Duke Health System adds state’s first hand transplant program

One of the newest additions to the Duke University Health System is North Carolina’s first hand transplantation program.

Hand transplantation—officially recognized as vascularized composite allotransplantation—is one of the newest methods for rehabilitating patients who have lost one or both limbs below the elbow. Fewer than 150 hand transplants have ever been done in the world—with the first successful one performed in 1999, explained Dr. Linda Cendales, associate professor of surgery and director of the hand transplantation program.

“It’s super exciting...hand transplantation is still an innovative therapy,” Cendales said.

Duke’s program will focus on research into how a hand transplant might improve a person’s quality of life, Cendales noted.

“Our program at Duke is a very strong multidisciplinary program that is looking to evaluate the ability of people who receive transplants to perform their daily tasks compared to before they had the surgery, such as comparing the transplant to a prosthetic,” she said.

Dr. Allan Kirk, chairman of the department of surgery at the School of Medicine and professor of surgery, immunology and pediatrics, noted that hand transplantation research continues to help advance a variety of medical fields—including rehabilitation medicine, immunology and neurobiology.

"[Hand transplantation research] helps us advance numerous diverse fields, such as understanding why transplanted organs reject, how to manage the immune system to prevent that rejection and basic biology of how the immune system prevents infection, autoimmune disease, cancer, et cetera,” Kirk wrote in an email. “Watching a person re-innervate a transplanted limb teaches us how the brain recovers from stroke and how nerves can be impelled to redevelop after spinal cord injury and the like.”

The program at Duke is partially funded through a partnership with the Department of Defense—as part of a greater effort to treat war injuries such as limb amputation.

Fewer than 20 centers in the U.S. offer hand transplantation.

“Our hand transplant program is a partnership with the DoD to explore all the ways to help rehabilitate individuals who have returned from battle in need of limb replacement,” Kirk noted.

Cendales said that the program is currently recruiting and evaluating patients to be potential recipients of transplants.

Evaluations can take as long as a week—the medical team uses this time to evaluate the patient for their ability to have a successful transplant and for the patient to ask the team any questions he or she might have, she noted.

After the evaluation is complete and the patient is approved, the patient goes on to the donor matching process. The process for matching a donor hand to a recipient is similar to a common transplant, although there are some differences, Cendales added.

“The procedure is very similar to any other organ transplant,” she noted. “There is a waiting list. Our program matches for blood type, skin pigmentation, size, and sex, because what makes hand transplantation different is that it is a quality of life transplant and the transplantation is visible.”

Another difference Cendales noted with hand transplants is that there is no time limit on when they can be performed.

“Hands have been transplanted from two months to 30 years after amputation,” she said.

Although the Duke’s hand transplant program is still in its early stages, it has recently been approved to perform five transplants, Cendales said.

Kirk noted that for some patients, a hand transplant can change their lives entirely.

“[The foremost reason to start this program] is the clinical need for selected individuals who have lost one or more limbs and have significant impairment that can’t be easily rectified with a prosthesis,” he wrote. “This is a small number of patients, but in properly selected cases, the restoration of a limb is transformative.”