Hand, face transplants regulated like other organs

Sure your liver or kidney could save someone’s life. But would you donate your hands, or your face? Signing up to become an organ donor may get more complicated than just checking a box on your driver’s license.

The government is preparing to regulate the new field of hand and face transplants like it does standard organ transplants, giving more Americans who are disabled or disfigured by injury, illness or combat a chance at this radical kind of reconstruction.

Among the first challenges is deciding how people should consent to donate these very visible body parts that could improve someone’s quality of life — without deterring them from traditional donation of hearts, lungs and other internal organs needed to save lives.

”Joe Blow is not going to know that now an organ is defined as also including a hand or a face,” said Dr. Suzanne McDiarmid, who chairs the committee of the United Network for Organ Sharing, or UNOS, that will develop the new policies over the next few months.

Making that clear to potential donors and their families is critical — ”otherwise we could undermine public trust,” said McDiarmid, a transplant specialist at the University of California, Los Angeles.

”The consent process for the life-saving organs should not, must not, be derailed by a consent process for a different kind of organ, that the public might think of as being very different from donating a kidney or a heart or a liver,” she added.

These so-called ”reconstructive transplants” are experimental, and rare. The best estimates are that 27 hand transplants have been performed in the U.S. since 1999, and about seven partial or full face transplants since 2008, said Dr. Vijay Gorantla, of the University of Pittsburgh reconstructive transplant program.

But they’re gradually increasing as more U.S. hospitals offer the complex surgeries, the Defense Department funds research into the approach for wounded veterans — and as transplant recipients go public to say how the surgeries have improved their lives.

”These hands are blessed hands to me,” said Lindsay Aronson Ess, 30, of Richmond, Va., who received a double hand transplant in 2011. She had lost her hands and feet to a life-threatening infection in 2007.

Until now, deciding who qualifies for a hand or face transplant, and how to find a match and approach a potential donor’s family all have been done on an informal, case-by-case basis.

There has been no way to tell which hospitals’ techniques work best and how patients ultimately fare.

There have been reports of two deaths related to face transplants in other countries, and some transplanted hands have had to be amputated.

Source: Teleram news

Nightclub fire survivor thriving after hand transplant

It’s no struggle for most people to make a fist or lift a coffee mug. But for Joe Kinan of Lakeville, Mass., getting to that point has taken resilience, strength – and advancements in medical science.

On February 20th, 2003, Kinan was among a crowd of people trapped in a fire that occurred in The Station nightclub in West Warwick, Rhode Island. The fast-moving blaze claimed 100 lives and left more than 200 people injured.

Severely burned, Kinan has undergone more than 120 surgeries including a hand transplant. The procedure, performed just over a year ago, was the first of its kind for surgeons at Massachusetts General Hospital.

“Now there (are) quite a few things that I don’t have to ask for help for, which is very empowering,” Kinan said.

With his fiancée Carrie Pratt at his side, Kinan has completed a full year of physical therapy, doing drills to strengthen his new hand and gaining a new sense of independence.

“Just freedoms of every sort. To be able to come out here in the morning and pour my own cup of coffee without dragging Carrie out of bed for it speaks for itself,” Kinan said .

Kinan and Pratt, a fellow burn survivor, met several years ago at the World Burn Conference in Vancouver, Canada.

“From the get-go he’s been working hard at this,” Pratt said. “Every chance he gets, he’s moving his hand. He’s picking stuff up. He’s squeezing a tennis ball. He wants to make every moment count. He even wiggles his fingers in his sleep.”

Kinan’s new hand was donated by 18-year-old Troy Pappas, a freshman and star athlete at Bates College in Maine, who died last October after an accidental fall. When Pappas got his driver’s license at age 16, he signed up to be an organ donor.

The first successful hand transplant was performed in the late 1990s, but the procedure remains very rare. It’s estimated that fewer than 90 people have undergone a hand transplant worldwide.

Dr. Curtis Cetrulo Jr. led the team that spent fifteen hours attaching Kinan’s new left hand.

“You have to choose your patient right,” said Cetrulo, offering praise for Kinan’s perseverance. “People were coming out of the woodwork all over the hospital who had cared for Joe and knew how tenacious he was and what a fighter he was and how compliant he would have been with the regimen post-operatively in taking his medications and working hard to get a good functional outcome, so his personality was almost a no-brainer.”

While Kinan’s spirit was never in doubt, the long surgery was particularly difficult because he is a burn survivor.

“There was skin graft only down to his fascia on his arm so we had to sort of come up with a creative technical solution to that problem and when we procured the allograft we took extra veins and extra tissues from the donor hand to allow the blood to flow out of that hand and back up his upper arm,” said Cetrulo. “So, while he was a perfect patient from a social perspective, he was a difficult patient technically. But we were able to surmount those obstacles and it turned out for the best.”

Cetrulo credits Kinan’s dedication and tenacity, citing him as an inspiration.

“Really at the end of the day it’s for his life, so he can do some of the things that he couldn’t previously,” said Cetrulo. “He always sends me new videos, popping up in my inbox, washing his car for the first time in 10 years or holding a cup of coffee or holding hands with Carrie, his fiancée, and these are the things that make it worthwhile to me.”

It’s been a long journey – one of fortitude, medical miracles and generous gifts – but soon that hand will hold new life.

Kinan and Pratt are expecting a baby.

Source: Top news today