Penn Medicine Performs Bilateral Hand Transplant

For the first time in the Delaware Valley Region, a patient has undergone a complex and intricate bilateral hand transplant that could significantly enhance the quality-of-life for persons with multiple limb loss.

 The procedure was performed by Penn's Hand Transplant Program which operates under the leadership of the Penn Transplant Institute and in collaboration with Gift of Life Donor Program, the nonprofit organ and tissue donor program which serves the eastern half of Pennsylvania, southern New Jersey and Delaware. At this time, the patient is progressing well and both the patient and donor family wish to remain anonymous.

Working closely with their partners at Gift of Life Donor Program, a team of 30—12 surgeons, three anesthesiologists and 15 nurses—performed the 11-and-one-half hour procedure, Penn's first venture into the emerging field of Vascularized Composite Allotransplantation (VCA). The team included experts in solid organ transplantation, orthopaedic surgery, plastic surgery, reconstructive microsurgery, and anesthesia.

"At Penn, we have the level of surgical and academic expertise required to not only offer complicated VCA procedures, but also the capabilities to help establish the standards for this emerging field," says L. Scott Levin, MD, FACS, director of the Penn Hand Transplant Program, chairman of the Department of Orthopaedic Surgery, the Paul. B. Magnuson Professor of Bone and Joint Surgery, Professor of Surgery (Division of Plastic Surgery).

Double hand transplantation is a complex procedure that involves surgical and non-surgical components. First, the proposed recipient must undergo extensive medical screenings and evaluations before surgery.

 During the surgery, the hands and forearms from a donor are attached which includes connecting bone, blood vessels, nerves, muscles, tendons and skin. First, the forearm bones - the radius and ulna - are connected with steel plates and screws. Next, the arteries and veins are attached via delicate microvascular surgical techniques. Once blood flow is established through the re-connected blood vessels, surgeons repair each muscle individually and rejoin tendons and tendons to muscles, one-by-one. After the muscles and tendons are completed, surgeons reattach nerves before the final careful closing of the skin occurs.

"As a top academic medical center, we have the range of expertise required to perform these complex procedures involving multiple, interacting structures and systems in the body," adds Benjamin Chang, MD, co-director of Penn's Hand Transplant Program, program director and associate chief of the Division of Plastic Surgery and associate professor of Clinical Surgery. "We will continue our three-pronged mission of striving for clinical, educational and research excellence in VCA which will help many amputees."

After surgery, hand transplant patients are prescribed daily immunosuppressant medications to prevent their bodies from rejecting the new limbs, which is then followed-up by months, perhaps years of rigorous physical therapy to regain hand function and use. Physicians expect that patients compliant with follow-up care will see significant improvement in function within the first year after the initial surgery.

In contrast to the requirements of identifying a solid organ donor, selecting a donor for hand transplants involved additional matching criteria such as gender, ethnicity, race, skin color and tone, and size. These procedures raise difficult and novel ethical challenges. Respect for donors and their families and careful selection of recipients along with commitment to informed consent are essential.

Text and photo by Penn Medicine

Video by Kurtis Sensenig