgery, Ray's sutures were starting to heal, and the transplanted tissue had started to look pink and healthy, a sign that the artery and vein connections were working. Arrows point out where doctors biopsied the tissue to make sure it was healthy
The John's Hopkins team carefully watched as Ray healed to make sure that there were no signs the new sex organs were being rejected. Two weeks out, the tissue appeared healthy
By check-in on day 340, the transplant was functional and had even grown hair
Ray said in an interview with MIT Technology Review: 'I don’t regret it. It was one of the best decisions I ever made.'
Speaking about the traumatic experience of his accident to the media for the first time, Ray said he 'remembers everything'.
'I remember thinking a quick thought: "This isn’t good." And then I was on my back,' he said.
'It was one of those injuries that really stresses you out and you think, "Why would I keep going?" I guess I always just kept this real hope that there's an answer out there.'
In 2013, Ray met Dr Richard Redett, a plastic surgeon at Johns Hopkins Medicine in Baltimore who decided he may be an ideal candidate for a penile transplant. His team lead a scheme that aims to give penis transplants to 60 soldiers.
Ray said: 'This was actually something that could fix me. I could go back to being normal again.'
There had only been four penis transplants before Ray's - the first was in China in 2006, which was unsuccessful.
The US Navy corpsman, known only as Ray (pictured after his operation in 2018), was tending to wounded soldiers during an ambush by the Taliban when he stepped on a roadside bomb in 2010
Ray received the life-changing news in March 2018 that a donor was available in another state. He was walking his dog at the time.
The infantryman raced into action while medics boarded a charted jet from Maryland to meet the donor - a brain-dead man - before transporting the penis on ice to the hospital to begin the 25-surgeon operation at 2am.
'We felt very confident we could do it, but we had never done it,' said Dr Redett. 'If you're not anxious for something like that, you're not thinking hard enough.'
Most men needing a penis are given a phalloplasty, a member made of tissue, blood vessels and nerves taken from a forearm or thigh.
'For him, it was almost either you do this transplant, or you live the rest of your life with your defect,' said Dr Redett.
But operations to create such a penis carry a higher infection risk and the patient doesn't regain natural use of their penis.
A diagram from the new case report details the donor anatomy that was transplanted to Ray. He not only received the scrotum and penis of the donor, but a complex network of for crucial arteries and veins (labeled around the periphery), the corpus cavernosum (center), which is key to Ray's ability to achieve an erection, part of the donor's urethra and a bundle of nerves that let Ray's new penis feel pleasure (center)
In 2013, the veteran met with a plastic surgeon, Dr Richard Redett (left) of Johns Hopkins Medicine in Baltimore, who said he was the perfect candidate for a penile transplant
A total penis transplant, where the body part is transferred from one individual to another, is called vascularized composite allotransplantation.
Ray was able to have the transplant because he had a urethra and a specific set of blood vessels created for the transplant to work.
Surgeons had to stitch nerves, arteries, veins and blood vessels finer than human hairs from the transplant penis to Ray.
The donor's scrotum was also transferred - but their testicles were removed for ethical reasons to avoid the risk of the patient having his babies.
To ensure its success, Ray’s procedure would have to be more extensive than any of the previous transplants performed.
Not only did Ray’s surgical team, led by Dr Redett, need to harvest the donor penis and reattach it to Ray’s body, but the blast had taken a chunk of Ray’s abdominal tissue and part of his thigh as well as his scrotum.
The complex surgery also involved transplanting the donor's skin, muscles, tendons, nerves, bone and blood vessels
The testes were not transferred, to sidestep the ethical quandary that could arise if Ray also had his donor's sperm.
Doctors would need to keep