Can you spot which hand Emily Fennell was born with, and which was recently attached? Hint: the bandage is the only real give away.

The latest recipient of a hand transplant is coping well in Los Angeles. On March 5th, Emily Fennel, age 26, received a donor right hand to replace the one she lost nearly five years earlier in a car accident. Now, more than six weeks later, she once again has two working hands and is on the road back to a normal life. In the weeks and months ahead, Fennel will continue to undergo occupational therapy – picking up small objects and relearning how to use her right hand. Doctors think she’ll one day have as much as 60% of the functionality of her original limb. You can see Emily discuss her condition before and after the transplant in the videos at the bottom. With more than a dozen cases in the US, and over 40 worldwide, these transplants are slowly becoming a more common procedure…but seeing doctors attach a new hand to Emily’s arm still seems utterly incredible!

In order to transplant the new hand onto Fennel’s arm, surgeons had to connect 23 tendons, 2 bones, 2 arteries, and at least 3 nerves. The connection was made along a skewed ellipse, rather than a circle like a bracelet. This was to ensure that scar tissue didn’t create a ring at the wrist that would impair movement or healing. While Fennel is reportedly adjusting well to the transplant, at this point in the recovery process she has no feeling in the attached hand. The connected nerves grow slowly (~1 millimeter per day) and so it will take many more weeks or months before she can receive sensations from the new limb. This numbness, however, has not stopped her from training to rebuild atrophied muscles in her arm and dexterity in her hand.

Hand transplants are extraordinary works of surgical finesse, but they come with a high price. Fennel will have to spend the rest of her life on immunosuppressant drugs to keep her body from rejecting the donor tissue. Those medications increase risks for high blood pressure, liver damage, kidney damage, cancer, and body wide infections.

Despite these dangers, Fennell is not alone in pursuing hand transplants at UCLA. The UCLA Hand Transplantation Program is still seeking prospective patients for the procedure, and while eligibility is limited, and the screening process rigorous (involving medical and psychological tests), I’m sure many will pursue entry into the program. Especially as the first success, Fennell, seems very happy with the results of her transplant.

The general field of transplants has become increasingly bold in the past few years, which has paid off with remarkable successes. We’ve seen several double hand transplants, as well as full face transplants. With stem cells, we’ve seen new organs grown inside patients using nothing more than their own cells and a donated ‘scaffold’ of the organ. Combined with Emily Fennell’s recent surgery, these accomplishments paint a picture of a field of medicine that is accomplishing tasks that would have seen impossible a few decades ago. In the next few years, some of these surgeries could become almost common.

That’s assuming, of course, that they don’t get replaced by something better. While Fennell decided that prosthetics weren’t the right solution for her amputation, others have chosen that route. We’ve seen how not only are robotic limbs becoming more adept, the most advanced prototypes are able to provide sensory feedback. As hand transplant surgeries improve in the years ahead, so too will these robotic alternatives. How long until they become as good as the biological versions? Fennell was able to find a near perfect match for her missing hand, but what about all the amputees who aren’t so fortunate? Whether it’s due to hopes of augmentation (eventually robotic limbs will surpass biological ones, even if takes fifty years) or a limit in opportunity, I think prosthetics will continue to be a strong solution for amputees even as hand transplants improve. If I had to weight the risks of immunosuppressant drugs versus the comfort of having a biological hand…I’m not sure how I would decide.

The beautiful thing is that patients can decide. We have options for amputees that simply weren’t available a generation ago. Advanced robotic hands or waiting for a biological replacement – these are both pretty amazing options. Someday in the future we’ll probably be able to add ‘grow a new hand from your own stem cells’. Fennell’s success with her new limb is another sign that we live in an extraordinary age. Medical technology keeps improving, and as it continues on its accelerated trajectory there may soon be no injury that we cannot repair, no tissue that we cannot replace, and no one that we cannot help.

I love medical science.
…Now check out the videos below to see the incredible procedure:

*note: If videos do not appear below, please refresh your browser.

This first video is a brief overview of Fennel’s story, with a focus on the most recent updates on her condition. Her recovery is amazing.

In this extended video you get to see even more of Fennel’s backstory and recovery from the operation:

This final video focuses on the surgery itself, which took place March 4th and 5th over 14 hours.

[image credit: UCLA Health System/Ann Johannson Photography]
[video credits: LA Times, UCLA Health System]
[sources: UCLA News, LA Times]

Kepner's surgery underway. Photo courtesy of University of Pittsburgh Medical Center

Kepner, a 57-year-old pastry chef living in Georgia, got his new hands after a nine-hour surgery at the University of Pittsburgh Medical Center. He is still recovering, but has strong circulation in both hands and has showed no signs of organ rejection. The success of his surgery is in part due to a unique new procedure to improve an organ’s chance of being accepted by the body.

Whenever an organ transplant takes place, doctors have to suppress the recipient’s immune system so that it does not reject the new organ outright. This suppression requires toxic drugs that can increase the chances of infection, cancer, diabetes, or other complications. But in the past decade, an innovative procedure has been used to reduce the need for such drugs while still minimizing the likelihood of rejection. Used during Kepner’s transplant, the procedure transplants stems cells from bone marrow into the donated organs, helping the immune system more quickly recognize the hands as part of the body.

Kepner has a long road ahead of him. He’ll need extensive physical therapy before he can use his new hands effectively. This is because when limbs are lost, the areas of the brain responsible for their control get shifted on to other functions. But there’s good news: doctors have recently shown that by reconnecting the nerves to the hands, the motor cortex recognizes their presence and can regain control. It’s not exactly plug-and-play, but the plasticity of the brain will improve Kepner’s ability to use his new hands over time.

The donated hands came from 23-year-old Jeff Keen, who died in an unspecified accident. As an organ donor, Keen’s liver, kidneys, heart, and one lung have already found new homes in five different recipients. Not only that, but his hand donation has made medical history. This was the first double hand donation in the US, and the ninth worldwide. Even single hand transplants are a pretty rare and recent procedure, with the first successful case in the US taking place in 1999 (there have only been six since). It’s an amazing thing how far organ transplants have come, and hard to imagine the future benefits they might still have in store.

Kepner signing up for his upcoming transplant

As we’ve reported in the past, prosthetic technologies are constantly getting better and better. Soon, a prosthetic limb could respond directly to the motor-sensory cortex, providing the same feeling and control as a natural limb. The day will soon come that prosthetics will be so well designed and integrated into the body that many folks will prefer them to natural limbs. But for many people, even a fully functional prosthetic could never replace the real thing, psychologically speaking. Procedures like these transplants show the amazing strides we’re taking to improve the quality of life for amputees.

Our ability to grow new organs in a laboratory setting has increased by leaps and bounds in recent years. Soon, you’ll even be able to custom-order an organ from the company Tengion.  At some point in the near future, growing a new hand might be a real possibility, cutting out the need for transplants between individuals and all the risks of rejection that come with.

But until these practices become safe and widespread, organ donation will continue to prove itself a public good, especially as our ability to perform successful transplants continues to increase. Unless you’re an Egyptian pagan, you probably won’t need your organs after the lights go out. So right now, look down at your hands, and imagine them making pastries with their new owner long after you’re dead. Isn’t that kinda cool?

So what’s it say on your driver’s license?

The source for most of this story comes from handtransplant.com, a website showcasing the success Jewish Hospital and its partners have achieved with hand transplants since they pioneered the world’s first long term hand transplant in January 1999.

As with all organ transplants (hearts, livers, and even hands) one of the greatest challenges a patient faces is organ rejection, a process where the immune system attacks the new organ as a foreign invader. For decades now we have had the medical means to fight organ rejection, although the treatment is error prone, requires the patient to stick to a rigourous regiment of drugs, and is plagued with several negative side effects.

Even assuming the problem of organ rejection can be contained, the problem of properly attaching the tiny veins, arteries, and other parts of the body to the new organ is quite a challenge.  New advances in microsurgery have greatly enhanced our ability to overcome this challenge, paving the way for the hand transplants of today.  Here is a crude outline of the procedure:

The surgeon will progress with tissue repair in the following order: bone fixation, tendon repair, artery repair, nerve repair, then vein repair. The surgery can last from 12-16 hours. In comparison, a typical heart transplant takes six to eight hours and a liver transplant, eight to twelve hours. Typical post-operative complications include blockage of the blood supply, infections and rejection.

Want to learn more?  Check out this detailed video of one man’s experience with a double hand transplant:

Image: source