Hand transplantation, like organ transplantation, is a surgical procedure to transplant a hand(s) from a brain dead donor to a recipient.
Purpose of our Research
To develop better surgical treatments for individuals suffering with amputated upper extremities.
Our Research Focus
Overcome immunological, ethical and technical/surgical hurdles standing in the way of performing human hand transplants.
Our Hand and Face Transplant Research
Hand and Face transplants are also termed Composite Tissue Allotransplantations (CTA). In contrast to solid organ transplants, CTA are made up of a "composite" of several different types of tissue, i.e. skin, muscle, bone, subcutaneous tissue, blood vessels, nerves, etc... As it relates to transplantation, perhaps more important than the mix of tissues in CTA, is the fact that hands and facial tissues contain "skin", which is very immunogenic.
The skin's high immunogenicity is related to one of its primary functions, serving as a barrier that protects our inside from the surrounding environment. The skin accomplishes this by being a very sensitive outpost for the immune system. Skin is one of the most immunogenic tissues in our body. While this finely tuned system is very effective at keeping foreign bodies out it also makes skin very problematic to transplant from one individual to another. When transplanted from a donor to a recipient the recipient's immune system mounts a very strong rejection response. Much stronger than when solid organs are transplanted.
This very strong rejection response caused by "skin" is what makes CTA unique among transplants and is the primary reason why solid organs have been successfully transplanted in humans for more than 50 years while the first hands and facial tissue transplants were performed only in the late 1990's. Until then the medications developed to supress the immune system and prevent it from rejecting solid organs were not strong enough to prevent skin from rejecting.
In 1998 researchers in Louisville, USA, in animal experiments, discovered that a combination of immunosuppression medications (Tracolimus, FK506 and Prednisone) successfully prevented skin from rejecting. This landmark discovery, led them and other teams around the world to begin performing human hand and face transplants. For the first time, this discovery made it possible for patients suffering with amputated limbs and facial disfigurement to enjoy the same benefits as solid organ transplant recipients.
At the time, the concept of transplanting human hands and faces was new and brought with it many psychosocial implications and like so many pioneering treatments brought out many skeptics who for their own reasons believed these new treatments were not ethical. To address this, the same team in Louisville established a research program to address the ethical implications of transplanting human hands and faces. Their program consisted of developing a multidisciplinary team of scientists and clinicians in the fields of psychology (body image); psychiatry; bioethics; sociology; and plastic, head, and neck, ophthalmologic and transplant surgery. Together they developed a set of ethical guidelines to direct their efforts and a research strategy to investigate risk versus benefit in human hand and face transplantation.
In 1998 a team in Lyon, France performed the first successful human hand transplant. For a detailed account of the research and events leading to the first human hand transplants see:
- Proceedings of the 1st International Symposium on Composite Tissue Allotransplantation, Transplantation Proceedings, 30(6): 2686-2787, 1998.
- Proceedings of the 2nd International Symposium on Composite Tissue Allotransplantation, Microsurgery, 20(8): 2000.
- Composite Tissue Allotransplantation (CTA): Present state and future outlook. Transplantation, 73(5): 832-35, 2002.
|Participants of the 2nd International Symposium on Composite Tissue Allotransplantation, held in Louisville, USA on May 17–18, 2000|
Participants at this historic meeting included, from left to right:
Top Row: Harold E. Kleinert, MD; J.C. Guimbertau, MD, PhD; Neil Jones, MD; Charles Hewitt, PhD; Guoxian Pei, MD, PhD; Mathew D. Scott (1st successful human hand transplant recipient); Timothy Heidler (1st successful human larynx transplant recipient); Darla K. Granger, MD, Martin M. Klapheke, MD; Marl Siegler, MD, Marshall Strome, MD; William Schwartz, MD; Joseph E. Kutz, MD
Bottom Row: Allen D. Kirk, MD; Mark Hardy, MD; Jean-Michel Dubernard, MD; Warren Breidenbach, MD; John Jones, MD; Gunther O. Hofmann, MD, PhD; Scott A. Gruber, MD, PhD, John H. Barker, MD, PhD; James R. Bain, MD.
Click on the below links for a complete list of publications by our institution that focus on "preventing skin rejection in hand and face transplantation" and the "ethical and psychosocial aspects of hand and face transplantation".