Saturday, February 06, 1999

Hand transplant raises hope for others

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Those in need consider risks of procedure

BY TIM BONFIELD
The Cincinnati Enquirer

Tony Billing, 28, a registered nurse, has worn a prosthetic device since he was 14. (Ernest Coleman photo) | ZOOM |

        If he could arrange it, Tony Billing would like to be the next American to get a hand transplant.

        But amputees Walter Springer and Lois Beckman say a transplanted hand isn't worth the risk.

        Some Tristate residents who lost their hands to industrial accidents, infections, birth defects and other condi tions have been closely following news from Louisville about the first American to get a hand transplant.

        Their views reflect the high hopes amputees have for something better than their artificial limbs, and the deep concerns among doctors and potential patients that the risks of hand transplants outweigh the benefits.

        “I would definitely be interested in it,” Mr. Billing said. “I've been following this every day on the Internet and I've already e-mailed the surgeons to put my name on the list.”

        Mr. Billing, 28, is a former paramedic who works as a registered nurse at Franciscan Hospital-Western Hills Campus. He was born without a right hand and has worn a hand-like prosthetic device since he was 14.

        The hand can open and close in response to muscle commands sent by electrodes connected to other parts of Mr. Billing's arm. It is strong enough to crush an aluminum can but not strong enough to crush a steel can.

        As far as it goes, the device works well. But ...

        “It's not a hand, no matter which way you look at it,” Mr. Billing said. “To have the sense of touch, a full range of motion, that would be worth the risk.”

        Questions remain, however, whether people can get high-level function from a transplanted hand.

        On Jan. 25, surgeons at the Louisville Medical Center transplanted a hand taken from a cadaver to the left wrist of Matthew Scott, 37, of New Jersey.

        So far, doctors report no signs of rejection or infection and some movement in the fingers. Mr. Scott was expected to go home this week,

        where he will continue months of therapy and testing.

        After the procedure, lead surgeon Dr. Warren C. Breidenbach, told reporters that Mr. Scott cannot expect to have a fully normal hand.

        “In an ideal situation, he would be able to make a fist,” Dr. Breidenbach said. “He would be able to pick up a tennis ball, pick up a glass or open a door.”

        Mr. Scott probably will not be able to use his hand to button his shirt collar or pick up a penny. As reconnected nerves gradually grow together, Mr. Scott may regain some sensation of touch and temperature, but how much remains to be seen.

        In people who have had their own hands reattached after injuries, doctors say nerve function generally does not return to better than 50 percent of normal.

        From what he's heard so far, a transplanted hand won't work much better than a prosthesis, said Rich Rosenberg, owner of the Rosenberg Orthopedic Lab.

        “If you don't get tactile feedback, or more than 22 pounds of gripping force, or if you can't pick up a dime off a hard, flat surface then you haven't gained anything,” Mr. Rosenberg said.

        The lack of convincing evidence that a transplanted hand will work better than a prosthesis, combined with the serious medical risks of a lifetime of anti-rejection drugs, adds up to a “no thank you” for many amputees.

        Lois Beckman, 52, lost both feet, her left hand and the fingers of her right hand to a near-fatal strep infection 14 years ago. She uses a hook-like prosthetic on her left hand that “works great,” she said.

        “I can pick up a penny. I can crush a pop can,” Ms. Beckman said. “About the only thing this hook can't do very well is hold a knife tight enough to cut my food.”

        A hand transplant sounds intriguing, but “I'd be concerned about the side effects from the anti-rejection drugs.”

        Those side effects are serious, said kidney transplant expert Dr. Rino Munda.

        The drugs are designed to weaken the immune system, which makes it harder for patients to fight off infections. That means a case of influenza can turn into a life-threatening case of pneumonia.

        Organ transplant patients also face increased cancer risks, especially for leukemia and Kaposi's sarcoma, which experts believe are triggered by viral infections. Other risks included elevated blood pressure, and higher risk of diabetes and liver or kidney damage.

        Such risks are acceptable for heart, liver and other organ transplants, because the patient would die without the transplant. People can live a normal life span without a hand, Dr. Munda said.

        Mr. Scott's doctors are using a lower dose of anti-rejection drugs than many organ transplant patients receive. That may lower the risk of side effects, but it also increases the chance of rejecting the attached hand.

        In September, the world's first hand transplant was done in France. An international team of surgeons attached a cadaver's hand to the forearm of 48-year-old Australian, Clint Hallam. As of late January, Mr. Hallam has gained some movement in the hand.

        Dr. John Kitzmiller, a reconstructive plastic surgeon, said he does not expect patients to be clamoring for limb transplants. They might, if and only if scientists can develop “more selective” anti-rejection drugs that can preserve transplants without crippling the immune system.

        Fixing the immune system problem would open a huge door for people who could benefit from all sorts of organ, tissue or limb transplants, Dr. Kitzmiller said.

        Walter Springer, a retiree living in Goshen, is one amputee who plans to wait until the hand transplant experiments prove their worth.

        Mr. Springer lost his right hand in 1983 when it was mashed at work by a falling steel beam. He gets by with a hook-like prothesis much as Ms. Beckman does.

        “It works pretty well. I can split wood and cut a tree down with a chain saw. I do pretty much whatever I want to do,” Mr. Springer said.

        Mr. Springer said he doesn't want to risk any dangerous side effects, especially if the hand won't work much better than his hook. He also doesn't want to get stuck with the bill for a complicated surgery and a lifetime of expensive medications.

        “How much is something like that going to cost?” Mr. Springer asked.

       

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