Despite success, demand low for hand transplants

by Marie Mccullough

A year after a young amputee left the Hospital of the University of Pennsylvania with transplanted hands and forearms, the lead surgeon calls her progress "nothing less than spectacular."

Yet Penn has no waiting list for hand transplants.

The distinguished medical center is part of an ironic trend: Availability of the complex has been growing faster than demand for it.

Of perhaps two dozen programs worldwide, 10 are in the United States. Two years after launching, two of the American centers have done no transplants. Five, including Penn, have each had one patient.

Even the University of Pittsburgh Medical Center - the country's second-oldest, second-busiest program - has had just five patients since its first surgery, in 2009.

"There are many issues, including funding and patient selection," said Joseph E. Losee, Pitt's director of reconstructive transplantation. "That's why you're not seeing that many being done."

The biggest issue, by all accounts, is the one that has been controversial from the start. Hands are not lifesaving, yet patients must take immune-suppressing drugs for the rest of their lives to prevent , just like recipients of . The drugs put them at risk of tumors, infection, diabetes, hypertension and .

"The risks of immunosuppression have to be weighed against the benefits" of improved quality of life, said Brian Carlsen, surgical co-director of the hand transplant program, which has not yet had a patient.

Researchers are avidly trying to get the body to tolerate transplants with less medication. Achieving this could open the door to replacing many nonessential body parts, from thumbs to wombs.

Meanwhile, hand must undergo rigorous psychosocial testing designed to weed out those who are not up to a transplant lifestyle, including being vigilant for hand swelling or other indications of trouble.

"If there is any sign of rejection, they have to come to the hospital. It doesn't matter if you have a vacation planned or if you have a big test the next day," Losee said.

Matthew Scott has not found the medical regimen to be onerous. The Mays Landing, N.J., resident became the first U.S. hand transplant patient in 1999, when doctors in Kentucky replaced the appendage he had lost in a firecracker accident.

"I'm 13 years out and, to be honest, I've been just fine," said Scott, 51, paramedic trainer for Virtua Health. "I don't live my life that much differently than before the transplant."

Although only about 80 people worldwide have received hands since the first successful operation in France in 1998, outcomes have been reassuringly good. Studies show that a year after surgery, 96 percent of grafts survive - better than any other field of transplantation.

Most of the 19 U.S. patients reportedly have regained significant function and sensation - albeit with lots of physical rehabilitation.

Penn's patient, Lindsay Ess, 29, of Richmond, Va., lost her lower legs and lower arms to a bloodstream infection. She declined to be interviewed, but lead surgeon L. Scott Levin described her outcome so far as "almost miraculous."

"She's now living independently," Levin said. "She can take off her lower extremity prostheses with her hands. She's tolerating her medications extremely well."

Obtaining limbs from deceased donors also has turned out to be easier than anticipated.

"We thought we'd have people lining up and no raw materials," Pitt's Losee said. "For us, at least, donors aren't the problem."

While immune suppression is the primary obstacle, a close second is money. Because hand transplants are elective and still considered experimental, they are not covered by most health insurance. (Insurers do cover the immune drugs.)

The Kentucky program, which involves the University of Louisville and Jewish Hospital, has used research grants from the Department of Defense to subsidize the care of its eight patients, said surgeon Joseph Kutz. He estimated hospital costs at $225,000 per patient.

Given the high hurdles and low demand, why have hand graft programs proliferated in the U.S.? Some say it's because premier institutions want to offer premier treatments.

"It's a good question," said Carlsen at Mayo. "All I can say is, when we started, we felt there was patient need. And we felt the time was right and that, being who we are, we should be able to offer this treatment option."

not rated yet
add to favorites email to friend print save as pdf

Related Stories

Marine moves fingers after rare hand transplant

Mar 23, 2009

(AP) -- Surgeons have transplanted a hand onto a Marine who was hurt in a training accident, and he has some movement in his fingers, according to the hospital where the operation occurred.

Spanish doctor says leg transplant patient elated

Jul 12, 2011

A young man who underwent the world's first double leg transplant might be able to walk with the aid of crutches in six or seven months if his rehabilitation goes well, the surgeon who oversaw the operation said Tuesday. ...

Recommended for you

What are the chances that your dad isn't your dad?

Apr 16, 2014

How confident are you that the man you call dad is really your biological father? If you believe some of the most commonly-quoted figures, you could be forgiven for not being very confident at all. But how ...

New technology that is revealing the science of chewing

Apr 15, 2014

CSIRO's 3D mastication modelling, demonstrated for the first time in Melbourne today, is starting to provide researchers with new understanding of how to reduce salt, sugar and fat in food products, as well ...

After skin cancer, removable model replaces real ear

Apr 11, 2014

(HealthDay)—During his 10-year struggle with basal cell carcinoma, Henry Fiorentini emerged minus his right ear, and minus the hearing that goes with it. The good news: Today, the 56-year-old IT programmer ...

Italy scraps ban on donor-assisted reproduction

Apr 09, 2014

Italy's Constitutional Court on Wednesday struck down a Catholic Church-backed ban against assisted reproduction with sperm or egg donors that has forced thousands of sterile couples to seek help abroad.

User comments