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The transplant comes with some long-term complications. The recipient will likely have to take anti-rejection drugs for the rest of his life, which could put him at risk for infections, kidney problems and certain types of cancers, the Times reported. The immunosuppressants that prevent his body from rejecting the transplant can weaken his overall immune system, which means that he has to wash his hands constantly.

But Ray shrugged off those concerns, telling the Review that agreeing to the transplant was “one of the best decisions I ever made.” The procedure hugely improved his quality of life, he said, and gave him renewed confidence to go out and meet new people.

“This surgery was a way for me to overcome that little subconscious voice or whatever it was that would always keep me feeling different from everyone else,” Ray told the Review. “It was one of those injuries that really stresses you out and you think, ‘Why would I keep going?’ I guess I always just kept this real hope that there’s an answer out there.”

For now, the prohibitive cost of the procedure makes it out of reach for most wounded veterans. As The Washington Post’s Eli Rosenberg reported last year, the transplant was not covered by insurance. The hospital covered most of the costs, estimated at $300,000 to $400,000.

Finding organ donors has also been a challenge, especially given the awkwardness of asking grieving families about their recently deceased relative’s genitals. In Ray’s case, doctors were intent on finding a donor who was young and healthy, had a similar skin tone and was only two hours from the hospital. It took five years before one came along.