>From today’s Vancouver Sun
TRANSPLANT OF HAND EXPECTED WITHIN A YEAR, U.S. TEAM SAYS
The unprecendented operation, using a hand from a dead donor, would attach
skin, muscle bones, tendons, nerves and blood vessels.
PAMELA FAYERMAN
Vancouver Sun Health Issues Reporter
The first transplant of a human hand from a dead donor to a needy recipient
is expected to take place in the U.S. sometime in the next year.
A surgical team from Louisville, Ky., in Vancouver Tuesday to present its
findings at an international conference, is interviewing suitable
recipients, such as amputees and those with congenital defects.
The new surgery-connecting skin, muscle, bones, tendons, nerves and blood
vessels-still requires approval from the University of Louisville Hospital
review board. But it has been preceded by successful experiments in rats,
pigs, primates and dogs.
It is already common for doctors to replant a person’s own fingers, hands
or even arms severed in farming; industrial accidents or other traumas.
Dr. Peter Gropper, director of hand surgery at Vancouver Hospital, a
clinical professor at the University of B.C., arid co-chair of the
conference in Vancouver, performs about 25 such replantations a year.
He said in an interview the proposed hand transplant surgery has everyone
in his field captivated.
“I think it will occur but whether it will be successful or accepted is
hard to predict.”
He said is unaware of any plans for hand transplants in Canada.
Transplanting human hands on to people born without hands or whose hands
have been amputated is truly novel and is generating tremendous excitement-
and trepidation in the medical world.
Doctors are expecting a lively ethical debate about whether people should
have such transplants when their lives are otherwise not at risk.
It’s one thing to transplant hearts or othe organs into people who would
die without them; but transplanting a hand can’t be justified on those
grounds.
In fact, it may put lives in peril because of transplanted-tissue
rejection, infection and other diseases stemming from the drug therapy that
accompanies transplantation procedures
The use of immunosuppressants to prevent the immune system from rejecting a
transplanted part can lead to infections and malignancies such as
post-transplant lymphomas.
The anti-inflammatory, anti-viral and antibiotic drugs that must be used
with transplantation also have a range of side effects but are more easily
managed by reducing dosages.
Those complications were the focus of discussion at a session featuring the
Kentucky team, which presented its research to delegates at the Seventh
Congress of the International Federation of Societies for Surgery of the
Hand.
The conference, at the Vancouver Trade and Convention Centre, is being
attended by 1,200 hand surgeong from 42 countries.
Kentucky team member Dr. Diane Pidwell said the post-operative management
of a hand-transplant patient is largely dictated by tests to determine
whether rejection is occurring.
That’s easier than in internal transplants such as hearts because doctors
can watch skin tissue to see if it is rejecting the donor tissue, “meaning
we won’t have to constantly be doing invasive biopsies.”
The medical team’s legal adviser, Jeannette Martello, said informed consent
is so critical that a 12-page consent form in simple lay language has been
drafted for those contemplating the “innovative elective procedure.”
“Obviously, the most important consent is the patient’s because we are
introducing a potentially life-threatening procedure for a non-life
threatening problem,” she said.
To ensure transplant candidates are fully informed of the risks, she
proposes independent psychological evaluation, and said the team would not
consider performing the surgery on patients younger than 18 or older than
65.
Martello said that because the surgery is not life-saving, “we’ will accept
a higher rate of failure” meaning doctors would be willing to quickly
amputate the transplanted hand if it was being rejected.
Dr. Warren Breidenbach, the Louisville hand surgeon who will likely perform
the first human hand transplantation, said he is totally confident in the
technical aspects of the surgery itself
But. he admits the transplant loss or failure rate may range. frm.25 to 50
per cent because of potential complica.tions.
Still, he said in an interview he knows of many patients who would consider
the risks to be outweighed by the potential benefits.
“People can try using an artificial prosthesis but some feel their lives
have been so severely altered by the loss of a hand. And if you lose a part
of your body as an adult, it’s very hard to learn how to compensate without
it,” said Breidenbach, a U.S.-born doctor who did 12 years of medical
training in Alberta and Quebec before moving to Kentcky.
A transplanted hand may never perform as well or feel as much sensation in
the fingertips, but Breidenbach predicts a transplanted hand would still
outperform a prosthesis.
Donors of hands would be the same people who allow the use of their other
organs if they die suddenly. “Their hands would be amputated once they are
declared brain dead.”
The amputated hand would be cooled to minus 40 degrees centigrade and
transplanted during a six-to-12hour procedure involving a 20-person medical
team within four hours of harvest.
Ian Gregson (mailto:[email protected])
Amputee WEB Site <> AMPUTATION Online Magazine
http://www.portal.ca/~igregson/index.html
Moderator Amputee & D-Sport Listservs
