An Italian plastic surgeon has applied for permission to perform the world's first penis transplant.

Professor Nicolo Scuderi of Rome's Umberto I Hospital says he has three patients who want transplants and he is just waiting for the government's okay.

The plastic surgeon says the operation is not as complicated as re-attaching a penis, as occurred in the infamous case of John Wayne Bobbit whose wife cut off his penis.

However, he admits it will probably not be clear until after the first transplant is performed whether the patient will be left impotent.

"We can restore vascularity. We can restore sensitivity to the organ, but we don't know how much sensitivity and function will be regained," he said.

Sex changes

Of the three patients lined up to have the operation, two are women who have been given legal permission to change their sex.

The other is a man who had his penis amputated because he wanted to change sex, but has since changed his mind.

Loretta Bobbit became world famous after she cut off her husband's penis

Professor Scuderi said organs for transplants could either be obtained from clinically dead patients who were still on life support machines or from twinning sex change patients - with men who want to be women agreeing to donate their penis to women who wnat to be men.

Currently, plastic surgeons perform penis reconstructions on women who want to be men and for men who have had their penises amputated, whether by accident or because of illnesses such as cancer.

This is usually preformed by using muscles from the forearm.

Ethics

Professor Scuderi admitted there were ethical questions involved in penis transplants, since the penis was not a vital organ and patients ran immunological and other risks in having the operation.

He also stated that he would not initially agree to transplants for cosmetic reasons, for example, giving into requests from men for larger penises.

"The surgery is very complicated and very risky. It's not an aesthetic procedure," he said.

He said his enthusiasm for pioneering work on penis transplants had been boosted by the first hand transplant performed recently in France.

Immunosuppressive drugs

British plastic surgeons are not sure if the time is right for penis transplants.

Michael Brough of the British Association of Plastic Surgeons said the operation itself was relatively straightforward.

The problems arose with the dosage of current immunosuppressive drugs which would be needed for a patient to accept an organ from another person and which could ultimately prove fatal.

He said people receiving penis transplants would need stronger drugs than those who had heart or liver transplants, but no-one knew how high the dosage should be.

The need for stronger drugs was because transplanted organs relating to the skeletal system were more likely to be rejected than others.

Mr Brough said a patient would have to be fully informed of the risk they were taking in having an operation - particularly since the condition being treated was not in itself life-threatening.

"As with the hand transplant, you can live a relatively normal life without a penis. It is not a life-threatening condition. Without a heart, that's it," he said.

He added that it was also likely to be more difficult to find matches for patients because there would be fewer donors available.

But he said he would welcome anyone taking "the first step" towards transplant operations.

China

News of the application for a penis transplant came as army surgeons in China announced that they had built a new penis for a six-year-old boy.

The boy, Jiang Rongming, had his penis bitten off by an angry donkey in the northeastern Jilin province earlier this year.

Surgeons rebuilt it using his own skin and abdominal tissue.

He can now urinate normally and surgeons say they expect he will regain full use of the organ eventually.

However, he will need another operation when he is older to restore normal sexual function.