Written by Liesl Venter

The long road

It has been a lot to comprehend, says Van der Merwe, who admits that he was often tempted to give up on the research project that has put him to the medical hall of fame.

Confronted by the after-effects of botched circumcisions time and time again, he wanted to find a solution for men whose genitalia had been amputated, and he was convinced the only way was penis transplants.

“It was a crazy idea that was not getting much support. The transplant community was resistant and sceptical about the practicalities of asking for a donor penis. We had no funding despite knocking on every possible door, but we persevered.”

He can’t even recall meeting the patient all that clearly. “I don’t know when I first saw him. Of course, now we have a connection for life. At the time I was not thinking he was going to be the first man we successfully transplant a penis onto. It was not that planned a scenario.”

He reflects for a moment, deep in thought, trying to recapture the details of their meeting. “I guess it must have been at least a year after he had his penis amputated that I first consulted with him. We had started recruiting patients for an actual transplant from around 2011, and various doctors and departments were referring men to us.

"He had been sent by a plastic surgeon he had gone to see in the hope of finding a solution. He was a good candidate for our programme and joined the list.”

Ten patients have participated in this study. “We now still have nine men on the programme who are waiting for donor penises.

"There is no timeline involved with this – we do the next operation when we get the next penis that matches with one of our patients. They are in no particular order.”

Hordes of others have expressed interest, all with the same intention: to get on to this exclusive list and be granted a new lease on life.

“It is very difficult, because this is after all still just a research study,” says Van der Merwe.

“We are not able to help people who have been in accidents or have suffered from disease. At this stage we are only considering men who have lost their penises due to ritual circumcision.”

Van der Merwe says helping these patients is a driving force for him. Young men, barely out of boyhood and not fully understanding the impact of what has happened to their bodies.

It’s not uncommon for them to ask medical staff when their penis will grow back. Completely distraught when the full realisation hits home that they will never again urinate standing up, have intercourse, or become fathers.

“These patients tell you of the stress they suffer, how unbearable their lives are. They are desperate for help, any help,” he says.

Not only do they have to live with the mutilation, they more often than not keep it a secret even from their closest family.

The recipient of the world’s first penis is believed not to have told anyone of the operation. He has no intention of speaking about it and has asked his doctors to keep his secret.

Circumcision injuries

Ritual male circumcision is among the most secretive and sacred of rites practiced by several tribal and cultural groups in South Africa, says Louise Vincent, a professor in the Department of Political and International Studies at Rhodes University.

Yet the alarming rate of death and injury in recent years has led to several government regulations and interventions.

While initiates are traditionally not permitted to seek western medical attention while in their initiation programme, due to the severity of the wounds hospitals are seeing more and more of these young men.

Statistics are few and far between. It is estimated that close to 1 000 men have died since the mid-90s and at least twice as many have had penises amputated.

The South African government has scaled up initiatives to ensure the safety of young men undergoing traditional circumcision.

Working closely with traditional leaders, a programme was launched last year that has chiefs choosing the medical doctors to perform the circumcisions at initiation schools.

Millions of rands have been set aside to synergise traditional culture with modern medicine, educating tribal leaders on the importance of carrying out circumcisions in safe and healthy environments.

The country has also increased education on the importance of medical male circumcision as a way of fighting the HIV/Aids pandemic. Between 2010 and 2013 at least 1.3-million men were circumcised medically in the country.

Transplants are not easy to come by in South Africa. At least 4 300 people are currently waiting for an organ or cornea transplant, but in 2013 – the last available figures – only 566 organ and cornea transplants were done.

Of these, 335 were solid organ transplants that included 25 hearts, seven lung and 37 liver transplants.

No doubt transplant experts the world over will continue to watch developments very closely.

Most international and local commentators maintain rejection could still be experienced – even a year down the line – and questions remain around the  patient's eported ability to experience sensation.

For Van der Merwe and his team, the early successes are more than enough at this stage.

“We will deal with the challenges as and when they come along. Of course there has been criticism.

"We have, however, tried to cover our bases. There is no such thing as a perfect study – there is always room for improvement.”