Definition and Overview

A hand transplant is a complex surgical procedure that allows amputees to receive a donor hand, usually from brain dead patients. The procedure is beneficial for those who have lost one or both of their hands due to an injury or complications of an existing disease like diabetes.

The procedure is considered a better alternative to using orthotic devices and prosthetic hands when it comes to improving the quality of life of patients.

The first hand transplant was performed back in 1964 but it was unsuccessful as the patient’s body rejected the donor hand. Since then, researchers and surgeons consistently tried to improve and develop the technology behind the procedure. They have succeeded and the first successful hand transplant was performed in 1999. More technological advances eventually allowed both unilateral and bilateral transplants, double hand transplants, and even paediatric hand transplants. The accuracy of the procedures, with regards to restoring the function of the transplanted hands, also improved considerably.

Nowadays, there are a lot of hospitals that run special hand transplantation programs as well as clinics that specialise in the said procedure.

Who Should Undergo and Expected Results

Hand transplants are beneficial for patients who have lost either one or both their hands. While previous transplants have involved mostly below-elbow amputees, more and more cases of above-elbow amputees are also now benefiting from the procedure.

There are many reasons that can cause a person to lose one or both of his hands. These include:

  • Accidental injury or trauma
  • Severe infection
  • Burns
  • Frostbite
  • Lifestyle factors, such as smoking
  • Diseases, such as Buerger’s disease, cancer, and neuroma, or when the nerve tissues of the hand thicken
    The success rate of hand transplant procedures has been steadily improving and it is higher among transplants performed by specialty clinics that focus solely on the procedure. A surgery is considered as a success if the patient does not suffer any adverse reactions due to the procedure or prescribed medications and if the transplanted hand has the same movement, sensation, and warmth as a normal limb.

Despite this, the number of hand transplants has remained relatively low due to the complexity of the procedure, the high costs involved, and the high incidence rating of post-surgical complications.

How Does the Procedure Work?

Hand transplantation is a highly extensive procedure lasting between 8 and 12 hours. It is even more complex than a heart transplant, which typically only takes around 6 to 8 hours. This is because hand transplant involves a number of structures that has to be connected individually. These include the bones, tendons, arteries, nerves, vein, and the skin. For this reason, the surgery is also referred to as composite tissue allotransplantation.

Prior to the surgery, a patient has to undergo a comprehensive psychological screening period, during which the results and possible implications of the procedure will be explained by the surgical team in detail. The patient will be told of what exactly to expect from the surgery and the function of his newly transplanted hand/s. This pre-surgery psychological screening is designed to help a person deal with the emotional effects of:

  • Losing a limb and regaining it
  • Changes in the appearance, feeling, and functional ability of the hand/s

The recovery period that follows a hand transplant surgery is also extensive. Although the patient may already be physically healed, he still has to continually undergo a long rehabilitation period. During this time, regular therapy is conducted to ensure that the hand functions normally and that the patient is psychologically sound following a life-changing procedure. In addition, the patient will be given immunosuppressive drugs to make sure that his immune system does not reject or respond negatively to the newly transplanted hand.

Patients are strongly advised to follow the instructions of their surgeons and attending physicians, to attend therapy sessions on a regular basis, and to take their medications as prescribed. Doing so will increase the likelihood of a successful procedure and will help reduce the risk of complications.

Due to the various aspects involved in a hand transplant surgery, the procedure is performed by a multi-disciplinary team that include hand and plastic surgeons, anaesthesiologists, psychologists, physical and occupational therapists, and nurses.

Possible Risks and Complications

As a comprehensive surgery, hand transplants come with its fair share of risks and possible complications, which include:

  • Delayed reactions – Historical records of previous hand transplants performed showed a tendency to develop delayed reactions when the body rejects the transplanted hand. This can occur several months or even years since the procedure was performed.

  • Psychological reactions – Some patients showed a tendency to have different mental and emotional reactions to the transplanted hand. While some may have no problems understanding and accepting the nature and limitations of a hand transplant, some patients had difficulty doing so. In one such case, the patient eventually requested for the removal of his transplanted hand due to his inaccurate expectations regarding the results of the procedure.

  • Drug-related side effects - The immunosuppressive drugs given to patients after the surgery are known to compromise the immune system to a certain extent. This can thus increase the patient’s risk of infections and illnesses. However, new advances in the procedure itself as well as in the nature of the medications used have helped reduce this risk.

In addition, the procedure comes with the usual risks associated with all types of surgeries, such as bleeding, blood loss, and infection.

References:

  • Barbara Woodward Lips Patient Education Center. Hand and arm transplantation. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2011. Foroohar A, et al. The history and evolution of hand transplantation. Hand Clinic. 2011;27:405.

  • Petruzzo P, et al. The International Registry on Hand and Composite Tissue Transplantation. Transplantation. 2010;90:1590.

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