After five years of planning, Canada’s first succesful hand and forearm transplant was recently performed on a 49-year-old recipient by 18 surgeons at the University of Toronto.
“When the patient was listed, there was increased anticipation and when a donor match was found, I had some disbelief that it would really happen. When the surgery started it was all business and went according to our plan” said Dr. Steven McCabe, director of U of T’s Hand Program and director of University Health Network’s (UHN) Hand and Upper Extremity Transplant Program at Toronto Western Hospital.
The procedure, which lashed roughly 14 hours, was lead by Dr. McCabe and included a UHN multidisciplinary team composed of other surgeons, psychiatrists, immunologists and other medical and adminstrative staff.
“I am really happy we could bring this procedure to Canada and specifically for our patient. There have been a lot of meetings and a lot of planning to bring this about,” emphasized McCabe.
Since her surgery, the patient “has started a program of hand therapy to keep her joints mobile and her tendons gliding until her muscles are re-innervated,” McCabe explained.
A surgery of this calibre requires the donor’s upper limb to be attached by connecting bone, muscles, major arteries, nerves, tendons, veins, and soft tissue. “The peripheral nerves must regenerate from the site suture to the target muscles. This could take several months to regain motion,” McCabe added.
The past few years have seen significant improvements in the areas of patient selection and the surgical procedure itself. “Our patient is a healthy well informed intelligent woman who was highly motivated to have this operation,” McCabe commented. To date, there have been 110 hand transplants completed around the world.
McCabe expressed both optimism for the future as wel as pride for the group’s accomplishment after the surgery was completed, saying, “I am reassured and proud to be a small part of this history. Advances in transplant immunology have the potential to revolutionize plastic and reconstructive surgery. This hand transplant is a small step to that end as we will learn more information about transplantation by hand and upper limb transplants.” Each phase of the surgery process, which included the evaluation prior to the procedure and the post-surgery rehabilitation, required the involvment of different experts and personnel. “The logistics and medical care are quite complicated and luckily we have a superb, experienced transplant center and TGLN [Trillium Gift of Life Network] to help guide the process. It is amazing to be a hand surgeon at this time and a lucky confluence of events for me personally.” McCabe added.
For this procedure, UHN’s Multi-Organ Transplant Program (MOTP) and Toronto Western Hospital’s Hand and Upper Extremity Transplant Program gathered expertise on immune suppressants and the prevention of rejection, while the TGLN oversaw the organ donation process.
Ultimately, the achievement could not have occurred without the support of a hand and forearm from the family of the donor. With respect to the patient’s confidentiality and privacy, the name of the recipient and the date of the surgery will not be released by the hospital.