Penn doctors perform double hand transplant

From bionic to regenerative, physicians now have the technology to rebuild certain organs that were once lost.

In what Perelman School of Medicine professor L. Scott Levin termed a “medical miracle” to a crowd of medical practitioners, reporters and curious spectators at a press conference on Nov. 1, it is now possible to transplant hands and arms from deceased individuals to patients who don’t have them.

Penn Medicine, in collaboration with the Gift of Life Donor Program, performed the first bilateral hand transplant in the Delaware Valley region last month. The surgery transplanted two new hands and forearms onto a patient that had lost them.

Using vascularized composite allotransplantation (VCA) — which Levin, the director of the Penn Hand Transplant program, called the most advanced technology available to doctors today ­— different organ tissues can be combined to make a whole. The transplants performed used VCA, a technique also used in face transplants.

Professor of Bioethics Arthur Caplan said this was not the first hand transplant ever performed and that the majority of recipients have had “pretty good results.” In many instances, the nerves in the transplanted arms regenerate enough so that patients can perform everyday activities, such as feeding themselves and bathing.

In this case, Penn Med’s patient is already able to brush her face, wave, gesture, and wipe away tears with the use of splints, all of which she would have needed help with in the past.

“This patient will hopefully not reject the hands, and they’ll be with the patient forever,” Levin said. He added that there are no signs that the patient will reject the arms. “This patient will hopefully gain independence,” said Levin.

Before the 11.5 hour surgery took place, however, doctors had to find a donor of the right size, age, gender and skin type to donate the arms. Professor of clinical surgery Benjamin Chang added that, once selected, the arms had to be frozen and transported. The patient’s stumps were then opened up, and the arms were attached.

But despite the obvious benefits of such a donation, there are ethical concerns. Caplan mentioned that, in order to avoid organ rejection, recipients are given immunosuppresants. These drugs, he explained, double the chances of lethal cancer, can damage the kidneys, negatively affect physical appearance and open the recipient up to an array of infections.

“Even ordinary things [like athlete’s foot] can be a crisis,” he said.

There’s another ethical issue that isn’t present with solid organ transplants. With VCA, the recipient, their family and the donor’s family can recognize the transplanted arms. Caplan pointed out that they’re never covered up and thus people see them everyday.

And from the donor’s family’s perspective, there’s another psychological hurdle — oftentimes it’s difficult to part with a dead loved one’s physical body parts. “Would you donate your [dead] sister’s hand?” Caplan asked, continuing, “is it acceptable to take risks when you’re not doing a lifesaving procedure?”

He and other members of the medical team decided that this type of surgery is more ethical when done bilaterally — replacing both hands — than unilaterally, which would replace just one hand.

In the future, Caplan said, there will be more work with faces, transplanting reproductive organs and possibly transplanting voice boxes to people who lost theirs from smoking or surgery.

“[We] have learned a new dimension … of medical care” with this surgery, Levin said.

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