Hand Transplantation - Essay Example

Hand Transplantation - A Review The feasibility of hand transplantation has been studied and the methods to successfully refine the techniques have come a long way from the first attempt in Ecuador in 1964 to the first successful operation some three decades later in France, 1998 (Errico, et al. 2012; Faterni, et al. 2011; Kaufmann, et al. 2009; Kaufmann, et al. 2012; Luculescu, et al. 2012; Starzl, et al. 2013). Currently there are 31 patients recorded to have successfully undergone whole hand transplantation by grafting hands from cadaverous donors (Brandacher, et al. 2010; Dubernard, et al. 2003; Errico, et al. 2012; Marinescu, et al. 2012; Moise, et al. 2011; Roberts and Akinlosotu 2011; Wu, et al. 2011). The aims of transplanting an actual arm onto amputees is to give them additional hope in regaining their normal lives, since the grafting of an actual human arm instead of a prosthesis has been recorded to give better control over daily activities such as regaining fine motor skills due to the re-establishment of sensory stimulation (Errico, et al. 2012; Foroohar and Levin 2011; Frey, et al. 2008; Kalliainen 2012; Landin, et al. 2011; Sirigu, et al. 2011). However, the procedure is not as simple as an organ transplant since many things must be taken into consideration, such as the compatibility of the donor of the hand to its recipient, the different parts of the hand that must be grafted onto the recipient, whether or not the patient is mentally prepared to undertake the surgery, as well as the high costs of maintenance such as lifetime immunosuppressant intake. It is thus important to not only take into account what the patient desires, but also to give insights on the many changes that can be expected after the hand allotransplantion. Methodology The hand allotransplant surgery is a complex microsurgery procedure wherein each systemic components of the donor hand such as the bones, vascular tissues, nerves and skin are painstakingly attached to the recipient’s amputated upper arm, taking into consideration the extent of the amputation and the alignment of the tissues that will be attached. Such methods include composite tissue allotransplantation (CTA) for the skin and muscle tissues, vascularized CTA for the blood vessels, use of immunosuppressants such as monoclonal or polyclonal antibody preparations, FK 506, mycophelate mofetil, tacrolemus, and cyclosporine in order to prevent the recipient’s body from having allergic reactions and ultimately rejecting the grafted hand, and psychologically preparing and stabilizing the patient in receiving another person’s body part as their own (Azari, et al. 2011; Barker, et al. 2011; Bozulic, et al. 2007; Brandacher, et al. 2010; Brenner, et al. 2002; Cunningham, et al. 2004; Dubernard, et al. 2003; Kumnig, et al. 2012; Landin, et al. 2012; Petruzzo, et al. 2004; Roberts and Akinlosotu 2011; Schuind 2010; Schuind, et al. 2006; Sirigu, et al. 2011). Follow-up methods to assess whether the hand allotransfer is a success is by measuring the dexterity and control of the patient’s grafted hand such as using a series of grip and pinching tests, and checking the allotransplanted hand and tissues through imaging modalities such as ultrasound biomicroscopy, MRI scans and electromyographic studies (Kaufman, et al., 2012; Luculescu, et al. 2012; Petruzzo, et al. 2004). An information repository in the form of a registry of hand and composite tissue transplantation is available for surgeons and other areas of specialization to support them in decision-making such as showing procedures that are suitable to the patient’s degree of hand amputation and results such as the extent of a patient’s hand rehabilitation (Errico, et al. 2012; Faterni, et al. 2011; Foroohar and Levin 2011; Kaufmann et al. 2012; Landin, et al. 2012; Luculescu, et al. 2012; Moise, et al. 2011; Petruzzo, et al. 2004; Schuind 2011). Results and Discussion So far, the success rate of hand allotransplantation has been up to 94%, and the failure was attributed to non-compliance with the drug regimen by one patient (Errico, et al., 2012; Petruzzo, et al. 2004). However, due to the few patients that underwent and successfully completed the expensive surgical procedure of hand allotransfer, not much information has been available and generated regarding exact techniques used and success rates over the years. Thus it is important that the registry of hand and composite tissue transplantation be referenced by professionals that aim to conduct hand allotransplantations, especially since there are various procedures already done and reported, as well as success rates for each finished operation and follow-ups on every patient (Errico, et al. 2012; Faterni, et al. 2011; Foroohar and Levin 2011; Kaufmann et al. 2012; Landin, et al. 2012; Luculescu, et al. 2012; Moise, et al. 2011; Petruzzo, et al. 2004; Schuind 2011). It is expected that due to the updates being recorded in the registry, there would be a continuous progress in the field of allotransplantation of hand and other composite tissues. While hand allotransplant may seem like a promising choice for many amputees, it has in its own several problems which may well outweigh the benefits, especially in the long run. For example, like patients that successfully completed an organ transplant, recipients of hand allotransplant grafts have to endure a lifetime of taking in various drugs such as anti-steroidal and immunosuppressant drugs continuously to prevent the body’s rejection reactions (Barker, et al. 2011; Bozulic, et al. 2007; Brandacher, et al. 2010; Brenner, et al. 2002; Landin, et al. 2012; Moise, et al. 2011; Petruzzo, et al. 2004; Schuind 2010; Starzl, et al. 2013; Wu, et al. 2009). There is also the large gap between the lifetime costs of undergoing hand allotransplant (above $500, 000) and the installation of a prosthetic arm (around $ 20, 000), and the difference between the two values must also be considered by the amputees (Errico, et al. 2012; Roberts and Akinlosotu 2011). Ethical issues could also arise such as to whether a hand transplant is necessary enough to prolong a patient’s life or not, as well as the acceptability of the operation in various religions or sects (Bozulic, et al. 2007; Faterni, et al. 2011; Luculescu, et al. 2012). Psychological issues that might arise from grafting another person’s hand must also be addressed, including the reconciliation of negative feelings from the initial amputation as well as the acceptance of an alien body part, and a thorough mental preparation must also be included in the post-operational processes (Foroohar and Lewis 2011; Kunmig, et al. 2011; Roberts and Akinlosotu 2011). Lastly, surgeons and specialists must also take into consideration the patients’ choice on whether undergoing a hand allotransplant or simply going for the prosthetics, as well as avoiding influencing the patients’ decision as much as possible (Brenner, et al. 2002; Cunningham, et al. 2004; Errico, et al. 2012). It is thus valuable that before undertaking the hand allotransplant, considerations regarding the patient’s physical, mental, and financial capacity for such a procedure must be taken into account first. Conclusion Hand allotransplantation is a complex surgical procedure with high success rates, and it has pros such as patients regaining muscle control and sensitive motor skills, as well as cons such as having to take expensive anti-rejection drugs for life. Surgeons and other specialists must assist patients in deciding whether to have it or not, explaining the implications of undergoing such procedures and guiding them throughout the process. 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Transplantation Proceedings, 2009: 41(2): 463-465. Read More