icine in North Carolina, also have an- nounced penile transplant programs. In fact, surgeons from Massachusetts General Hospital completed the fi rst successful penis transplant in the U.S. May 8 and 9 on a civilian patient whose penis was removed as a result of cancer. During a press conference following the surgery, doctors stated they believe the patient should have normal urina- tion and sexual function soon. According to Lee, penile transplan-
tation began from the school’s ongo- ing work with DoD on arm and hand transplants for wounded warriors. “When it comes to a missing hand or a missing penis, there is no similar tissue from the patient that can be used to replace the defect,” Lee explains. “We determined that the best treatment for someone whose genitourinary area has been signifi cantly mutilated would be a penile transplant, which would return both form and function.” The Johns Hopkins transplant team
operated on cadavers to perfect the re- attachment of penile nerves and blood vessels. Along the way, they discovered an important new use for an existing artery, which improves blood fl ow to the penile shaft skin, a breakthrough reported in Plastic and Reconstructive Surgery, the journal of the American Society of Plastic Surgeons. Yet another challenge was the cock-
tail of antirejection drugs a transplant recipient would have to take for the rest of his life, all of which are capable of causing serious side eff ects. But after much research, the Johns Hopkins team was able to reduce the number of antirejection drugs from three to one at a much lower dose. For a penile transplant to be suc-
cessful, Lee says, the donor and re- cipient must be immunologically compatible and have matching blood types. Comparable skin color is an- other consideration. The amount of tissue that must be
replaced also is important. “Every inju- ry is diff erent,
[CONTINUES ON PAGE 84] AUGUST 2016 MILITARY OFFICER 67
Infertility Treatments: DoD versus the VA
Blasts from the impro- vised explosive devices extensively used in the wars in Iraq and Afghanistan have resulted not only in traumatic leg amputations, but also in pelvic, abdominal, urogenital, and brain and spinal cord injuries — injuries that have resulted in the inability of many wounded warriors to have children. Many of these injuries
affect veterans in the prime of their reproductive years. In particular, the inability to con- ceive and start a family can be a devastating psychological setback for wounded warriors. Rooted now in 20 years of
established medicine, in vitro fertilization (IVF) can be an effective solution for many injured servicemembers and veterans. DoD offers IVF for wounded warriors on active duty, yet when they transi- tion into veteran status, the VA does not offer this same treatment. Instead, veterans find themselves subject to an outdated provision in the law passed in 1992, which the VA believes prevents it from cov- ering IVF treatments.
Currently, if an injured
veteran needs IVF to start or continue a family, they have to fund it themselves at an aver- age total cost of over $12,000. According to Capt. Kathy Beasley, USN (Ret), MOAA deputy director of Government Relations, that is why “we sup- port current legislation that will fund and direct the VA to provide IVF for these men and women who want the basic right to start a family and to move forward with their lives.” Sen. Patty Murray (D-
Wash.) agrees and has called on members of Congress to change the existing law. The Senate passed its version of the Military Construction and Veterans Affairs funding bill May 19, which would re- quire the VA to cover fertility treatments and counseling for veterans with a “service- connected condition that results in being unable to procreate without the use of the fertility treatment.” The provision would affect nearly 1,800-2,000 post-9/11 servicemembers. However, the House also must approve similar language.
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