Hand transplantation, or simply hand transplant, is a surgical procedure to transplant a hand from one human to another. The donor hand, usually from a brain-dead donor, is transplanted to a recipient amputee. Most hand transplants to date have been performed on below-elbow amputees, although above-elbow transplants are gaining popularity. This was the first of a new category of transplants in which multiple organs are transplanted as a single functional unit, now termed "vascularized composite allotransplantation" (VCA). The operation is extensive, and typically lasts from 8 to 12 hours. In comparison, a typical heart transplant operation lasts 6 to 8 hours. Surgeons usually connect the bones first, followed by tendons, arteries, nerves, veins, and skin.
Use of immunosuppressive drugs afterward For a hand transplant to succeed, the recipient is required to take immunosuppressive drugs, as in other organ transplants such as kidney or liver, to minimize rejection, or risk destruction of the hand by the recipient's natural immune system. These drugs risk weakening the recipient's immune system, which may increase the risk of infections and some cancers. Many recent advances in solid organ transplantation have made these medications more tolerable. A period of extensive hand therapy/rehabilitation after transplantation helps the recipient gain function of the transplanted hand. Compliance with immunosuppressive medications and intensive physical therapy after hand transplants is associated with significant success in regaining the function of the new hands and/or arms.
History
A hand transplant was performed in Ecuador in 1964, but the patient experienced transplant rejection after only two weeks due to the primitive nature of the immune-suppressing medications at that time.
23 September 1998 hand transplant The first short-term success in human hand transplant surgery occurred with Clint Hallam, from New Zealand. Hallam lost his hand in an accident while in prison. The operation was performed on 23 September 1998, in Lyon, France, by a team assembled from different countries around the world led by French Professor Jean-Michel Dubernard, including Professor Nadey Hakim, from the UK. A microsurgeon on the team, Earl Owen from Australia, was privy to the detailed basic research, much of it unpublished, that had been carefully gathered by the team in Louisville. After the operation, Hallam was not comfortable with the idea of his transplanted hand and failed to follow the prescribed post-operative drug and physiotherapy regime. The case became an example of the necessity of a fully committed team of caregivers, including psychologists, who can correctly select and prepare the potential transplant recipients for the lengthy and difficult recovery, and for the modest functional restoration of a transplanted hand. Hallam's transplanted hand was removed at his request by the transplant surgeon Nadey Hakim on 2 February 2001, following another episode of rejection that was, at least in part, caused by his stopping the anti-rejection medication.
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