Hand transplant

Overview:

A hand transplant is a procedure that involves replacing a hand or a portion of the upper limb of a person via surgery with a donor’s hand. The process is intricate and requires around 24 hours to be completed.

However, there is contention among the experts and the healthcare fraternity regarding the surgery. The discussion revolves around the point that other organ transplants are important for a person’s survival and essential for increasing life. However, a person can survive without their hands, making the detailed procedure with many risks questionable.

On the flip side, a hand transplant can assist a person tremendously with daily activities and can improve the way they feel. The transplant has proven to impact the physical and mental well-being of a person beneficially.

A bilateral hand transplant is done when both hands of a person are replaced surgically with the hands of a donor. 

Why Is A Hand Transplant Needed?

A person may be advised to undergo a hand transplant for the following reasons to help them regain functionality in the hands.

• The person’s hand or hands are amputated due to serious burns, a severe injury, or sepsis.
• A person may require a hand transplant if they have a congenital abnormality that has affected the growth and development of bones in the hands of the person.

What Are The Factors Considered While Matching A Donor’s Hand: 

• The blood group of the person has to match with the donor’s.
• The tissue type and the skin color have to be similar.
• The ages of the donor and recipient are considered.
• The donor has to be of the same gender as the person receiving the transplant.
• The size of the hand and the muscle mass should match. 

Who Is Eligible For A Hand Transplant:

• The person has to undergo a physical test that involves X-rays, blood examination, and other parameters to determine that the person is physically fit for the procedure.
• The person is evaluated mentally too to find out if they can handle the post-transplant care.
• It is ensured that the person doesn’t have any nerve conditions like peripheral neuropathy that can lead to complications.
• The person should not have chronic ailments such as diabetes, kidney issues, heart problems, or cancer.

• The person should not be having any serious infection.
• They should be a non-smoker and do not consume excessive alcohol or drugs.
• The person should be able to manage the expenses of the procedure.

The Hand Transplant Procedure:

Before the transplant takes place

Before the person has a hand transplant the doctor has a detailed discussion with them explaining to them the benefits as well as the risks. The person is also briefed about the post-transplant care that is lifelong.

The person is evaluated by the team of doctors and surgeons for their eligibility for a transplant. Once they are approved, they are put on a waiting list. Till a suitable donor is found, they have to attend appointments with their doctor and the transplant team for physical testing and investigations. 

The person is advised to do strengthening exercises in the arm with the help of physical therapists.

They may be required to relocate within the vicinity of the hospital to reduce travel time. The person is asked to continue to stay near the hospital for many months after the transplant.

The transplant team should be notified by the person if they have developed any medical condition or if they have changed their place of residence or lodging and contact details.

During the transplant procedure

The surgery is a complicated and intricate process and lasts for about 18 to 24 hours. The person’s family and attendants are updated throughout the procedure with the progress.

The doctor connects the bones first using metal plates. After that, the blood vessels are stitched together along with the nerves and the muscle tendons with a special microscope. Once all the parts are stitched the skin is sealed.

What happens after the procedure:

After the surgery is completed the person is admitted to the intensive care unit (ICU) for regular monitoring of the hand functioning like moving of the fingers, the sensation in the hand, etc. The temperature of the room is maintained at a slightly higher side to facilitate better blood flow in the hands.

Once the person has stabilized, they are moved to a regular hospital room for around seven to 10 days after the surgery to recovery optimally. The pain in the arm or hand is effectively managed by the transplant team. A physical therapist teaches the person various exercises that enhance the functioning of the hand. The person may however be required to wear a splint to keep the hand supported and stable.

The person may have trouble sleeping and adjusting to the new body part.

There are chances that the immune system of the person’s body may consider the new hand as a threat and go into attack mode. Hence the doctor prescribes immunosuppressants to prevent the immune system from destroying the new hand. These medicines have to be taken by the person for the rest of their lives at the same time in the same way. The medicines may have side effects as they reduce the body’s ability to fight infections but the transplant team works toward minimizing them. The person is also recommended for blood tests to check the effectiveness of the medicines.

There cannot be a definitive outcome of the hand transplant procedure. However, the success of the procedure is evaluated on the functionality of the person’s hand.

After the transplant, a person is usually able to lift small objects like nuts and bolts and heavier ones like a jug full of water. They can use a fork and knife, tie their shoelaces, and catch a ball.

The transplant significantly improves hand functionality, movement, and sensation. It enhances the self-esteem and self-image of the person.

The Risks Involved In Hand Transplant:

The complications that can happen due to the transplant surgery include:

• Bleeding and chances of infection at the site of surgery.
• Formation of blood clots that hamper the blood circulation in the hand.
• Failure of transplant and in rare cases death.
• Sometimes there may be a skin color change.
• The person can develop skin cancer.
• There may be a post-transplant lymphoproliferative disorder which is the excessive production of lymphocytes.
• The immunosuppressants have side effects that include tiredness, headache, nausea, vomiting, elevated blood pressure, tummy upsets, and vulnerability to infections. The medicines may also lead to conditions like diabetes and Cushing syndrome when the body has excessive cortisol which is a stress hormone.
• The immune system can however reject the new hand. The rejection is of two kinds. 

1. Acute rejection when the immune system goes into attack mode after a few days of the transplant and kills the tissues and blood vessels in the hand causing swelling, pain, and discoloration of the skin. The rejection can be contained with the help of medicines.
2. Chronic rejection happens after months or years of a transplant due to the inability of immunosuppressants to act, leading to a failed transplant. 

Conclusion:

The loss of a hand can be devastating as it can impair the functionality of a person significantly. Many people choose prosthetics which are artificial hands but with the advancements in technology and expertise hand transplant surgeries are being preferred by doctors for people who match the criteria required for a transplant. Although the surgery has multiple risks the benefits outweigh them by giving a person the functionality of a very important organ of their body.  

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