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Penn Medicine: Establishing Penn Hand Transplant Program at HUP

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December 21, 2010, Volume 57, No. 16

 

Levin Shaked

The Penn Transplant Institute, the department of orthopaedic surgery and the division of plastic surgery at the Hospital of the University of Pennsylvania (HUP) have collaborated to form the Penn Hand Transplant Program. The Program will operate under the leadership of the Penn Transplant Institute and in collaboration with the Gift of Life Donor Program, the nonprofit organ and tissue donor program which serves the eastern half of Pennsylvania, southern New Jersey and Delaware.

The Penn Hand Transplant Program is headed by Dr. L. Scott Levin, Paul B. Magnuson Professor of Bone and Joint Surgery, chair of the department of orthopaedic surgery and professor of surgery, division of plastic surgery and Dr. Abraham Shaked, professor of surgery and director of the Penn Transplant Institute.

In contrast to the requirement of identifying a solid organ donor, selecting a donor for hand transplants involves additional matching criteria such as gender, ethnicity, race, skin color and tone and size. “Hand transplantation raises difficult and novel ethical challenges. Respect for donors and their families, the selection of recipients and the commitment to informed consent are all essential,” said Dr. Arthur Caplan, director of the Penn Center for Bioethics. “Penn’s program has engaged these thorny questions in a careful, deliberate and thoughtful manner so as to try and ensure that transplant candidates receive the best and most comprehensive care available anywhere.”

The first two patients slated to receive bi-lateral hand transplants at HUP have undergone extensive medical screenings and evaluations. It is hoped that the first transplant will be performed sometime in the coming year.

The Penn Hand Transplant Program will only perform bi-lateral transplants. “People who have lost one arm can function fairly well doing every day tasks and beyond. Many single-arm amputees don’t even bother with prosthetics except for cosmetic purposes. Even people who’ve tragically lost both arms are able to be somewhat self-sufficient if they have their lower extremities,” said Dr. Levin. “However, someone who has had both arms and legs amputated is completely and totally dependent. The most basic functions of life are virtually impossible to perform—locomotion, grooming, feeding. Just imagine what it would be like to be unable to go to the bathroom alone...or to be unable to brush your hair,” added Dr. Levin. “It’s our goal at Penn to effectively and closely combine the roles of orthopaedics, plastic and transplant surgery in the field of composite tissue allotransplantation (CTA) so we can successfully treat these patients and give them back their independence.”

“Reconstructive surgery is the new frontier of surgical transplantation and the results are promising,” said Dr. Shaked. “Our experience over the decades in solid organ transplantation can successfully be applied to composite tissue allotransplantation and we fully support this major advancement in the care of patients in need of limb transplantation.”

The primary cause of amputation in the United States is trauma, but it may also be the result of septicemia—a severe infection in the bloodstream—as is the case with the first Penn candidates. While patients who undergo transplant surgeries face a lifetime of taking immunosuppressive drugs which increase their risk of diabetes, infection and hypertension, there is a quality of life trade-off that some are willing to accept.

“We have the level of surgical and academic expertise necessary to not only successfully offer complicated tissue allotransplantation procedures—but also to set the standards in this emerging field,” added Dr. Joseph Serletti, chief of Penn’s division of plastic surgery and the Henry Royster-William Maul Measey Professor in Plastic and Reconstructive Surgery. “As a top academic medical center, we’ll continue our three-pronged mission of striving for clinical, educational and research excellence now in CTA.”

The experience and expertise of the Penn Transplant Institute extends beyond single organ transplants—such as heart, lung, liver, kidney and pancreas—to multi-organs, such as heart/kidney and liver/lung. The success rates for all of Penn’s transplant programs are equal to, and in most cases exceed, the national averages as reported by the United Network for Organ Sharing (UNOS). Penn maintains this record of successful outcomes even though its physicians and surgeons are treating some of the sickest patients.

“This region leads the nation in the number of individuals and families who say yes to organ and tissue donation,” added Howard M. Nathan, president and CEO, Gift of Life Donor Program.  “The generosity of these families enables thousands of men, women and children to receive a second chance at life through transplantation each year.”  

Only three other medical centers in the United States have performed hand transplants and only about 50 people in the world have received hand transplants since the first successful operation was performed in France in 1998. The first documented case in the world was performed in Ecuador in 1964 but was unsuccessful as it was performed before the development of modern immunosuppressive medications. To date, nine people have received hand transplants in the US, including three bi-lateral hand transplant recipients.

 

Almanac - December 21, 2010, Volume 57, No. 16