Patients right across the U.K. will soon be able to get hand transplants on the National Health Service (NHS). The publicly funded procedures will be offered at the Leeds Teaching Hospital in the north of England, and it is expected that between two and four transplants will be performed each year. The new hands will be warm to the touch and be able to move with much greater dexterity than can currently be offered with prosthetics.
Screening for potential recipients will begin from April this year, although not everyone who has lost a hand will be eligible, as doctors will have to assess their psychological and physiological suitability for receiving a transplant. Each operation, estimated to cost around $70,000 (£50,000), requires four teams of surgeons working simultaneously. So far, only 80 people worldwide have undergone the procedure.
The surgeon who will be leading the pioneering team is consultant plastic surgeon professor Simon Kay, who performed the U.K.’s first, and to date only, successful hand transplant in 2012 on Mark Cahill, after his right hand became affected by gout. Cahill has said that the transplant “transformed” his life, enabling him to once again perform tasks such as tying his shoe laces, carrying his granddaughter and driving a car.
“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,”says Jonathan Fielden, NHS England’s director of specialized commissioning. “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.”
Patients have to be extensively psychologically screened before the procedure can go ahead. Mr Cahill, for example, was one of only two deemed suitable out of 20 patients who were considered. The donor limb must then match a number of criteria, such as blood type, size and skin tone. Once all of these are in place, the operation takes between six and 12 hours, depending on the complexity of the surgery.
Firstly, the bones are joined together with titanium plates, then the key muscles and tendons are attached. The surgeons then connect the major blood vessels using microsurgery, and once they are in place and the blood is flowing into the hand, they then attach the remaining nerves, muscles, and tendons, before stitching up the skin. Some sensation of touch returns almost immediately, but it usually takes around another 18 months before full mobility and sensations return. Patients are then required to take immune-suppressant drugs for the rest of their lives to stop their body from rejecting the hand.
Both single and double hand transplants will be offered by the NHS from this year.