Limb Transplants -- Modern Miracle or Future Frankenstein?

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Biology 103
2003 First Paper
On Serendip

Limb Transplants -- Modern Miracle or Future Frankenstein?

Adina Halpern

We all know that transplants save lives. Liver, heart, renal, and other organ transplants are hardly controversial. But what happens when transplants do not save lives? What happens when they actually endanger them? At least twenty-one hands and arms have been transplanted since 1998 (and one in 1964) (1). Sure, the cosmetic and functional value of having a new hand could seem like a miracle to those without hands or arms, but do these benefits outweigh the risks?

Limb attachments are not uncommon. Dr V Pathmanathan and his team, who transplanted a left arm onto baby Chong Lih Ying from her twin sister who had died at birth, had already performed over 300 such operations (2). The controversy occurs when the limb is not simply reattached, but is transplanted from one person to another. This is because limb transplant patients, like any other transplant patients, need to be given anti-rejection medication, immunosuppressive therapy (1), so that the body's immune system does not recognize the new limb's tissue as foreign and destroy it (3). In fact, Chong Lih Ying was the only limb transplant patient not to receive immunosuppressive drugs. Because her arm was transplanted from her twin, there was very little risk of rejection (2).

As the name suggests, immunosuppressant drugs given to limb transplant patients greatly lower the body's immune system (4). This puts limb transplant patients at a much greater risk of cancer, infections, and other disorders (5), as has been the case in renal and liver transplants (6). Even with these drugs, the patient still has a great risk of rejection. Six weeks after Jerry Fisher's hand transplant, he had already experienced three episodes of rejection, a common and expected occurrence in limb transplant patients (7).

To avoid rejection, and to regain functions of the limb, limb transplant patients must follow a strict regime of intense physical therapy. During the period immediately preceding his hand transplant, Jerry Fisher underwent a two-hour physical therapy session six days a week, as well as therapy exercises on his own every two hours (7). Even so, normal functions of the limb come slowly, and according to test results to date, a transplanted limb will never have the full function of a limb with which one was born (6).

Transplant recipients must also undergo intense psychological therapy in order to view the hand as part of the self and not to associate it with the deceased body from which it came. They must also be able to deal with the fact that the limb could be lost yet again in the case of rejection or if the immunosuppressant drugs were to put their lives in grave danger (1). This was the case for Clint Hallam, the world's first hand transplant patient (aside from the recipient of the unsuccessful 1964 operation in which primitive immunosuppressive drugs were used). In 2001, Hallam's new hand was amputated. The doctors involved claim that it was due to Hallam's lack of commitment to the taking of immunosuppressant drugs and undergoing physical therapy (4) but Hallam claims that it was due to rejection and "mental detachment" (7). No matter where the blame lays, the truth is that the operation was unsuccessful and that this is a real risk that transplant patients must face.

The next most recent limb transplant took place in January of 1999 (4) – just under five years ago. We therefore cannot know the long term effects of limb transplants. Of renal and liver transplants, which have a much longer history and broader base than do limb transplants, only 30-60% last at least fifteen years before a second transplant is needed. (6) Heart transplant patients, which require similar dosages of immunosuppressant drugs to those of limb transplant patients, have an annual risk of lymphoma of 0.3%. Assuming that this risk is the same for limb transplant patients, Matthew Scott, for example, who was 37 when he received his new hand, has a lymphoma risk alone at 12.9%, assuming his natural life expectancy is 80 (8), as well as risks of other diseases. It must also be taken into consideration, however, that renal, liver, and heart transplant recipients are typically already sick when they receive their transplants. Limb transplant patients, though missing limbs, are otherwise in good health. They could therefore have a lower risk of disease.

The picture thus far looks dismal, but it is important to remember that for many amputees, life itself can be dismal. People missing one or both hands are unable to perform, or perform with difficulty, many tasks that the rest of the population takes for granted, such as shaving, cooking, and carrying large objects. They are also greatly debilitated in their capacity for human touch, which is so dependant on the hand (9). There are also cosmetic benefits of having two hands. Although these, in comparison to the functional benefits, are small, they must still be taken into consideration. The constant stares and unusual treatment received by those without two hands can be traumatizing.

Although limb transplant patients may never regain the full function of their new limbs, limb transplants make possible much more than do prostheses. After just two months, Jerry Fisher could toss a ball, use a paddle, tie and untie his shoes, and lift and carry a 35-pound crate. He was also ecstatic about his newfound ability to "Pick up the baby every morning just to hold him." After two years, Matthew Scott could throw a baseball, swing a light bat, write his name, feel the sensations of hot and cold, tie his shoes, pick up checkers, and use his cellular phone (7).

After reviewing the near exhaustive list of disadvantages and the comparatively short list of advantages, one would be tempted to render limb transplants simply unethical and selfish on the parts of both surgeon and recipient. After all, lives are not at risk with the loss of a limb as they are when organ transplants are necessary (6). However, it is not the quantity of disadvantages versus advantages that is at issue. Rather, it is their quality. One can never know the feeling of being without one or more limbs until one or more limbs are lost. One cannot judge Jerry Fisher as being selfish for wanting to pick up his baby son. One should not accuse the doctors who perform these highly controversial operations of being simply ambitious when they are greatly contributing to the field of medicine. As long as they have informed the patients of both the advantages and the risks of this new surgery and have psychologically tested the patients before going through with the operation, they have fulfilled what I feel are their ethical obligations.

I must therefore conclude that although limb transplants are not for everyone who is without a limb, they are nonetheless ethical. For these people, death is a risk worth taking. Although they do somewhat resemble the works of Frankenstein, to their recipients, limb transplants are modern miracles.

References

1)Hand Transplant, A plethora of information about hand transplants put together by Brown University students.

2)Time will tell for baby given dead twin's arm, News Article on IOL, South African news, classifieds, and information site.

3)Man Gets First Double-Arm Transplant, Article originally on ABCNEWS.com, on Marylin's Transplant Page, which includes over 300 news articles about transplants.

4)Hand Transplant History, A history of hand transplants and hand transplant technologies on the official transplant website.

5) Surgeons perform another successful hand transplant, A site combining the history of hand transplants with an article about Jerry Fisher, America's second hand transplant recipient.

6) ASSH / Hand Transplantation, A discussion on the ethics of hand transplants on the American Society for Surgery of the Hand site.

7) Arm-Hand Tx 2001, A selection of new articles associated with www.handtransplant.org.

8) bmj.com Benatar and Hudson 324 (7343): 971, A case study of two situations where limb transplants were considered but not performed.

9) Longing for Human Touch, Article originally in the Los Angeles Times, on Marylin's Transplant Page.

 

 

Continuing conversation
(to contribute your own observations/thoughts, post a comment below)

05/27/2005, from a Reader on the Web

I enjoyed reading the success stories. Becoming a amputee (right leg above) I can really relate to what it must feel like to have just that little bit of hope and just that little bit of success with feeling. No one knows what an amputee life is really like except for us. The rejection we receive, the stares and even the feeling of not being complete. If there was a way for me to have a right light I would jump at the opportunity. I believe amputee look at in as the what have we to lose. If doesn't work I won't be any worse than we are now even with the risks of rejection or possible death. Transplants are like a small gleam of light at the end of the tunnel. It doesn't matter what the odds we want to see that light come closer. Thank You Arlene Stout

 

Comments made prior to 2007
i was born without my left hand and am trying to find out more about hand transplants as i want one. i find it hard to find a job and it gets me really down. would you please be able to tell me more about it please. and how much it would cost and where i can get it done. kind regards ... Natasha Attard, 21 November 2007

Comments

Raghavendar Rao T's picture

Transplantation of Right Hand and Left Leg

Hi,
My son (Mr. Haricharan) lost both the limbs Right Hand and Left Leg due to High tension Electric Shock on 10-Aug-2012 and still facing issue due to Scars and not able to cope-up with Prosthesis.

i am looking for Transplantation of Hand .. he is 5 Yrs kid and very active and healthy in all aspects.. i am in India-Hyderabad and ready to travel to any country to takeup this option.

kindly suggest if there any scope for Hand transplantation for 5 Years kid in any place where there are positive results.

Thanks in advance.

Raghavenra

Serendip Visitor's picture

you can definitely go to the

you can definitely go to the jaipur foot centre. people wear artificial limbs of both hands and legs.

geeta's picture

limb transplant for kids below 14 years

i am searching for an answer to my question ....can my son get a leg tranplant done as he has to undergo an amputation as advised by orthopdc surgeon . if possible i will make him go through the procedure once.
how practical is it for growing kids

Pradeep Bansal's picture

leg tranplant

hi

i lost my left leg above knee nearby hip in a train accident in 2012... can i get transplant, would you please be able to tell me more about it please. and how much it would cost and where i can get it done. kind regards

Pradeep Bansal

sumair's picture

right AK leg amputee

Hi,

i lost my right leg above the knee on 28.4.2012.is there any transplant for me.please let me know.thanks.

Bryan Aegerter's picture

Left Leg amputation at the knee

I was in a motorcycle accident which resulted in the loss of my left pinky and left leg at the knee. Now it still hasn't been a year since the accident but certain things are getting very irritating to say the least. I'm not really worried about the pinky but an option to get a leg back would be amazing. My leg was cut off at the hospital after they determined it couldn't be saved since more than %80 of the muscle was dead from the knee down. Some how my left knee was dislocated and all the blood vessels going to and from my lower leg were severed. Since I had to crawl to the side of the road because I was riding at night no one saw me go off the road as a result I was in the ditch for over 2 hours before being air lifted to the nearest hospital. So I guess my real question is would be any easier for me since I have my entire femur and my knee cap?

Emerson wright's picture

Light behind the cloud

I'm so sooty to hear u guys pain good bless n keep the faith

Uma Shankar Sharma's picture

transplantation of hands for my sister

My sister lost her both hands in an accident .! can u please sugeest me that where should i go for transplantation of hands.! and is is really possible.! plzzz let me knw.!

shanti's picture

right arm from the elbow down

my nephew who is 2 months old doesnt have right palm along with wrist plz inform me about surgeons who perform such surgeries and is it possible for him to get the functional palm again?

Fran McAllister's picture

Limb Transplants

Wow, what a wonderful article. I am a bi-lateral amputee, right leg below the knee and left leg above. What I would give to be able to go for a real walk with my husband - to not have to plan on every item involved in visiting someone (ie. how many steps to lift my wheelchair up, if I'm wearing my prosthetics (unable to right now due to weight gain) do they have a railing going up their outdoor steps, or is the bathroom door wide enough for my chair to get through if I need to use the washroom). To feel the grass again, I know that sounds stupid or silly, but really it isn't. And the way your sheets feel on your feet first thing in morning after a great sleep? Or the way new socks feel? Other than being able to walk with my husband, I would actually be able to wear jeans, and not have to worry "is the leg wide enough to check my below knee limb for blisters?" What a gift that would be, and I would not hesitate one moment if it ever became possible. As far as looks, who cares - I wear a metal tube right now, if that doesn't smashingly sexy, yeah right. Try looking beautiful and sexy in sneakers with your little black dress and no stockings, ha! DOESN'T HAPPEN! Oh wow....just to even dare dream it.

Fran in NC

Ruth Wyant's picture

leg amputee, above knee.

is there anyway to get a leg tranplant, My husband lost a leg Nine years ago.

Serendip Visitor's picture

Transplants and Cloning

The idea of cloning and transplanting fascinates me, however I feel that it is creepy and Mary Shelly rightly predicted it in Frankenstein.

shah's picture

Rt. Upper & Lower limb transplant needed

I have cousin of mine, he is 15yrs old & over a year back in an accident he lost his right upper limb (below elbow) & right lower limb (below knee). I wish to get some information that from where & how can I get him fuctional Mayo-electric upper & lower limbs transplanted.

Herman Pretorius's picture

Right leg above knee ( lost in the line of duty )

Hi i am Herman Pretorius from South Africa
i would really appreciate it if someone especially a dr that needs a free human guinea pig for his / her further experiments.
could reply to me, as towards the possibility of a leg transplant.
i am willing to be a free guinea pig, because i don't have money for such a thing...heck.. i don't even have money to go over seas. PLEASE let me know, i am willing to sacrifice my life, just to give it a try.

uday's picture

polio with lower limb

i am suffering from polio from 3years of old,now i am 27years
is there any chance to transplantation. Plz
suggest me if possible

Anonymous's picture

My friends left leg was cut

My friends left leg was cut off in an accident when she was 4 years old. Now she is 21 years. Can you please suggenst me whether a leg transplant can be done anywhere in this world. PLease do the needful.
Thanking you

Jimmy's picture

transplants from living donors

I am 56 years old. My youngest son is 31. Nearly three and a half years ago, he was blown up in Iraq, nearly died from the loss of blood, but did lose his right arm (just below the elbow) and right leg (about 8 inches above the knee). So, what if I wanted to give him my two limbs? The way I see it is his life is still young, mine is not. He has two young daughters that he can not simply play with, along with the other impediments to an ordinary life.

I am perfectly willing. IS THIS DOABLE!?

Dan's picture

any response.

Jimmy,

Did you ever get a response? I have a similar situation and was wondering the same question.

Dan

Adinath's picture

Can undergo transplant surgery

I'm 26 yrs male bilatral amputee with rt leg ak and left cheopart (forefoot) i'm otherwise healthy so i wanted to know that any research on limb transplant or prosthetics w'll help me

Shwet Kashyap's picture

Problem of growth of arm by birth

Sir,

One of my friend's sister was born with left hand not fully
developed and now she is some 25 years old with the hand being short in length and fingers are very short too.

Please suggest any remedy.

Regards

Anonymous's picture

Matthew Scott's surgery success

A correction~

Cited from above: "The next most recent limb transplant took place in January of 1999 (4) – just under five years ago. We therefore cannot know the long term effects of limb transplants. Of renal and liver transplants, which have a much longer history and broader base than do limb transplants, only 30-60% last at least fifteen years before a second transplant is needed....Limb transplant patients, though missing limbs, are otherwise in good health. They could therefore have a lower risk of disease."

As of the date of this posting, "Submitted by SerendipUpdate on Fri, 01/18/2008 - 4:10pm," Matt's surgery was actually just days under the very highly celebrated Ten Year Mark, quite a milestone for the Jewish Hospital team and all those that have received nonessential transplants as a result of his incredible courage and bravery, especially in the face of all those ethics crazed individuals that made life even more difficult than it needed to be for someone going through such a life altering ordeal. He is an amazing person. There are so many who can now consider transplants and owe him gratitude for performing his job of recipient so well thus causing the experiment to succeed. It was not an easy endeavor.

Now, it is days before the Eleventh Anniversary of the first successful hand transplant. While there have been more transplants and some sadness in transplant news, medical miracles are being made and science is being improved as lives are changed. No one of us with the limbs, whether they work well or not, can ever possibly know what it is like to function without them. We have no right to judge or moralize.

~ A Friend

Modern Miracle, and Then Incredible People!

tushar's picture

Right hand palm with two fingers only

my age is 19years,i was born with my right hand have only two fingers,please would somebody tell me where to go .

anonymous's picture

Arm transplantation

i lost my arm 6yrs ago in an accident my arm below elbow was amputated can it be retransplated?

Cyam moheed ur rehman's picture

lost his right arm in an accident nearly 4 months ago from elbo

my friend son who is 22 years old.met with an accident and lost his right arm from upper arm . Doctors has to cut it . Now we want to know will it be possible for transplanttion of arms.andwhat will be the procedure.

Terry A Lambert's picture

right leg

I lost my right leg in nov. 2005 and have been walking on a prosthetic leg and always having trouble with fitting to tight or to loose ,rubbing sores. I s their anything anywhere A such thing as A leg transplant? I myself am A organ donor and I beleive when my time comes if someone else can benefit from part of my body I would gladly have them do so. If someone would possibly have some information on this please send it to me. Thanks Terry A Lambert

Sandy Rios 's picture

I know what u mean

Terry i too know what u mean about the discomfort, i have my right leg amputated to and prosthetic leg of mine does the same of what you went or are going through.Im a hairdresser and i feel as if my life came to an end.Ive had 4 surgeries,my life style before this happened was eventful i was daring,spondanious,ive work with the best of the best in my buisness,i belong to a nudist resort which i visit every other weekend ive dance the nite away and loved life and lived life and enjoyed every moment of it, and now i feel and say to myself why god why i gave u my best igave to the homless i went to church i gave to my local schools and supported and event they had,so again why, why me, i feel less of a women and who would want me know.My question to u Terry has anyone answer your preyers about the transplant on your leg and if they did can u please give me some answers on if it worked or not, i'll try anything at this point or just looking for a friend to talk to, so please write me back Thank u Terry Sandy Rios

Ravi's picture

Right Leg Amputated

I am aged 47, my right was amputated duing 2006. I want to know whether it is possible to Transplant LEG.

spencer donnelly's picture

leg transplant.

my right leg was amputated above the knee, 35 years ago does anyone know of any successful treatments to date?

Anonymous's picture

Born without left hand

I was born without a left hand from my elbow down i was wondering were could i find a surgeon to do this in ireland???

surya prakash kalapala's picture

Lower limb transplantation

my son aged about 35 years, he lost his right leg below knee joint with an accidennt in the year 2000. Now he is on artificcial leg. Is there any possiblity to transplant the leg.

Razeen Kamies's picture

Right Hind Quarter Transplant

Hi i am 25 years old and was in a motor vehicle accident about a year and a half ago resulting in me losing my entire right leg its called a hemi-pelvictomy could you please be so kind as to tell me if it would be possible for me to have surgery done and how much it would cost even if its a half a leg i would be satisfied with that? please help

Tehwar Abbas's picture

Both Arms Transplantation

My younger brother age 30 lost his both arms in bomb blast (19 August country Pakistan). would you please be able to tell me more about it please. and how much it would cost and where i can get it done. kind regards

Denver Physical Therapy Colorado's picture

Finding out about research

In an unfortunate way, meaning I wish this didn't have to be the stimulus for this. With the number of veterans who have lost limbs in the Iraqi war has increased the funding and research into limb replacement.

To stay up to date on the latest research I would recommend using Google Scholar.

Anonymous's picture

Child born without left arm

I have a friend whose son was born with a birth defect and did not have his arm from the elbow down. He is currently two years old. I was wondering at what age can transplant surgery take place and where can you get information about surgeons who perform such operations?

Anonymous's picture

hi

Hi,

Same is the case with my baby who is just 7 days old.
He did not have his arm from the elbow down.
Have you got any information about surgeons or is it possible for him to get the functionala forearm?

Anonymous's picture

forearm transplant

i have a grandson born without a forearm. could this be possible for him?

Anonymous's picture

History

I have read your article, and there is a little mistake to be corrected.
The first arm transplant was performed in 1941 by an Ecuadorian surgeon to a marine of that country.

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