Vascular Composite Allotransplantation
Duke’s hand transplant program is led by one of the world’s leaders in vascularized composite allotransplantation (VCA), an innovative method of transplanting multiple tissues, such as a hand, as a functional unit. Our comprehensive approach guides our research on hand transplantation, which remains an investigational procedure. It is an option for people who have lost one or both hands.
Hand Transplantation Expertise
Less than 100 people have received hand transplants in the world. The head of our hand transplant program participated in the first two hand transplants performed in the U.S. in 1999 and 2001. Since then, less than 30 hand transplants have been performed in the U.S.
Our federally-funded hand transplantation team conducts research that is helping doctors to understand how to minimize rejection, develop new immunosuppressive therapy approaches, diagnose skin rejection, and other tissues responses following transplant. Our leading surgeon also participates in the development of guidelines for the safe implementation of VCA in the U.S.
Choose Duke for your hand transplant because we offer:
- Proven experience. Our program is run by one of the world’s leaders in hand transplantation and VCA, who is trained in microsurgery, hand surgery and transplant surgery. She participated in the establishment of the first hand transplant program in the U.S.
- Access to clinical trial. We are currently recruiting people to participate in a study to determine the safety and efficacy of hand transplantation as a treatment for people with loss of limb below the elbow. You may be a candidate for evaluation if you are between the ages of 18-65, willing to travel to Duke and have lost a limb.
- Comprehensive research. Our basic, clinical and translational research (meaning how we apply our lab research to patient care) guides our systematic approach to hand transplantation.
- Team of dedicated specialists. We work with many specialists throughout Duke Health in the fields of transplantation, orthopaedics, hand surgery, microsurgery, plastic surgery, immunology and anesthesiology. Our team also includes mental health and rehabilitation specialists, trained nurses, and support staff. Together, we help you through the process from the beginning, minimize your risk of rejection, and help you work toward the best possible outcome.
- Support for the future. Learning to live with a transplanted limb is an ongoing process that includes extensive physical and occupational therapy, mental health support and social work services. We support you as you adapt to the feeling and function of your new hand or hands.
Before Your Hand Transplant
During your extensive evaluation, we discuss the functional outcome, treatment options, risks, alternatives, benefits, and complications, as well as the need for immunosuppressive medication to prevent rejection. If you choose to pursue a hand transplant, multiple tests and screening procedures are necessary.
Check blood type and compatibility, assess organ and immune system function, and screen for viruses or infections that could affect your outcome.
Evaluates your social support, and other parameters to understand how well you have dealt with the loss of your limb, and the status of your overall well-being.
Determines the function you currently have in your residual limb.
MRI and X-ray bone scans are performed to evaluate your residual limb.
We involve your designated caregivers -- family members or friends -- from the time of your first evaluation. We educate them about their important role in caring for you after your hand transplant.
All hand transplant candidates will participate in transplant education to educate you and your caregivers about the process, the medications you need to take, and the recovery process.
You will be notified when a suitable donor hand is available. Donors for a limb have been donors of other organs as well. If you live outside of the Durham area, our team can assist you in gathering the resources and support you need.
After Your Hand Transplant
Although organ rejection happens after transplants, we use innovative strategies and research to prevent rejection and injury. We provide you and your caregivers resources and support to live a healthy life after transplantation. Our team is always available to answer your questions and address your concerns.
Our rehabilitation therapy specialists start working with you almost immediately after your surgery, and will continue to provide intensive therapy designed to maximize the functional outcome of your new hand or hands. We help you adapt to the feeling and function of your new hand or hands, and learn to use it for every day activities. You will wear different splints or braces for at least one year to protect your hand while you are undergoing therapy.
You and your loved ones will be able to speak with other transplant recipients and their families, ask questions and share information about issues related to the transplant experience.