NHS patients in England are to become some of the first in the world to benefit from publicly-funded pioneering hand and upper arm transplants.
NHS England has given the go-ahead for a leading centre at Leeds Teaching Hospitals NHS Trust to begin assessing suitable adult candidates and performing the highly-complex procedure from April.
Hand and upper limb transplant offers patients the only method of reconstruction that looks and functions like a normal hand. Transplanted successfully, the hand will, in time and with expert aftercare, move with strength and dexterity, sense its surroundings, feel warm to the touch and heal itself when injured.
People who have had a hand transplant also report a better quality of life and wellbeing, and the majority are eventually – after extensive physiotherapy – able to undertake daily living activities.
Dr Jonathan Fielden, NHS England’s Director of Specialised Commissioning, said: “The NHS is leading the world in offering this cutting edge procedure, which has been shown to significantly improve the quality of life for patients who meet the strict criteria.
“We will be working closely with Professor Kay and his colleagues at Leeds, as well as NHS Blood and Transplant, to ensure that this highly innovative service for the NHS can get up and running as soon as possible.”
The centre in Leeds is headed up by leading consultant plastic surgeon Professor Simon Kay, who successfully performed the UK’s first hand transplant in 2012 and will accept suitable patients from around the country.
The beneficiary of that transplant, Mark Cahill from West Yorkshire, has reported regaining almost complete use of his transplanted hand, allowing him to, for example, tie his shoelaces, carry his granddaughter and drive a car.
Over the next 5 years Professor Kay and his team at Leeds will work in partnership with hand and wrist consultant Mr Henk Giele and a team of experts at Oxford University Hospitals NHS Foundation Trust. The service in Oxford will undertake assessments and non-surgical elements of follow-up care.
Prof Simon Kay said: “We are delighted to be confirmed as the provider of this new service. The extensive multi-professional expert team here at Leeds is keen to now assess new patient referrals and benefit patients and their families in a way they may never have thought possible before.
“The Leeds unit has an existing surgical service which can now continue with NHS England support. Oxford has an existing organ transplantation service and strong track record in research in this area.”
Mark Cahill said: “My experience as a patient and my quality of life since the hand transplant has been fantastic. I would like to thank once again the family of the donor who gave their permission for me to have the hand of their relative at such a difficult time for them. It really has transformed my life”.
Due to the special matching required of donor limbs for transplant and the complex nature of the procedure, patients will be carefully screened for psychological and physical suitability. It is anticipated that between two and four patients a year will be listed for surgery to benefit from the procedure as an alternative to having a prosthetic limb or hand.
NHS Blood and Transplant will work closely with the team in Leeds to identify possible donors for those accepted for surgery, with a primary focus on blood group, skin tone and hand size. The option to choose to donate limbs is not recorded on the NHS Organ Donation Register, so specific permission will be sought from the families of potential donors after their death.
James Neuberger, Associate medical director at NHS Blood and Transplant, said: “NHS Blood and Transplant welcomes the news that Leeds Teaching Hospital Trust has been commissioned to provide hand and upper arm transplants for patients in England.
“Our Specialist Nurses for Organ Donation, identified the potential donor and obtained the family’s consent for the donation which led to Leeds’ earlier successful transplant. We are grateful to the donor’s family for their generous decision to agree to donation and will support the families of limb donors in future.
“We look forward to our continued involvement, and more patients in England benefitting from hand transplants provided by Professor Kay and his team.”
Approximately 80 hand transplants have been performed worldwide. Success rates are high provided patients are selected carefully and fully-prepared psychologically. After the operation, patients need to take life-long medication to stop limbs being rejected, and follow daily physiotherapy routines.
A quick guide to the procedure
- The transplant procedure first requires a deceased person’s family to agree to donate a limb. This limb must match the recipient patient in terms of their blood type, immunology, arm size and skin tone. Because of this, matches occur only rarely and so the process depends greatly on the good will of donors and their families.
- When a suitable donor limb is found, time is of the essence, and the patient is prepared for surgery immediately.
- Transplants may be performed at the level of the hand, forearm, or upper arm and may be performed on one or both arms.
- The procedure involves four teams of surgeons working simultaneously and starts by identifying and matching anatomical structures in both the right and left arms of the donor and recipient limbs.
- The two bones in the upper arm are then attached to each other with titanium plates and screws. Just as with a typical broken bone, these bones should eventually heal together, but the titanium plates will remain in place to ensure stability.
- After the bones are attached, surgeons connect key tendons and muscles.
- Then, using operating microscopes, the surgeons connect key blood vessels – including the two main arteries in the upper arm – to ensure that blood is able to flow into and out of the new limb as soon as possible.
- Once blood is circulating to the limb, the remaining nerves, tendons and muscles are attached, before the team finally close the skin.
- The limbs of the donor are reconstructed using prostheses that look like real arms.
- Extensive aftercare, including immunosuppressant drugs, physiotherapy, occupational therapy and psychological support, is required after the procedure to ensure that the patient’s body doesn’t reject the new limb, that it develops feeling and function, and that the patient can adjust to the reality of living with new hands that they will ultimately consider to be their own.