In 2008, surgeons completed two procedures that could forever change transplant surgery. In August, doctors in Munich announced that a farmer was recovering from a double-arm transplant—the first double-arm transplant in the world. In December, the Cleveland Clinic announced they'd replaced about 80 percent of a woman's face. Many surgeons think that arm, hand, and face replacements are the next logical steps in transplants. Is the world ready?
Being first isn't always best
In 1964, physicians around the world were attempting transplants of all kinds when doctors in Ecuador performed the first hand transplant. Unfortunately, like early organ transplants, it didn't work—within two weeks the hand was rejected and doctors had to remove it.
Being second isn't much better
In 1998, doctors performed delicate microsurgery on New Zealander Clint Hallam. For 13 hours at Edouard Herriot Hospital, an international team of scientists led by French surgeon Jean Michel Dubernard stitched a cadaver's forearm and hand to Hallam's upper arm. Completing the hand transplant required microsurgery skills and patience—doctors knitted medial nerve to medial nerve, radial artery to radial artery, radius to radius. Like with other transplants, both donor and recipient must share the same blood type.
After years of studying transplant pioneers and earning a PhD based in xenographs research (he transplanted organs from one species of monkeys to another), Dubernard felt he was prepared to perform a hand transplant on a human. When he was unable to find a suitable French candidate, an Australian colleague recommended Hallam. Fourteen years earlier, Hallam had lost his forearm in a circular saw accident. It was later revealed the accident actually occurred in jail and that Hallam was a longtime con-man.
Critics claimed that Dubernard performed the surgery for the media attention, but the surgeon argued he and his staff did a thorough psychological evaluation of Hallam as well as a background check. (Unsurprisingly, Dubernard had a role in the first partial face transplant, also surrounded by controversy.)
At first, the forearm and hand worked well for Hallam, although he hated that the donor limb was larger than his other arm and a different skin tone. He hid his freak arm as much as he could. Hallam's arm wasn't just grotesque-looking, though; it began itching and flaking, and he was plagued daily by pins and needles. He begged the doctors to remove it, but they refused. Hallam felt emotionally detached from his hand. Finally, a group of British surgeons agreed to remove the limb in 2001. The physicians from France claimed the only reason Hallam's arm rejected is because he failed to take his immunosuppressant drugs and exercise it.
From hands to a face
Frenchwoman Isabella Dinore received the first partial face transplant in 2005.
After taking too many sleeping pills, Dinore had passed out. As she lay unconscious on the floor, her black Lab chewed off her nose, mouth, and lower face. Without lips, muscles, and skin on the bottom half of her jaw, Dinore struggled to speak and eat—she had to eat through a tube. Physicians couldn't help her with traditional plastic surgery and thus felt she would be a good candidate for a face transplant.
Bernard Devauchelle, a French maxillofacial surgeon at Lyon University, saw a picture of a brain-dead woman with a mouth, nose, and lips similar to Dinore's features. He removed a triangle of Maryline St. Aubert's skin with its arteries, nerves, and veins and spent hours graphing the skin onto Dinore's face.
It was rumored St. Aubert was brain-dead because she tried to kill herself. Many people thought Dinore had attempted suicide, too. Dubernard, who had worked alongside Devauchelle in the surgery, argued Dinore accidentally overdosed. Physicians criticized the decision to give a suicidal woman a face transplant. People once again alleged Dubernard had performed the surgery for media attention—Corbis had an exclusive deal for photos—and some urged an ethics investigation.
Dubernard oversaw Dinore's recovery. Shortly after the surgery, he injected some of St. Aubert's stem cells (from her bone marrow) into Dinore in the hopes her body wouldn't reject the transplant, but the stem cell infusion failed. Dinore suffered two bouts of rejection, contracted herpes and a pox virus, and struggled with kidney failure.
A year later, Dinore appeared in the media, showing off her new face. She used her new lips to smoke again.
Laurent Lantieri, head of plastic surgery at Henri-Mondor Hospital in France, spent 16 hours stitching new lips, cheeks, nose, and mouth to Pascal Coler's face. Since Coler was six years old, large masses had been growing on his nerves because of a condition called neurofibromatosis. As the masses increased in size, Coler's face became less recognizable. Strangers pointed at him because of his misshapen visage.
The large masses compressed the nerves, arteries, and fat in Coler's face, causing lasting damage; the transplanted cadaver's face stops the masses from developing. Lantieri didn't alter Coler's bone structure, so Coler looks as he would if he never had the disease.
What the doctors say
When a patient receives a lung or a liver, the body's white blood cells attack the new organ because the body believes it is an invader. That's why immunosuppressant drugs are so important for transplant patients: immunosuppressants mollify the immune system. When a transplant includes so many different tissues, organs, veins, arteries, nerves, fat, and bones, the body targets the limb even more ferociously than it attacks one organ—the white blood cells believe the more transplanted tissue means there are more invaders.
In 2007, a study was published with the results of 18 transplants of 24 hands/digits/forearms. (11 folks received one hand, four received two hands, two received two forearms, and one received one thumb.) The good news: limb transplantation has a 100 percent survival rate. (In the early days of organ transplantation, most patients died.) And graph survival is also 100 percent for the first two years. The bad news: 12 patients suffered acute rejection and six Chinese recipients had their hands removed. All patients had enough nerve function in their new limbs that they knew when they were hurt, but few used fine motor skills or had sophisticated nerve function.
Some experts wonder if limb transplants should be conducted when prosthetic limbs are available. Fifteen people in the 2007 study said the limbs improved their quality of life, but many suffer with lingering problems from the immunosuppressant drugs, kidney failure, diabetes, and infections.
One thing is certain, though: Dubernard won't be performing any more limb transplants. He reached the maximum age to practice medicine in France.