He had already been talking to the grieving family for hours when he got the call from his bosses at the New England Organ Bank.
The patient who had just died, they said, looked like a good candidate to donate more than just his kidneys and lungs. Would the family be willing to donate his penis?
Even under normal circumstances, Daniel Miller-Dempsey’s job can sound impossible. When a patient is declared brain-dead, but is still on life support, he asks the family about removing their loved one’s organs and putting them into other people. The patient’s lungs are still breathing, the heart still pumping, the skin still pulsing with blood. “You have to have a family get to a point where they understand that [their loved one] has died, even though they look the same as they did the day before,” he said.
This kind of conversation doesn’t faze Miller-Dempsey. He has been working at the organ bank for 16 years, ever since he donated part of his own liver to his dad, at 24. His colleagues are just as unflappable when asking about donations of hearts, livers, and other organs that remain comfortably hidden beneath layers of muscle and skin.
But it was a different story when more complex transplant surgeries became possible and they had to start asking for donations of faces and hands.
“We were all nervous, because this was uncharted territory,” he said.
He and the other family services coordinators made a decision: They would not assume that a family was too fragile to consider the question. “Every family who had the opportunity to donate was asked,” he said.
So when his bosses called recently to tell him that the family he was talking with could provide the organ for the first penis transplant in the United States — an operation years in the planning at Massachusetts General Hospital — Miller-Dempsey knew what to do.
In the previous hours, he had expressed his sympathies to the family. He’d made sure the parents weren’t still hoping that their son would be revived — in which case a discussion about organ donation might be counterproductive. He’d found them open to the idea of donation.
Now, he asked them if they had seen news stories about face and limb transplants. They had.
He explained that their son was not a candidate for those procedures, but instead for something newer. It was called a genitourinary vascularized composite allograft — or GUVCA.
In layman’s terms, he explained, that meant a penis transplant.
The family was surprised. “There was some levity in the room,” said Miller-Dempsey.
They couldn’t believe that that was something that could be done.
And then they said yes — of course their son’s penis should be donated. They were happy to sign the special permission forms, drafted and vetted by lawyers and counselors and surgeons, for an experimental tissue graft.
As it turned out, that particular penis was not the one transplanted onto Thomas Manning, a 64-year-old bank courier from Halifax, Mass., who this month became the first American to have another man’s phallus grafted onto what was left of his own after a cancer surgery.
Over the last few months, two families were asked to donate their loved one’s penis. Both said yes. One went to Manning. But the other one didn’t end up working out “for clinical reasons,” said Alexandra Glazier, the president and CEO of the New England Organ Bank. The penis had the correct blood type and skin tone — that’s why the family was asked about donating it — but other issues, discovered later, made it unsuitable.
The organ bank will be looking for other potential donors.
Next on the list to receive a penis transplant at Mass General is a 49-year-old man who lost both legs and his genitalia after a bad car accident in 2012. He found himself unable to run his business from a wheelchair, and had to give it up. He also had to give up hunting, fishing, and camping trips.
“Dealt with it alright,” he told STAT in response to emailed questions. “Haven’t tried to hang myself or nothing.”
It was a roll of the dice as to whether this patient or Manning would end up being the first transplant recipient. It depended, mostly, on the availability of a suitable organ with the right blood type.
“We didn’t know who was going to go,” said Dr. Dicken Ko, head of urology at Mass General, who was one of the leaders of the surgical team, which included seven surgeons, six fellows and residents, and more than 30 others.
That 49-year old on the waiting list, who asked to remain anonymous, hopes that he’ll have his turn soon. He hopes a transplant will restore “everything back to 100 percent,” he said. “This would be life-changing for me.”
It could be a bit of a wait.
Donation candidates are not as common as one might think. “It’s only about 1 percent of deaths that are clinically eligible for organ donation,” Glazier said. “Most organ donation occurs when a patient has been declared dead based on neurologic criteria and is on a ventilator. It’s not the case when an individual has died at home of a heart attack.”
Miller-Dempsey said the family he approached about the penis donation was disappointed to know that particular organ wouldn’t have a new life in another body.
“They were excited to think that their son was going to be doing something very new and innovative. They certainly would have liked that to have happened, but they were very understanding that it was beyond their control,” he said.
They were able to donate some of their son’s other organs, Miller-Dempsey said, and took “great comfort knowing that he was going to save many lives, which he did.”
There will be more of these conversations for Miller-Dempsey, with yet more families all over New England willing to donate the most intimate parts of their loved ones’ bodies. Yet, even after 16 years, none of those encounters are routine.
“This is a job where you get to sit down with the best that humanity has to offer, over and over again,” he said. “To see a family be able to step outside of their grief and misery and think about other people is very profound. It gets you out of bed in the morning.”