Information for potential hand transplant patients

Advances in immunosuppressive drugs for transplantation have allowed for non-life threatening types of transplants to be performed including pancreas, kidney, larynx and the hand transplant.

Research

The Hand Transplant is a research study reviewed by the University of Louisville IRB.  If you would like to share personal health information to be considered as a potential candidate for hand transplant, please complete the attached Research Authorization form.  Please read it very carefully.  Signing the Research Authorization does not provide consent to be in the Hand Transplant Research Study, it provides more information for screening purposes.  By signing this document, it does  not mean that you will be automatically in the study.

Please do not complete the Research Authorization form if any of the following apply:

• You do not have private health care insurance to provide you with the required immunosuppressive drug therapy
• Your amputation is a result of a congenital defect
• Your amputation is limited to the foot or leg
• You have had positive Hepatitis A, B, or C
• You are younger than 18 and older than 65

After reading the research authorization very carefully, please print off the form, sign it and return by fax to the Research Manager: 502-562-0326.

Please include a telephone number and a good time to contact you.

Hand Transplant Program

• The Hand Transplant Program is a partnership with Kleinert Kutz Hand Care Center; Jewish Hospital; and University of Louisville.
• Large animal studies have proven successful.
• The hand transplant protocol has been reviewed by:
• University of Louisville IRB
• Jefferson County Medical Society
• Department of Defense
• Nation's first hand transplant procedure performed at Jewish Hospital January 24-25, 1999 on Matthew Scott.

Pre Transplant

The hand-transplant procedure is for individuals who have experienced the difficult loss of a hand or forearm due to:

• Trauma
• Life saving interventions that caused permanent injury to the hand or forearm

At this time, hand transplant procedure is not being considered for congenital anomalies, loss of a limb due to cancer or for leg amputations. Further research is needed in these areas. This procedure is not being considered for individuals whose injury is limited to fingers.

The prospective patient should otherwise be healthy.

Tests required for further evaluation include, but are not limited to:

• X-rays
• Extensive blood work
• Physical measurements of the affected limb
• Psychiatric evaluation and psychological projective testing
• Consults with transplant surgeon, hand and microsurgeon, social worker, physical therapist, orthotist, primary care physician and other physician disciplines as appropriate
• Other tests as indicated such as gastrointestinal tests, etc.

Post Transplant

Drug Therapy

All hand transplant patients will be on immunosuppressive therapy which includes drugs that must be taken everyday for the life of the hand transplant. The immunosuppressant drug therapy is similar to the drugs that are taken by kidney transplant patients. Side effects of these drugs include but are not limited to:

• Hypertension (high blood pressure)
• Acne
• Tremor of the hands
• Gastrointestinal discomfort
• Increased risk of infection
• Increased hair growth
• Weight gain
• Liver and kidney dysfunction
• Increased risk of developing skin cancers, lymph node tumors and other cancers
• Diabetes requiring insulin

Risk of infection caused by the immunosuppressive drugs may make it necessary for recipients to alter their daily activities particularly in the first six months. Activities to consider include:

• Avoiding children with communicable diseases
• Avoiding crowds
• Wearing a mask while outside or in dusty, crowded places
• Avoiding emptying cat liter box
• No house plants
• No gardening
• No swimming in fresh water such as lakes or ponds

The Procedure

The hand transplant procedure is generally thought to be technically easier than a replant because the transplanted tissues have not been damaged due to traumatic injury. The hand transplant procedure involves the transplantation of bone, muscle, tendon, joint, nerves and arteries. Donated limbs would come from brain dead living donors similar to solid organ transplants. Kentucky Organ Donor Affiliates are coordinating these arrangements. For more information on Kentucky Organ Donor Affiliates visit their web site at www.kyorgandonor.org.

Following the hand transplant procedure, intensive physical therapy will be required to regain hand and arm function.. The patient will also have biopsies and lab evaluations as needed. Individuals will need to stay in the Louisville area for the first three months.

For further discussion on the psychiatric issues of hand transplantation, click to the article by the Jewish Hospital Transplant Center psychiatrist at www.handtransplant.com/procedure/psychiatric-issues.html.

To obtain more information about the hand transplant procedure, visit the feedback page. If you or someone you know would like to be considered as a candidate please include a phone number where we can contact you or call the Research Manager at 502-562-0313.

Send comments to Brenda Blair