Hand transplantation

Hand transplantation is a surgical procedure to transplant a hand from one human to another. The "donor" hand usually comes from a brain-dead donor and is transplanted to a recipient who has lost one or both hands/arms. Most hand transplants to date have been performed on below elbow amputees, although above elbow transplants are gaining popularity. Hand transplants were the first of a new category of transplants where multiple organs are transplanted as a single functional unit, now termed "Vascularized Composite Allotransplantation" or VCA.

The operation is quite extensive and typically lasts from 8–12 hours. By comparison, a typical heart transplant operation lasts 6 to 8 hours. Surgeons usually connect the bones first, followed by tendons, arteries, nerves, veins, and skin.

The recipient of a hand transplant needs to take immunosuppressive drugs similar to other transplants such as kidneys or livers, 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 which may lead to an increased risk of infections and some cancers. There have been many advances in solid organ transplantation over the years that have made these medications quite tolerable.

After the transplant, there is a period of extensive hand therapy/rehabilitation which helps the recipients regain function of the transplanted hand. Those patients who are dedicated to taking the medications and performing the physical therapy following a hand transplant have had remarkable success in regaining function of the new hands/arms.

A hand transplant was performed in Ecuador in 1964, but the patient suffered from transplant rejection after only two weeks due to the primitive nature of the immune-suppressing medications at that time.

The first short-term success in human hand transplant occurred with New Zealander 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 including Prof Nadey Hakim who represented the UK, and Professor Jean-Michel Dubernard from France. A microsurgeon on the team, Earl Owen from Australia, was privy to the detailed basic research, much of it unpublished, that had been carefully gathered by the team in Louisville.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 by the transplant surgeon Nadey Hakim on February 2, 2001 following another episode of rejection.

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