Hand transplantation

Editor-In-Chief: Vijay S. Gorantla, MD, PHD [mailto:gorantlavs@upmc.edu]

Overview
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 drugs, as the body's natural immune system will try to reject the hand. These drugs cause the recipient to have a weaker immune system, and suffer severely even from minor illnesses.

A hand transplant was performed in Ecuador in 1964, but the patient suffered from transplant rejection after only 2 weeks.

The first short-term success in human hand transplantion occurred with New Zealander, Clint Hallam. The operation was performed on September 23, 1998 in Lyon, France. After the operation, Hallam wasn't comfortable with the idea of his transplanted hand, and failed to follow the post operation drug and physiotherapy programme, and his body started rejecting the hand. The transplanted hand was removed at his request on February 2, 2001.

The Hallam case demonstrates the risk of performing these procedures in unsuitable patients. Hallam, a convicted con-man, had many red-flags which made him a poor candidate for undertaking the rigorous post-operative regimen required for success. The French surgical team and their process for patient selection were criticized by many peers for seeming to seek media publicity for being the first to perform the procedure instead of carefully selecting a better candidate.

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.

In contrast to the earlier attempts at hand transplantation, the Louisville group had performed much of the basic science research and feasibility studies on the proposed procedure. There also was considerable transparency and internal review board oversite involved in the screening and selection of prospective patients.

University of Louisville doctors also performed a successful hand transplant on Michigan native Jerry Fisher in February 2001.

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 tranplants (6 double) which occurred between 2000 and 2005, might open the way for more common transplant operations of such organs as the face or larynx.