Medical staff rushing organs to a surgery for transplantation.
Thanks to the remarkable evolution of organ transplantation, it's now possible to replace genitals that don't work properly or have been injured. Surgeons have been transplanting ovarian tissue for more than a decade, and they're now successfully transplanting penises and wombs too.
Rules and regulations aren't keeping up with the rapid rise of genital transplants.
Earlier this year, an American soldier whose genitals were injured by a bomb in Afghanistan received the first-ever transplant of a penis and scrotum at Johns Hopkins Medicine.
Rules and regulations aren't keeping up with the rapid rise of genital transplants, however, and there's no consensus about how society should handle a long list of difficult and delicate questions.
Are these expensive transplants worth the risk when other alternatives exist? Should men, famously obsessed with their penises, be able to ask for a better model simply because they want one? And what happens when transplant technology further muddles the concept of biological parenthood?
"We need to remember that the human body is not a machine with interchangeable parts," says bioethicist Craig M. Klugman of DePaul University. "These are complicated, difficult and potentially dangerous surgeries. And they require deep consideration on a physical, psychological, spiritual, and financial level."
From Extra Testicles to Replacement Penises
Tinkering with human genitalia -- especially the male variety -- is hardly a new phenomenon. A French surgeon created artificial penises for injured soldiers in the 16th century. And a bizarre implant craze swept the U.S. in the 1930s when a quack physician convinced men that, quite literally, the more testicles the merrier – and if the human variety wasn't available, then ones from goats would have to do.
Now we're more sophisticated. Modern genital transplants are designed to do two things: Treat infertility (in women) and restore the appearance and function of genitals (in men).
In women, surgeons have successfully transplanted ovarian tissue from one woman to another since the mid-2000s, when an Alabama woman gave birth after getting a transplant from her identical twin sister. Last year, for the first time in the U.S., a young woman gave birth after getting a uterus transplant from a living donor.
"Where do you draw the line? Is pregnancy a privilege? Is it a right?"
As for men, surgeons in the U.S. and South Africa have successfully transplanted penises from dead men into four men whose genitals were injured by a botched circumcision, penile cancer or a wartime injury. One man reportedly fathered a child after the procedure.
The Johns Hopkins procedure was the first to include a scrotum. Testicles, however, were not transplanted due to ethical concerns. Surgeons have successfully transplanted testicles from man-to-man in the past, but this procedure isn't performed because the testes would produce sperm with the donor's DNA. As a result, the recipient could father a baby who is genetically related to the donor.
Are Transplants Worth the Expense and Risk?
Genital transplants are not simple procedures. They're extremely expensive, with a uterus transplant estimated to cost as much as $250,000. They're dangerous, since patients typically must take powerful drugs to keep their immune systems from rejecting their new organs. And they're not medically necessary. All have alternatives that are much less risky and costly.
Dr. Hiten D. Patel, a urologist at Johns Hopkins University, believes these types of factors make penis transplants unnecessary. As he wrote in a 2018 commentary in the journal European Urology, "What in the world are we doing?"
There are similar questions about female genital transplants, which allow infertile women to become pregnant instead of turning to alternatives like adoption or surrogacy. "This is not a life-saving transplant. A woman can very well live without a uterus," says McGill University's Dr. Jacques Balayla, who studies uterine transplantation. "Where do you draw the line? Is pregnancy a privilege? Is it a right? You don't want to cause harm to an individual unless there's an absolute need for the procedure."
But Johns Hopkins urologist Dr. Arthur L. Burnett II, who served on the surgical team that performed the penis-and-scrotum procedure, says penis transplants can be appropriate when other alternatives – like a "neophallus" created from forearm skin and tissue – aren't feasible.
It's also important to "restore normalcy," he says. "We want someone to be able to have sense of male adequacy and a normal sense of bodily well-being on both physical and psychological levels."
Surgical team members who performed the penis transplant, including W. P. Andrew Lee, director of the department of plastic and reconstructive surgery, center.
As for the anonymous recipient, he's reportedly doing "very well" five months after the transplant. An update on Johns Hopkins' website states that "he has normal urinary functions and is beginning to regain sensation in the transplanted tissues."
When the Organ Donors Do It Live
Some peculiar messages reached Burnett's desk after his institution announced it would begin performing penis transplants. Several men wanted to donate their own organs. But for now, transplanted penises are only coming from dead donors whose next of kin have approved the donation.
Burnett doesn't expect live donors to enter the penis transplant picture. But there are no guidelines or policies to stop surgeons from transplanting a penis from a live donor or, for that matter, a testicle.
Live women have already donated wombs and ovarian tissue, forcing them to face their own risks from transplant surgery. "You're putting the donor at risk because she has to undergo pretty expensive surgery for a procedure that is not technically lifesaving," McGill University's Balayla says.
When it comes to uterus transplants, the risk spreads even beyond donor and recipient. Balayla notes there's a third person in the equation: The fetus. "Immunosuppressant medication may harm the baby, and you're feeding the baby with a [uterine] blood vessel that's not natural, held together by stitches," he says.
It's up to each medical institution that performs the procedures to set its own policies.
Bioethicists are talking about other issues raised by genital transplants: How should operations for transgender people fit in? Should men be able to get penis transplants for purely cosmetic reasons? And then there's the looming question of genetic parenthood.
It's up to each medical institution that performs the procedures to set its own policies.
Let's say a woman gets a transplant of ovarian tissue, a man gets a testicle transplant, and they have a baby the old-fashioned way.* The child would be genetically linked to the donors, not the parents who conceived him or her.
Call this a full-employment act not just for bioethicists but theologians too. "Catholicism is generally against reproductive technologies because it removes God from the nature of the procreative act. This technology, though, could result in conception through the natural act. Would their concern remain?" DePaul University's Klugman asked. "Judaism is concerned with knowing a child's parentage, would a child from transplanted testes be the child of the donor or the recipient? Would an act of coitus with a transplanted penis be adultery?"
Yikes. Maybe it's time for the medical field or the law to step in to determine what genital transplants surgeons can and can't -- or shouldn't -- do.
So far, however, only uterus transplants have guidelines in place. Otherwise, it's up to each medical institution that performs the procedures to set its own policies.
"I don't know if the medical establishment is in the position to do the best job of self-regulation," says Lisa Campo-Engelstein, a bioethicist with Albany Medical College. "Reproductive medicine in this country is a huge for-profit industry. There's a possibility of exploitation if we leave this to for-profit fertility companies."
And, as bioethicist Klugman notes, guidelines "aren't laws, and people can and do violate them with no effect."
He doesn't think laws are the solution to the ethical issues raised by genital transplants either. Still, he says, "we do need a national conversation on these topics to help provide guidance for doctors and patients."
[Correction: The following sentence has been updated: "Let's say a woman gets a transplant of ovarian tissue, a man gets a testicle transplant, and they have a baby the old-fashioned way." The original sentence mistakenly read "uterus transplant" instead of "ovarian tissue."]
Thanks to safety cautions from the COVID-19 pandemic, a strain of influenza has been completely eliminated.
The flu shot, explained
Influenza viruses type A and B are responsible for the majority of human illnesses and the flu season.
Centers for Disease Control
For more than a decade, flu shots have protected against two types of the influenza virus–type A and type B. While there are four different strains of influenza in existence (A, B, C, and D), only strains A, B, and C are capable of infecting humans, and only A and B cause pandemics. In other words, if you catch the flu during flu season, you’re most likely sick with flu type A or B.
Flu vaccines contain inactivated—or dead—influenza virus. These inactivated viruses can’t cause sickness in humans, but when administered as part of a vaccine, they teach a person’s immune system to recognize and kill those viruses when they’re encountered in the wild.
Each spring, a panel of experts gives a recommendation to the US Food and Drug Administration on which strains of each flu type to include in that year’s flu vaccine, depending on what surveillance data says is circulating and what they believe is likely to cause the most illness during the upcoming flu season. For the past decade, Americans have had access to vaccines that provide protection against two strains of influenza A and two lineages of influenza B, known as the Victoria lineage and the Yamagata lineage. But this year, the seasonal flu shot won’t include the Yamagata strain, because the Yamagata strain is no longer circulating among humans.
How Yamagata Disappeared
Flu surveillance data from the Global Initiative on Sharing All Influenza Data (GISAID) shows that the Yamagata lineage of flu type B has not been sequenced since April 2020.
Nature
Experts believe that the Yamagata lineage had already been in decline before the pandemic hit, likely because the strain was naturally less capable of infecting large numbers of people compared to the other strains. When the COVID-19 pandemic hit, the resulting safety precautions such as social distancing, isolating, hand-washing, and masking were enough to drive the virus into extinction completely.
Because the strain hasn’t been circulating since 2020, the FDA elected to remove the Yamagata strain from the seasonal flu vaccine. This will mark the first time since 2012 that the annual flu shot will be trivalent (three-component) rather than quadrivalent (four-component).
Should I still get the flu shot?
The flu shot will protect against fewer strains this year—but that doesn’t mean we should skip it. Influenza places a substantial health burden on the United States every year, responsible for hundreds of thousands of hospitalizations and tens of thousands of deaths. The flu shot has been shown to prevent millions of illnesses each year (more than six million during the 2022-2023 season). And while it’s still possible to catch the flu after getting the flu shot, studies show that people are far less likely to be hospitalized or die when they’re vaccinated.
Another unexpected benefit of dropping the Yamagata strain from the seasonal vaccine? This will possibly make production of the flu vaccine faster, and enable manufacturers to make more vaccines, helping countries who have a flu vaccine shortage and potentially saving millions more lives.
Founder Lewis Hornby and his grandmother Pat, sampling Jelly Drops—an edible gummy containing water and life-saving electrolytes.
When Lewis Hornby visited his grandmother at her nursing home afterward, he learned that dehydration especially affects people with dementia, as they often don’t feel thirst cues at all, or may not recognize how to use cups correctly. But while dementia patients often don’t remember to drink water, it seemed to Hornby that they had less problem remembering to eat, particularly candy.
Where people with dementia often forget to drink water, they're more likely to pick up a colorful snack, Hornby found. alzheimers.org.uk
Hornby wanted to create a solution for elderly people who struggled keeping their fluid intake up. He spent the next eighteen months researching and designing a solution and securing funding for his project. In 2019, Hornby won a sizable grant from the Alzheimer’s Society, a UK-based care and research charity for people with dementia and their caregivers. Together, through the charity’s Accelerator Program, they created a bite-sized, sugar-free, edible jelly drop that looked and tasted like candy. The candy, called Jelly Drops, contained 95% water and electrolytes—important minerals that are often lost during dehydration. The final product launched in 2020—and was an immediate success. The drops were able to provide extra hydration to the elderly, as well as help keep dementia patients safe, since dehydration commonly leads to confusion, hospitalization, and sometimes even death.
Not only did Jelly Drops quickly become a favorite snack among dementia patients in the UK, but they were able to provide an additional boost of hydration to hospital workers during the pandemic. In NHS coronavirus hospital wards, patients infected with the virus were regularly given Jelly Drops to keep their fluid levels normal—and staff members snacked on them as well, since long shifts and personal protective equipment (PPE) they were required to wear often left them feeling parched.
In April 2022, Jelly Drops launched in the United States. The company continues to donate 1% of its profits to help fund Alzheimer’s research.