Hand transplant

Overview

Hand transplant is a treatment for some people who have had one or both hands removed, called amputated. It also may be a treatment for some people who have lost one or both hands to injury. The loss may be at the hand, forearm or upper arm. A hand transplant transfers one or two donor hands and a part of the arms from a person who has died.

A hand transplant is a complex and rare operation. Only a few transplant centers worldwide do hand transplants. Healthcare professionals fully evaluate anyone seeking a hand transplant. This is to help ensure that the hand works as well as it can.

A hand transplant may restore some use of the hand and some feeling in it and make the hand look more natural. In that way, a hand transplant may make life better. But the surgery isn't lifesaving or life-extending. It's a high-risk procedure.

To have a transplant, you must take special medicines called immunosuppressants for life. These medicines lower the risk of your body rejecting the hand, but they have serious side effects. You also have physical therapy and healthcare appointments to check on your donor hand.

Why it's done

The purpose of a hand transplant is to try to improve the life of someone whose hand or hands were removed surgically, called amputated. It aims to give back some feeling in the hands and some use of the hands.

After a hand transplant, some people regain skills, such as:

• Grasping and using objects, such as tools.
• Eating with a knife and fork.
• Tying shoes.
• Driving.

Risks

A hand transplant is a complex procedure. Complications can result from:

• The surgery.
• The body's rejection of the transplant tissue, which may mean loss of the hand.
• Side effects of immunosuppressant medicines.

Surgical risks

Hand transplant has all the risks of transplant surgery. Risks include infection, bleeding and blood clots. A clot can cause less blood flow to your hand. This serious complication needs surgery to treat it right away.

Rejection risks

Your body's immune system may reject the new hand. Rejection happens when your body's immune system treats your donor hand as foreign to your body. Your immune system may try to destroy your donor hand the same way it attacks viruses or bacteria.

Rejection can happen in two ways:

• Acute rejection. Acute rejection happens any time after the first few days after surgery or within the first six months. The immune system tries to destroy the tissues in the donor hand. It also can happen when the immune system sends special proteins called antibodies to attack blood vessels and tissues in the donor hand.

  If you have acute rejection, you may have a rash, swelling, or a change in skin color of your hand or arm. There may be pain.

  Medicines can manage acute rejection. But rarely, some people need to have the donor hand or hands removed. Having had acute rejection doesn't mean you can't have another hand transplant. But it may make it harder to match you with a donor.

• Chronic rejection. This is rejection that happens over a longer time. The hand may become painful and not work well. There may be a loss of hair on the hand or changes in the fingernails.

  You need to watch for early signs of rejection. Report to your transplant team any changes in how your hand looks or feels. If your transplant team thinks your body is rejecting your donor hand, you may need to take more antirejection medicines.

  Your transplant team may order tests of your hand. These may include taking tissue from your donor hand to study under a microscope. This is called a biopsy.

Immunosuppressant risks

The antirejection medicines you need to take daily for the rest of your life weaken your immune system. The medicines, also called immunosuppressants, help prevent tissue rejection. But they put you at risk of infections. Immunosuppressant medicines also can raise your risk of kidney damage, cancer, diabetes and other serious conditions.

How you prepare

Deciding whether to have a hand transplant

Ask yourself these questions:

• Have I weighed the risks of having a hand transplant?
• Can I commit to lifelong follow-up care, including taking antirejection medicines?
• What do I hope this surgery does for me?
• Have I tried other treatments or talked with my healthcare professional about other treatments? This may involve getting a human-made replacement part, called a prosthesis. Or it may involve surgery to rebuild the hand, called reconstructive surgery.

A transplant team evaluates you for the procedure. To get a hand transplant, you must have:

• An amputation at the mid-upper arm or below.
• No history of long-term nerve conditions.
• No serious medical issues, such as diabetes, heart disease or cancer that hasn't been treated.
• Had no recent infections.

You also must not:

• Be pregnant.
• Smoke.
• Overuse alcohol or use illegal drugs.

Your evaluation includes:

• A complete medical exam. The exam may include X-rays, CT and MRI scans, blood tests, nerve tests, and other measures of physical health.
• A look at your mental health. This may include coping skills, family and social support, what you expect from the surgery, and how well you can manage care after the transplant.
• A look at how you can handle costs after the transplant.

Getting ready for your hand transplant

Once you're approved for a hand transplant, your team puts you on a waitlist for a donor hand or hands. To match you with a donor hand for a hand transplant, surgeons look at:

• Blood type.
• Tissue type.
• Skin color.
• Your age and the donor's age.
• Your sex and the donor's sex.
• Hand size.
• Muscle bulk.

There's most often no way to tell how long you might wait for a donor hand or hands that match your needs. Your care team evaluates you again every few months to make sure your information is up to date.

In the meantime, you can prepare by:

• Having presurgery workups. You need to visit the transplant center from time to time. This is so that your transplant team can do blood tests and see whether you're ready for a transplant.
• Making travel and lodging plans. Your transplant team asks you to stay somewhere within 10 hours of travel time to the transplant center while you wait for donor hands. After your surgery, the team may ask you to stay near the transplant center for 2 to 3 months. Your transplant team may be able to suggest long-term lodging if you need it.
• Staying in touch with your transplant team. Let your transplant team know right away if you have changes to your medical care. This may involve new medicines, getting donated blood, called a transfusion, or being diagnosed with a long-term medical condition.
• Doing exercises, if suggested. Physical therapists may work with you to make your arms stronger and better able to move before your transplant.

What you can expect

During surgery

Hand transplant surgery is complex surgery that can take 18 to 24 hours. A team of surgeons does the procedure. Your surgical team may transplant donor skin, muscles, tendons, cartilage, bones, nerves and blood vessels.

Once the donor hand is ready, surgeons use small metal plates to attach your bones to the bones of the donor hand. Your surgeons then use special stitches, called sutures, to attach the blood vessels, nerves and tendons. Surgeons use a special high-powered microscope to place the sutures. This is called microsurgery. Surgeons then close the skin.

After surgery

After your surgery, you're likely to spend 7 to 10 days in the hospital. Staff may keep the room you're in warm. This is to help blood keep moving in your donor hand or hands. During this time, you:

• Begin taking your daily doses of immunosuppressant medicines to keep your body from rejecting the transplanted tissue.
• Take medicines as needed to manage pain.
• Work with a special hand therapist. The therapist teaches you exercises to get and keep your hand working.
• Wear a splint on your hand to keep it stable when you're not doing exercises.

Your transplant team includes doctors, a transplant coordinator, a social worker, a therapist, pharmacists, dietitians and others. The team works with you to make a postsurgery treatment plan and give the care you need.

You need to stay near your transplant center for a few weeks after your transplant. Healthcare professionals do tests to look for signs of infection or rejection. You also keep doing hand therapy, even after you go home.

Immunosuppressants

Your daily postsurgical routine includes taking immunosuppressant medicines and managing the side effects. These medicines help stop your immune system from rejecting the donor hand or hands.

You can lower the risk of rejection and medicine side effects by doing the following:

• Commit to taking immunosuppressant medicines for the rest of your life unless a healthcare professional tells you to stop. Take them at the same time every day.
• Make regular appointments with your transplant team for blood tests and checkups.
• Contact your transplant team or your healthcare professional if you think you have an infection or tissue rejection.

Results

You and your transplant team can't know for sure what the results of your surgery will be.

Many people who have hand transplants can use their hands to pick up small objects, eat with a fork and knife, tie their shoes and do other tasks. Because hand transplants are fairly new, experts don't know the long-term results.

Your results are affected by:

• How far up the arm the transplant is.
• Your body's response to the new tissue.
• Other aspects of your recovery, such as your feelings about your new hand or hands.

Following your post-transplant care plan and having the support of friends, family and your transplant team help raise your chances of gaining as much use of your hand or hands as possible.

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