How many hand transplants have been done in the United States?
Currently, there have been more than 20 patients who have undergone hand transplantation in the United States. The first hand transplant in the United States occurred in 1999.
How do you choose the right donor?
The process for receiving a hand for transplantation is similar to that of other solid organs. The patient’s skin color and tone, hair pattern, size, and age are matched to that of an appropriate donor. The hand transplant surgeon will review the medical history and any other pertinent information about the donor and decide if he or she meets our criteria and are appropriate for the patient to receive the organ.
What is the evaluation process for a hand transplant?
The coordinator will receive the patient’s medical records and will set him or her up for an initial visit with the hand transplant surgeon, transplant nephrologist, and transplant social worker. Once the patient has been found to be an appropriate candidate, he or she will come back and meet the rest of the hand transplant team, followed by a psychological evaluation. The psychological evaluation will be done by both a psychiatrist and a psychologist working independently. Due to the nature of this type of transplant, the patient may need further follow-up before moving on in the evaluation process. An evaluation done by occupational therapy hand therapists will follow, as well as necessary diagnostic radiological exams. After all necessary consults, lab work, and tests have been completed, the patient will be presented to the Hand Transplant Selection Committee, which will decide if the patient is able to undergo hand transplantation. If the patient is found to be an appropriate candidate, the coordinator will notify the patient as well the organ procurement organizations to let them know the patient is ready to receive donor offers.
Why are unilateral non-dominant hand amputations not considered for transplantation?
The risk versus benefit of transplanting a unilateral non-dominant hand poses a greater risk to the patient based on the fact that he or she will be exposed to immunosuppressive medications for the rest of his or her life. Non-dominant hand amputees generally are able to functionally adapt better because they still have use of their dominant hand. Worldwide, it is generally accepted by other hand transplant programs to not transplant non-dominant, unilateral amputees. In the future, non-dominant unilateral hand amputees may be considered for transplantation.
How long is the evaluation process?
The evaluation process will be dependent on the patient, although it could be completed within one to two months.
How long does a hand transplant operation last?
The human hand consists of bones, muscles, tendons, nerves, arteries, veins, and soft tissue. It is a surgically complex procedure and may last anywhere from 10 to 24 hours.
What does it mean to be an “IRB-approved" program?
Being approved by the Institutional Review Board (IRB) ensures that patient safety and ethical standards are being maintained by the program.
Will insurance cover this procedure?
Hand transplantation is not recognized by the Centers for Medicare & Medicaid Services (CMS) or the Food and Drug Administration (FDA) at this time and is considered research. Therefore, insurance providers will not cover this procedure. Financial support is gained through our IRB-approved study/program to cover the evaluation, surgery, inpatient stay, and up to a year of hand therapy at UT Southwestern. A review of one’s insurance will occur prior to evaluation to ensure coverage for the post-transplant medications.
Why is hand therapy so important?
Hand transplantation is unique from other solid organ transplants in that it is the only type of transplant where one must actively “work it” in order for the organ to be functional. Hand therapy allows patients to work on developing both fine and gross motor skills while strengthening muscles and promoting nerve regeneration. It helps reawaken the part of the brain that has “gone to sleep” since the amputation, reactivating the brain’s response to the new limb.
Does receiving a hand transplant mean taking medication for life?
Yes. Medication to suppress one’s immune system will have to be taken daily for the rest of the patient’s life in order to help prevent rejection. If possible, the medications are reduced in number and dosage, but recipients can expect to be on some medication for the rest of their lives.
What does rejection mean?
Rejection refers to the body’s immune system attacking the transplanted limb because it sees it as foreign to the body. This may occur within days, months, or even years from the time of transplantation.
How is rejection diagnosed in a hand transplant recipient?
It is important for the patient to recognize signs and symptoms of rejection, which will be taught by the transplant coordinator. It may come in the form of a rash, scaling or thickening of the nail beds, or discoloration of the skin. The patient may or may not have symptoms of pain. A skin biopsy and lab work will be obtained to determine the severity of the rejection, and the patient will undergo treatment to help calm the body’s immune response against the transplant. A rejection episode does not automatically mean there will be an immediate loss of the limb. The sooner the discovery, the sooner treatment may be received, leading to an overall better result from a rejection episode.