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Medical Miracles: Hand Transplant

Meet your Guide

Bridget Trinastic, a senior at Monona Grove High School (class of 2016), is planning on becoming a pediatric nurse, but also has an interest in performing various types of surgery in the future. She hopes one day to be part of a new, innovative surgery such as this one, in order to help patients with varying medical problems. 

Hand Transplants: A New Hope for Hand Amputees

Overview

Hand Transplantation is one of the most uncommon surgeries. The first hand transplant was performed in 1964 in Ecuador, but within three weeks, the new hand was rejected by the patient's body. This rejection was due to a number of reasons, one of which being technology had not advanced enough for this surgery to be successful. Since 1964, there have been only twenty-four hand transplant surgeries that have been successful, the first one being in Lyon, France in 1998. Of these twenty-four transplants, six of them were a double hand transplant. This surgery is still being studied due to its unpredictability of success in patients, as well is the staggering amount of "cons" for this procedure.

The Procedure

Before a hand transplant is done, patients need to go through a series of tests and examinations. This may include a physical examination, blood and tissue typing, X-Rays, nerve function assessment, psychological testing, and more. This process can take many months. Once in the surgery room, the procedure will take eighteen to twenty-four hours with several surgeons performing the surgery. The first thing that will be connected between the donor hand and the patient’s arm is the bone. Next, sutures are used to connect the blood vessels, nerves, and tendons. Once everything is attached together, the skin is closed, and the surgery is done. After the surgery, the patient is placed in the ICU in a room that is warmer than other rooms in order to promote blood circulation to the donor hand. The patient is then moved to a regular hospital room after a few days, and is expected to stay in the hospital for a total of ten days so they can be monitored for any adverse reactions.

Bilateral Hand Transplant

Social Impact

  PROS CONS
MEDICAL There are no life-threatening complications possible for the patients due to the surgery. 

The immunosuppressive drugs can make the patient more susceptible to diseases or sicknesses due to their weakened immune system. 

Metabolic complications are possible such as hyperglycaemia, hyperlipidaema, and impaired renal function. 

The long term effects are unknown due to the "newness" of this surgery.

PROFESSIONAL

Patients are put through both physical and psychological testing, so the most qualified patients are selected for this procedure.

These patients selected agree to go through immunosuppressive drug treatments and therapy.

Many doctors are needed for one patient in order to administer postoperative treatment and immunosuppressive therapy. 
ETHICAL

This is a life-enhancing surgery.

The patients receive new hands which can help their confidence and self-esteem. 

This is not a life-saving treatment.

Safer options are available, such as bionic hand transplants. 

LEGAL This surgery can raise awareness about what organs are used if someone is an organ donor. There is a higher chance of mal-practice due to this surgeries life-enhancing description rather than life-saving. 
ECONOMIC No new materials are needed (natural).

The cost of the procedure throughout the lifetime of the patient is $528,293, whereas the cost of a single prosthetic is $20,653.

 

 

Media

This is a picture of how the donor hand and the patient's forearm are put together during the surgery:

Emerging Innovations

In order to perform a hand transplantation, a special procedure needs to be done, called a composite tissue allotransplantation. For CTA to be successful, the patient needs to take immunosuppressive drugs so the new hands are not rejected. These drugs are important to prevent rejection between the donor hand and the patient. Skin and muscle are the two systems on the outside that could cause rejection, along with bone marrow and lymph nodes inside the arm. When allotransplants first began, they started on a small scale, using tendons, nerves, and bone from cadavers that were frozen. Not all of these were successful, but they were a huge step in moving closer to where we are today. The patient who received the first full hand transplant in 1964 was only given steroids and azathioprine as the immunosuppressive drug. This is why the transplant was rejected in two weeks. In the 1980s a new immunosuppressive drug was introduced called Cyclosporin A. Cyclosporin A is what made the hand transplant in France successful at first, but the patient didn’t continue the drug or therapy so rejection occurred and the hand needed to be amputated. Immunosuppressives are continuously being found for these types of surgeries, but they can also be dangerous to the patient's overall health (read more in the pro/con section).

 

Future Directions

A new innovation is in the works for replacing immunosuppressive drugs with a local treatment for the transplanted limb. This would be better for patient’s overall health, because they would not need to weaken their immune system to prevent rejection of the new hand. This was discovered by a research team at the University of Bern lead by Dr Thusitha Gajanayake. Professor Robert Rieben, the leader of research in hand transplants at the University of Bern claims that with one single treatment, rejection is prevented. Currently this has only been tested on rats in the lab, but they keep working towards this discovery so that eventually they can perform a hand transplant using this method in Switzerland. If it works, this could get rid of the need for immunosuppressive drugs and therapy, and possibly reducing the lifetime cost of a hand transplant.

Learn More ----> https://www.sciencedaily.com/releases/2013/08/130821124426.htm      

What do you think?

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Learn More...

To learn more about the number of hand transplants done, look at this table

To learn more about how hand donors are picked, visit the Penn Transplant Institute website

To find answers to any more general questions about hand transplants or immunosuppressive drugs, click here

To learn more about the history of hand transplants, click here. 

 

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