Hand transplant
Encyclopedia
Hand transplantation is a surgical procedure to transplant
a hand from one human to another.
The operation is carried out in the following order: bone fixation, tendon repair, artery
repair, nerve
repair, then vein repair. The operation typically lasts 8 to 12 hours. By comparison, a typical heart transplant operation lasts 6 to 8 hours.
The recipient of a hand transplant needs to take immunosuppressive drug
s, as the body's natural immune system
will try to reject
, or destroy, the hand. These drugs cause the recipient to have a weaker immune system and mean that they may suffer severely even from minor infections.
after only two weeks.
The first short-term success in human hand transplantion occurred with New Zealand
er Clint Hallam
who had lost his hand in an accident while in prison. The operation was performed on September 23, 1998 in Lyon, France
by a team assembled from different countries around the world. A microsurgeon on the team, Dr. Earl Owen from Australia, was privy to the detailed basic research, much of it unpublished, that had been carefully gathered by the team in Louisville. After the operation, Hallam wasn't comfortable with the idea of his transplanted hand and failed to follow the prescribed post-operative drug and physiotherapy. His inaccurate expectations became a vivid example of the necessity of a fully committed team of caregivers, including psychologists, that can correctly select and prepare the potential transplant recipients for the lengthy and difficult recovery and for the modest functional restoration of a transplanted hand to be expected. Hallam's transplanted hand was removed at his request on February 2, 2001 following another episode of rejection.
The first hand transplant to achieve prolonged success was directed by University of Louisville
surgeons Drs. Warren Breidenbach and Tsu-Min Tsai in cooperation with the Kleinert Hand Institute and Jewish Hospital in Louisville, Kentucky
. The procedure was performed on New Jersey
native Matthew Scott on January 24, 1999. Scott had lost his hand in a fireworks accident at age 24. Later that year the Philadelphia Phillies asked him to do the honors of throwing out the ceremonial first pitch.
In contrast to the earlier attempts at hand transplantation, the Louisville group had performed extensive basic science research and feasibility studies for many years prior to their first clinical procedure.{for example, Shirbacheh et al, 1998} There also was considerable transparency and internal review board oversight involved in the screening and selection of prospective patients.
In March 2000, a team of surgeons at the University of Innsbruck in Austria began a series of three bilateral hand transplants over six years. The first was an Austrian police officer who had lost both hands attempting to defuse a bomb. He has completed an around-the-world solo motorcycle trip with his transplanted hands.
University of Louisville doctors also performed a successful hand transplant on Michigan native Jerry Fisher in February 2001, and Michigan resident David Savage in 2006.
On January 14, 2004, the team of Professor Jean-Michel Dubernard
(Edouard-Herriot Hospital, France) declared a five-year-old double hand transplant a success. The lessons learned in this case, and in the 26 other hand transplants (6 double) which occurred between 2000 and 2005, gave encouragement to other transplant operations of such organs as the face
, abdominal wall or larynx
.
On May 4, 2009 Jeff Kepner
, a 57-year-old Augusta, Georgia, resident, underwent the first double hand transplant in the United States at the University of Pittsburgh Medical Center by a team led by Dr. W.P. Andrew Lee, who also had been performing careful basic research on such transplants for many years. A CNN story on his follow up demonstrated the limited functional restoration to be expected, particularly following bilateral transplantation http://www.cnn.com/2010/HEALTH/08/26/double.hand.transplant/index.html.
On February 18, 2010 the first female in the United States underwent hand transplantation at Wilford Hall Medical Center in San Antonio, Texas. The procedure was performed by surgeons from The Hand Center of San Antonio and US Air Force. http://www.foxnews.com/health/2010/03/04/amputee-woman-gets-successful-hand-transplant/
On June 22, 2010, a Polish
soldier received two new hands from a female donor, after losing them three years earlier while saving a young recruit from a bomb.
On March 8, 2011, 26-year-old Emily Fennell underwent an 18 hour surgery to attach a right hand. This was performed in the Ronald Reagan UCLA Medical Center. http://newsroom.ucla.edu/portal/ucla/ucla-performs-first-hand-transplant-193338.aspxhttp://articles.nydailynews.com/2011-04-20/news/29473076_1_first-hand-transplant-new-hand-new-limb
In the fall of 2011, 28-year-old Lindsay Ess received a double hand transplant at the Hospital of the University of Pennsylvania
in an 11 1/2 hour surgery. http://www2.timesdispatch.com/news/health/2011/nov/01/tdmain01-after-years-without-limbs-lindsay-ess-beg-ar-1425112/
Although the one-year survival of the transplanted hands has been excellent with a fully committed institution, the number of hand transplants performed after 2008 has been small due to the drug-related side effects, the uncertain long-term outcome, and the high cost of the surgery, rehabilitation and immunosuppression (Schneeberger et al, 2008) http://www.springerlink.com/content/v087180nm7382327/.
Organ transplant
Organ transplantation is the moving of an organ from one body to another or from a donor site on the patient's own body, for the purpose of replacing the recipient's damaged or absent organ. The emerging field of regenerative medicine is allowing scientists and engineers to create organs to be...
a hand from one human to another.
The operation is carried out in the following order: bone fixation, tendon repair, artery
Artery
Arteries are blood vessels that carry blood away from the heart. This blood is normally oxygenated, exceptions made for the pulmonary and umbilical arteries....
repair, nerve
Nerve
A peripheral nerve, or simply nerve, is an enclosed, cable-like bundle of peripheral axons . A nerve provides a common pathway for the electrochemical nerve impulses that are transmitted along each of the axons. Nerves are found only in the peripheral nervous system...
repair, then vein repair. The operation typically lasts 8 to 12 hours. By comparison, a typical heart transplant operation lasts 6 to 8 hours.
The recipient of a hand transplant needs to take immunosuppressive drug
Immunosuppressive drug
Immunosuppressive drugs or immunosuppressive agents are drugs that inhibit or prevent activity of the immune system. They are used in immunosuppressive therapy to:...
s, as the body's natural immune system
Immune system
An immune system is a system of biological structures and processes within an organism that protects against disease by identifying and killing pathogens and tumor cells. It detects a wide variety of agents, from viruses to parasitic worms, and needs to distinguish them from the organism's own...
will try to reject
Transplant rejection
Transplant rejection occurs when transplanted tissue is rejected by the recipient's immune system, which destroys the transplanted tissue. Transplant rejection can be lessened by determining the molecular similitude between donor and recipient and by use of immunosuppressant drugs after...
, or destroy, the hand. These drugs cause the recipient to have a weaker immune system and mean that they may suffer severely even from minor infections.
History
A hand transplant was performed in Ecuador in 1964, but the patient suffered from transplant rejectionTransplant rejection
Transplant rejection occurs when transplanted tissue is rejected by the recipient's immune system, which destroys the transplanted tissue. Transplant rejection can be lessened by determining the molecular similitude between donor and recipient and by use of immunosuppressant drugs after...
after only two weeks.
The first short-term success in human hand transplantion occurred with New Zealand
New Zealand
New Zealand is an island country in the south-western Pacific Ocean comprising two main landmasses and numerous smaller islands. The country is situated some east of Australia across the Tasman Sea, and roughly south of the Pacific island nations of New Caledonia, Fiji, and Tonga...
er Clint Hallam
Clint Hallam
Clint Hallam was the first recipient of a human hand transplant.Hallam lost his hand in circular-saw accident at Rolleston prison in 1984, where he was serving time for fraud....
who had lost his hand in an accident while in prison. The operation was performed on September 23, 1998 in Lyon, France
France
The French Republic , The French Republic , The French Republic , (commonly known as France , is a unitary semi-presidential republic in Western Europe with several overseas territories and islands located on other continents and in the Indian, Pacific, and Atlantic oceans. Metropolitan France...
by a team assembled from different countries around the world. A microsurgeon on the team, Dr. Earl Owen from Australia, was privy to the detailed basic research, much of it unpublished, that had been carefully gathered by the team in Louisville. After the operation, Hallam wasn't comfortable with the idea of his transplanted hand and failed to follow the prescribed post-operative drug and physiotherapy. His inaccurate expectations became a vivid example of the necessity of a fully committed team of caregivers, including psychologists, that can correctly select and prepare the potential transplant recipients for the lengthy and difficult recovery and for the modest functional restoration of a transplanted hand to be expected. Hallam's transplanted hand was removed at his request on February 2, 2001 following another episode of rejection.
The first hand transplant to achieve prolonged success was directed by University of Louisville
University of Louisville
The University of Louisville is a public university in Louisville, Kentucky. When founded in 1798, it was the first city-owned public university in the United States and one of the first universities chartered west of the Allegheny Mountains. The university is mandated by the Kentucky General...
surgeons Drs. Warren Breidenbach and Tsu-Min Tsai in cooperation with the Kleinert Hand Institute and Jewish Hospital in Louisville, Kentucky
Louisville, Kentucky
Louisville is the largest city in the U.S. state of Kentucky, and the county seat of Jefferson County. Since 2003, the city's borders have been coterminous with those of the county because of a city-county merger. The city's population at the 2010 census was 741,096...
. The procedure was performed on New Jersey
New Jersey
New Jersey is a state in the Northeastern and Middle Atlantic regions of the United States. , its population was 8,791,894. It is bordered on the north and east by the state of New York, on the southeast and south by the Atlantic Ocean, on the west by Pennsylvania and on the southwest by Delaware...
native Matthew Scott on January 24, 1999. Scott had lost his hand in a fireworks accident at age 24. Later that year the Philadelphia Phillies asked him to do the honors of throwing out the ceremonial first pitch.
In contrast to the earlier attempts at hand transplantation, the Louisville group had performed extensive basic science research and feasibility studies for many years prior to their first clinical procedure.{for example, Shirbacheh et al, 1998} There also was considerable transparency and internal review board oversight involved in the screening and selection of prospective patients.
In March 2000, a team of surgeons at the University of Innsbruck in Austria began a series of three bilateral hand transplants over six years. The first was an Austrian police officer who had lost both hands attempting to defuse a bomb. He has completed an around-the-world solo motorcycle trip with his transplanted hands.
University of Louisville doctors also performed a successful hand transplant on Michigan native Jerry Fisher in February 2001, and Michigan resident David Savage in 2006.
On January 14, 2004, the team of Professor Jean-Michel Dubernard
Jean-Michel Dubernard
Jean-Michel Dubernerd is a medical doctor specializing in transplant surgery, as well as a former Deputy in the French National Assembly.Dr...
(Edouard-Herriot Hospital, France) declared a five-year-old double hand transplant a success. The lessons learned in this case, and in the 26 other hand transplants (6 double) which occurred between 2000 and 2005, gave encouragement to other transplant operations of such organs as the face
Face transplant
A face transplant is a still-experimental procedure to replace all or part of a person's face. The world's first full face transplant was completed in Spain in 2010.-Beneficiaries of face transplant:...
, abdominal wall or larynx
Larynx
The larynx , commonly called the voice box, is an organ in the neck of amphibians, reptiles and mammals involved in breathing, sound production, and protecting the trachea against food aspiration. It manipulates pitch and volume...
.
On May 4, 2009 Jeff Kepner
Jeff Kepner
Jeff Kepner is the first ever recipient of double hand transplant surgery in the United States. The surgery was performed at the University of Pittsburgh Medical Center on Monday May 4, 2009. Kepner lost both hands and feet in 1999 from a strep infection....
, a 57-year-old Augusta, Georgia, resident, underwent the first double hand transplant in the United States at the University of Pittsburgh Medical Center by a team led by Dr. W.P. Andrew Lee, who also had been performing careful basic research on such transplants for many years. A CNN story on his follow up demonstrated the limited functional restoration to be expected, particularly following bilateral transplantation http://www.cnn.com/2010/HEALTH/08/26/double.hand.transplant/index.html.
On February 18, 2010 the first female in the United States underwent hand transplantation at Wilford Hall Medical Center in San Antonio, Texas. The procedure was performed by surgeons from The Hand Center of San Antonio and US Air Force. http://www.foxnews.com/health/2010/03/04/amputee-woman-gets-successful-hand-transplant/
On June 22, 2010, a Polish
Poles
thumb|right|180px|The state flag of [[Poland]] as used by Polish government and diplomatic authoritiesThe Polish people, or Poles , are a nation indigenous to Poland. They are united by the Polish language, which belongs to the historical Lechitic subgroup of West Slavic languages of Central Europe...
soldier received two new hands from a female donor, after losing them three years earlier while saving a young recruit from a bomb.
On March 8, 2011, 26-year-old Emily Fennell underwent an 18 hour surgery to attach a right hand. This was performed in the Ronald Reagan UCLA Medical Center. http://newsroom.ucla.edu/portal/ucla/ucla-performs-first-hand-transplant-193338.aspxhttp://articles.nydailynews.com/2011-04-20/news/29473076_1_first-hand-transplant-new-hand-new-limb
In the fall of 2011, 28-year-old Lindsay Ess received a double hand transplant at the Hospital of the University of Pennsylvania
Hospital of the University of Pennsylvania
The Hospital of the University of Pennsylvania is a hospital affiliated with the University of Pennsylvania Health System located in the University City section of West Philadelphia. The hospital was founded at its current location in 1874 by the University of Pennsylvania School of Medicine,...
in an 11 1/2 hour surgery. http://www2.timesdispatch.com/news/health/2011/nov/01/tdmain01-after-years-without-limbs-lindsay-ess-beg-ar-1425112/
Although the one-year survival of the transplanted hands has been excellent with a fully committed institution, the number of hand transplants performed after 2008 has been small due to the drug-related side effects, the uncertain long-term outcome, and the high cost of the surgery, rehabilitation and immunosuppression (Schneeberger et al, 2008) http://www.springerlink.com/content/v087180nm7382327/.
External links
- www.handtransplant.org
- World's first successful hand transplant
- New York Times, December 6, 2005, "A Pioneering Transplant, and Now an Ethical Storm"
- CNN, May 8, 2009, "Pastry chef receives double hand transplant"