Ethical framework for penile transplantation surgery for trans-people

Medical science has made tremendous advancements during the last decades. A milestone was the first report of successful transplantation of a solid organ, the kidney, which was later followed by successful transplantations of... [ view full abstract ]

Medical science has made tremendous advancements during the last decades. A milestone was the first report of successful transplantation of a solid organ, the kidney, which was later followed by successful transplantations of other organs whose aim was to enhance quality of life (QoL) as hand, abdominal wall, larix, face, uterus transplantation and, in 2006, penis transplantation (PT) for a cis-man following traumatic penis amputation. None of the three penile transplantations reported so far in the literature were performed for the purpose of gender confirmation surgery.

To identify the main ethical issues that are likely to be associated with the development of PT for trans people, and eventually to develop prima facie ethical guidelines to allow this research, discussing, for example, body... [ view full abstract ]

To identify the main ethical issues that are likely to be associated with the development of PT for trans people, and eventually to develop prima facie ethical guidelines to allow this research, discussing, for example, body donation for anatomical studies, the use of cadaver vs living donors, and the ethics of research on PT for trans people.

Analysis of the ethical issues, and application of the Emmanuel’s et al. (2000) ethical requirements for research, on the feasibility of innovative PT surgery for trans people. Term paper for the MA in Bioethics, New York... [ view full abstract ]

Analysis of the ethical issues, and application of the Emmanuel’s et al. (2000) ethical requirements for research, on the feasibility of innovative PT surgery for trans people.
Term paper for the MA in Bioethics, New York Univesity, USA.

1) There is no specific ethical issue that could be raised up in merit of body donation for anatomical study when developing PT for trans people. 2) I argue that many people might have different attitudes towards donation of... [ view full abstract ]

1) There is no specific ethical issue that could be raised up in merit of body donation for anatomical study when developing PT for trans people.
2) I argue that many people might have different attitudes towards donation of specific organs such as face and penis, vs organs such as kidney and liver; I assume, in fact, that people might give special value to some organs rather than others.
Given the importance to the bond of a person with organs such penis (or face, for example), it appears important to inform donors that penis is one of the organs that could be transplanted, when that person is deceased.
3) Regarding the issue of living donor, I argue that in clinical research setting, without having a guarantee that neither the recipients neither the hypothetical living donors will benefit of the research, using a cadaver donor is ethically plausible, while using a living donor is not ethically plausible for the time being. According to the Declaration of Helsinki, in fact, in research settings “measures to minimize the risks must be implemented”.

Emanuel et al. (2000) previously proposed a framework of seven clinical requirements for clinical research, as scientific and social value, scientific validity, fair subject selection, favorable risk-benefit ratio (I hereby... [ view full abstract ]

Emanuel et al. (2000) previously proposed a framework of seven clinical requirements for clinical research, as scientific and social value, scientific validity, fair subject selection, favorable risk-benefit ratio (I hereby take a libertarian view - seeking to highlight autonomy and freedom of choice, emphasizing the primacy of individual judgment), independent review, informed consent, respect for enrolled research participants. All these are applicable and can be implemented when planning PT.
Finally, I argue that, when the clinician is proposing all different techniques available (no surgery, metaidoioplasty, epithesis, local flap, free flap, and PT) with a fair approach (using an unbiased communication model in order not to persuade the patient toward one technique rather than another), the patient’s vulnerability would not constitute anymore an ethical issue specific to the PT study.

There is no ethical issue that would make research on PT unjustified in the specific subgroup of trans people. The same ethical framework guiding other non-life threatening transplantations (e.g. face and hands) can be adapted... [ view full abstract ]

There is no ethical issue that would make research on PT unjustified in the specific subgroup of trans people. The same ethical framework guiding other non-life threatening transplantations (e.g. face and hands) can be adapted to the trans people group. Correct and complete information should be given to both potential donors and recipients; emphasis must be given to patient’s autonomy when self-assessing QoL, and foreseeable benefits vs possible risks; when selecting patients to be enrolled in research / innovative surgery, priority should be given to patients whose improvement in QoL is foreseeable.