Richard Mangino, 65, of Revere, MA, USA, had a twelve-hour bilateral (double) hand transplant procedure performed on him by a team of over 40 health care professionals, including surgeons, anesthesiologists, residents, radiologists, nurses, and physician assistants. In 2002 Mangino had contracted sepsis and had to have both his arms (below the elbow) and legs (below the knee) amputated.
Sepsis also known as blood stream infection is the presence of bacteria (or other pathogens) or their toxins in the blood (septicemia), or in other tissue.
The transplant, which was performed at Brigham and Women’s Hospital (BWH), involved several types of tissues, including bones, ligaments, muscles, tendons, skin, and blood vessels on both the left and right hands and forearms.
BWH announced the development of a hand transplant program in August last year. The hospital’s transplant team carried out its first bilateral hand transplant in May this year.
Staff at the New England Organ Bank obtained consent from the donor’s family. For this kind of donation, being registered as an organ and tissue donor on one’s driving license is not enough, the hospital informs – consent from the donor’s family is needed.
Today, Richard Mangino had the following words to say:
In thinking about what I wanted to say today, two words kept coming to my mind: gratitude and miracles. First I must express my deep gratitude to the donor family. They are, and always will be, in my prayers. My family and I grieve for the loss of your loved one. I am humbled and overwhelmed with emotion. Thank you for this incredible gift. Your selflessness and the expertise of this amazing care team have given me a new life. I am extremely grateful to Brigham and Women’s Hospital and to all of my care providers here.
I also want to take the opportunity to thank all who have cared for me since I got sick in 2002: those at Mass General, at Spaulding and Shaughnessy Kaplan. You collectively have played a vital role in getting me to this day. I must also express my heartfelt thanks for the many family members and friends who have been so supportive of me and my family. Your many acts of kindness have meant so much.
And finally, I must thank my family. My loving amazing wife of 42 years, Carole, and our three sons – Ricky, Rob, and David. And my precious grandchildren, Trevor and Nick. My family has been the inspiration to fight when things were hard and to never look back – always look forward. I love you all very much.
And finally a word about miracles… When I survived the devastating infection that took my limbs, people said it was a miracle. When I taught myself how to put on my prostheses and continued to do things like paint and mow the lawn, people said I was a miracle. When I began providing instruction to others who had lost limbs, to teach them what I had learned and how I did things…that felt miraculous. But the one miracle I have prayed for, since my oldest grandson Trevor was born, was to be able to feel the sense of touch again… To touch his and Nicky’s little faces, and stroke their hair, and to teach them to throw a ball. To me, THAT would be a miracle. And today, my miracle has come true. And I am eternally grateful.
Thank you.”
Performing Miracles (no music) from BWH Public Affairs on Vimeo.
The BWH transplant team hopes to build on its present success to provide other patients who lost their hands, with the considerable benefits of hand transplantation. The hospital says it is actively seeking suitable candidates for its hand transplant research study. Their aim is to research with a small group of patients to learn more about how to enhance hand transplantation science, how to deal with transplantation rejection problems, and patient outcomes.
On its website, BWH writes:
“We describe hand transplant surgery as a life-giving procedure because it has the potential to dramatically improve, i.e., restore, both a patient’s mental and physical health and his/her ability to function and integrate in society. However, as with any other type of organ transplantation, this improvement will require the patient to make a lifetime commitment to taking medications that suppress the body’s immune system.”
After extensive rehabilitation, hand transplant surgery may provide a patient with new hands, restoring their ability to carry out their daily duties like they used to, and in the majority of cases, to get back into employment. The benefit of having hands that they and others can see, hands like anybody else has, has enormous psychological benefits – it is a confidence and mood booster.
Animation from BWH Public Affairs on Vimeo.
The patient undergoes a rigorous screening process that generally takes a few months to complete. Apart from a psychiatric and social support evaluation to determine whether he/she is mentally ready for the procedure, a series of imaging tests are carried out to make sure he/she is physically suitable.
On determining that candidates are suitable, they are then placed on a transplant waiting list. The hospital liaises with NEOB (New England Organ Bank) to seek out a donor who matches the candidate’s age, blood type, etc. This can take several months. After 12 months, if no match is found, the team talk to the patients to determine whether they want to carry on waiting.
When a suitable donor is located, the hospital informs the patient immediately, telling him/her when to arrive at the hospital. Timing is crucial in hand transplantation, as it is in most transplant procedures. That is why BWH prefers those who live within a 12-hour travel radius of the hospital.
In a hand transplant procedure, the team reconstructs the hand, partial forearm, and sometimes the elbow and arm below the shoulder joint (if necessary).
While one team is removing the hand from the donor, another is preparing the recipient’s arm. The donor hand’s blood vessels are connected to the recipient’s blood vessels to restore blood circulation – surgeons do this with the aid of a microscope. Then the nerves are connected, as well as other tissue, including muscles, bone, cartilage, etc.
When the procedure is over, the patient is taken to an ICU (Intensive Care Unit) for observation. They will usually stay in the ICU for a couple of days and are then placed in a private ward (hospital bedroom).
The patient then starts working with a physical therapist (UK: physiotherapist) to rehabilitate the transplanted hand. The individual will also discuss any psychological concerns with a psychiatrist.
When the transplant and plastic surgery team think it is safe, the patient can then return home. When this occurs depends on several factors, but usually occurs between seven to fourteen days after surgery.
Why the patient is in hospital he/she will spend several hours a day with the physical therapist.
The patient will need to return to the hospital for routine visits, which will include the following services:
- Monitoring of immunosuppressants – transplant drug levels
- Blood tests
- Physical therapy (rehabilitative therapy)
- Imaging scans
- Checking for the return of sensation
- Checking for progress in movement to the hand
Rehabilitative therapy visits will be done daily for a number of months. The other visits will likely occur weekly during the first three months, and then once a month for the subsequent twelve months. Video conferences with collaborating medical centers will eventually replace lengthy hospital visits for those who live further away, the hospital informs.
After the twelve months are over, the patient will need to visit the hospital less often. However, his/her commitment to immunosuppressants – drugs that stop the body from rejecting the new organ(s) – is a lifetime one.
Written by Christian Nordqvist