By Alexandra Sifferlin
April 23, 2018

Physicians at Johns Hopkins University School of Medicine in Baltimore have performed the first total penis and scrotum transplant in the world, the hospital announced on Monday.

The surgery, which took place over 14 hours on March 26, was performed by a team of nine plastic surgeons and two urological surgeons. The penis and scrotum (without testicles) and partial abdominal wall came from a deceased donor. The recipient is a military veteran who was injured by an improvised explosive device (IED) blast in Afghanistan and wishes to remain anonymous. The hospital said he has recovered from the surgery and will be discharged from the hospital this week.

“It’s a real mind-boggling injury to suffer, it is not an easy one to accept,” the transplant recipient said in a statement released by Johns Hopkins. “When I first woke up, I felt finally more normal… [with] a level of confidence as well. Confidence… like finally I’m okay now.”

The procedure is the second penis transplant to be publicly reported in the United States, but the first full transplant of this kind. In 2016, surgeons at Massachusetts General Hospital performed the first penis transplant in the U.S. on a man who had his penis amputated due to penile cancer.

Read more: The New Transplant Revolution

The Johns Hopkins team has been planning for penis transplant procedures for years, with the goal of eventually helping wounded veterans. A 2016 report found that from 2001 to 2013, 1,367 men in the United States military suffered injuries to their genitals or urinary tract in Iraq or Afghanistan. The report also found that most of the injuries were caused by bomb blasts, and over a third were considered severe. Among the injured men, 94% were age 35 or younger. “Many men sustained disfiguring genital injuries during their peak years of sexual development and reproductive potential,” researchers wrote in the 2016 report.

A penis transplant is a complicated procedure that includes connecting all the arteries, veins, nerves, the skin and the urethra to the recipient. Each penis removal and injury can be different depending on which parts are removed, but surgeons hope that for at least some men, sexual function can be restored. “We are hopeful that this transplant will help restore near-normal urinary and sexual functions for this young man,” Dr. W.P. Andrew Lee, professor and director of plastic and reconstructive surgery at the Johns Hopkins University School of Medicine, said in a statement. Other men are now undergoing screening for the procedure, Lee said in a news conference.

The Johns Hopkins team decided not to transplant the donor’s testicles because such a transplant could allow genetic material to be passed on from the donor. The hospital said there are too many unanswered ethical questions surrounding that kind of transplant.

Penis transplants are estimated to cost $50,000 to $75,000. As of now, hospitals are largely footing the bills. Since the procedures are still considered experimental, they are not covered by insurance. Johns Hopkins covered the cost of the veteran’s transplant, and the doctors there are in the process of applying for a research grant that would offer coverage for further procedures.

Contact us at editors@time.com.

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