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The world’s first bilateral hand transplant took place in Philadelphia this month as an 8-year-old boy lost his hands and feet following a serious infection.
Zion Harvey underwent an amputation of his hands and feet and also had a kidney transplant several years ago as result of the infection. But surgeons at The Children’s Hospital of Philadelphia (CHOP) joined colleagues from Penn Medicine to conduct the life-changing transplant. The donor hands and forearms were successfully transplanted onto Harvey during the 10-hour surgical transplantation.
Zion Harvey prior to the surgery (Photo Credit: YouTube/Screen Grab)
Led by L. Scott Levin, MD, FACS, chairman of the Department of Orthopaedic Surgery at Penn Medicine, director of the Hand Transplantation Program at The Children’s Hospital of Philadelphia, and professor of Surgery (Division of Plastic Surgery) at the Perelman School of Medicine at the University of Pennsylvania, a 40-member multidisciplinary team of physicians, nurses and other staff from plastic and reconstructive surgery, orthopaedic surgery, anesthesiology, and radiology participated in the operation.
Zion Harvey with doctors prior to the surgery (Photo Credit: YouTube/Screen Grab)
“This surgery was the result of years of training, followed by months of planning and preparation by a remarkable team,” said Levin. “The success of Penn’s first bilateral hand transplant on an adult, performed in 2011, gave us a foundation to adapt the intricate techniques and coordinated plans required to perform this type of complex procedure on a child. CHOP is one of the few places in the world that offer the capabilities necessary to push the limits of medicine to give a child a drastically improved quality of life.”
Harvey was initially referred to Shriners Hospitals for Children but after an evaluation, doctors found him to be a suitable candidate for the first pediatric hand transplant.
“The collaborative effort between these institutions was necessary to assemble the team and organize the players to orchestrate such a complex and demanding procedure that had never been performed on a child,” stated Scott H. Kozin, MD, chief of staff for Shriners Hospitals for Children—Philadelphia.
The hands and forearms for the procedure were donated through the Gift of Life Donor Program, which serves the eastern half of Pennsylvania, southern New Jersey, and Delaware.
“The skills necessary to perform such complex surgery at CHOP have been acquired from lessons learned over the past 20-plus years of performing pediatric solid organ transplantation,” said Abraham Shaked, MD, PhD, the Eldridge L. Eliason professor of Surgery and director, Penn Transplant Institute. “We have learned the importance of closely monitoring and managing the activity of the immune system through years of experience, and are hopeful that Zion will enjoy excellent long-term allograft function and a normal life.”
A large surgical team was required for the 10-hour surgery. (Photo Credit: YouTube/Screen Grab)
Harvey is now recovering from the surgery and is excited to throw a football someday. He has adapted well to living without hands and has learned how to eat, write, and play video games without them. Harvey has received prosthetics for his feet and is able to run, walk, and jump independently.
Double hand transplantation is a complex procedure involving many surgical and non-surgical components. First, the potential recipient must undergo extensive medical screenings and evaluations before surgery. In this case, the patient’s previous medical condition, following sepsis at an early age, factored into the decision to perform the transplant.
During the surgery, the hands and forearms from the donor were attached by connecting bone, blood vessels, nerves, muscles, tendons, and skin. The surgical team was divided into four simultaneous operating teams, two focused on the donor limbs, and two focused on the recipient. First, the forearm bones, the radius and ulna, were connected with steel plates and screws. Next, microvascular surgical techniques were used to connect the arteries and veins. Once blood flow was established through the reconnected blood vessels, surgeons individually repaired and rejoined each muscle and tendon. Surgeons then reattached nerves and then closed the surgical sites.
Zion Harvey can't wait to throw a football with his new hands (Photo Credit: YouTube/Screen Grab)
Harvey continues to receive daily immunosuppressant medications to prevent his body from rejecting the new limbs, as well as his transplanted kidney. Zion is being cared for by CHOP’s nephrology and kidney transplant team, as well as his hand transplant surgical team. Post-surgery, he spent a week in CHOP’s Pediatric Intensive Care Unit, then was moved to a medical unit and eventually moved to an inpatient rehabilitation unit where he undergoes rigorous hand therapy several times per day, an essential step to gaining improvement in function.
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