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Hand transplantation surgery, the transfer of the hand(s) from a deceased human donor to a
patient with amputation of one or both hands, is an experimental reconstructive procedure
that has the potential to significantly improve the lives of hand amputees.
Hand transplantation is similar to face transplantation in that the tissues transplanted
include skin, tendons, muscles, ligaments, bones and blood vessels. The hand transplant team
at Brigham and Women's Hospital includes a wide variety of medical and surgical specialties.
The team hopes to build upon the success of their first face transplantation to provide
amputee patients with the significant benefits of hand transplantation.
Toward this goal, BWH is actively seeking qualified candidates for the hand transplant
research study. We will be studying a small group of people to learn more about:
- How to advance the science of hand transplantation
- How to support and limit transplant rejection issues
- How people do after hand transplantation
We describe hand transplant surgery as a life-giving procedure because it has the potential
to dramatically improve, that is to restore, both a patient's mental and physical health and
his/her ability to function and integrate in society. However, as with any other type of
organ transplantation, this improvement will require the patient to make a lifetime
commitment to taking medications that suppress the body's immune system.
Conventional hand reconstruction methods are always considered first, but they may provide
less than optimal results for certain patients. There are many sophisticated prostheses that
satisfactorily replace the basic function of an upper extremity (upper arm, forearm and
hand). However, replacing upper extremities (in whole or in part) with prosthetics remains
suboptimal in that prostheses do not provide sensation and do not have a natural appearance.
Hand transplant surgery, however, has the potential to deliver these desired functional and
aesthetic benefits. Functionally, hand transplant surgery can provide a patient with new
hands that, after extensive rehabilitation, allow him/her to perform daily activities and,
in most cases, return to work. Furthermore, the ability to restore a near-normal aesthetic
appearance of the hand(s) can lead to tremendous psychological benefits, including elevated
confidence and mood.
From the time we begin our search for a qualified hand transplant recipient to the
continuing care we provide following surgery, a significant amount of time, expertise and
attentiveness is contributed toward making the procedure a progressive success. Hand
transplant candidates go through an extensive screening process that is likely to last
several months. This screening includes a psychiatric and social support evaluation and a
series of imaging tests to help determine a patient's physical and mental readiness for the
procedure. If, upon completion of the screening process, it is determined that a patient is
a suitable candidate, we will place the patient on a transplant waiting list. We will then
begin working with the New England Organ Bank (NEOB) team to find a donor who matches the
recipient's tissue requirements - for example similar age and correct blood type. This
search could take many months, and, if a suitable donor is not found within one year, we
will speak with the patient to determine whether he/she is willing to continue waiting.
When a donor is found, we will immediately inform the patient about when to arrive at the
hospital for the operation. As the timing for this type of procedure is extremely important,
patients are expected to be readily available, that is, to reside within a 12-hour travel
radius of BWH. During the surgery, the parts most likely to be reconstructed include the
hand and partial forearm, and in some cases, if necessary, the elbow and arm below the
shoulder joint. One surgical team will work on removing the hand from the donor as another
team simultaneously prepares the arm on the recipient. Surgeons will then connect the donor
hand's blood vessels to the patient's blood vessels under a microscope to restore blood
circulation before connecting nerves and other tissue, such as bone, cartilage and muscles,
as needed.
Immediately after surgery, the hand transplant recipient will be taken to the Intensive Care
Unit (ICU) for observation. The patient will typically stay in the ICU for one or two days
and then be moved to a private room. At this point, a physical therapist will start working
with the patient to rehabilitate the transplanted hand, and a psychiatrist will discuss any
psychological concerns. The patient will stay in the hospital until both the plastic surgery
and medical transplant teams agree that it is safe for the patient to return home. This
post-operative stay is anticipated to be approximately 7-14 days, but can vary due to a
number of factors. Rehabilitation with the physical therapist will take several hours a day
while the hand transplant recipient is at the hospital.
Following discharge from the hospital, hand transplant patients will need to return to BWH
for routine visits. These visits will include monitoring transplant drug levels (immune
suppressants) through regular blood tests, rehabilitative therapy, imaging tests, assessing
quality of life, and checking for the return of sensation and movement to the hand.
Rehabilitation visits will take place daily for several months, whereas the other visits
will typically take place on a weekly basis for the first three months and then at least
once a month for the first year following surgery.
After the first year, it is expected that hand transplant patients will need to visit the
hospital less frequently. However, patients must be prepared to make a lifetime commitment
to immune suppressants to help prevent the rejection of the transplanted hand.
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