About the Hand Transplantation Program

Hand transplantation, or vascularized composite allotransplantation (VCA), is a rare procedure performed by only a few surgical teams around the world. CHOP’s Hand Transplantation Program was established in 2014 when its first patient, Zion Harvey, was identified as a candidate for the complex surgery.

The Hand Transplantation Program offers:

  • In-depth evaluation of children who could benefit from pediatric hand and upper extremity transplantation
  • Management of the waiting list for eligible patients through the United Network for Organ Sharing (UNOS)
  • Communication with the Gift of Life Donor Program, a nonprofit organ and tissue donation program that serves the eastern half of Pennsylvania, southern New Jersey and Delaware
  • 3D modeling to aid in the selection of appropriate donor limbs
  • Coordinated efforts of multiple specialists to plan for and carry out the procedure
  • Extensive pediatric surgical expertise required to complete the complex hand transplant operation
  • A large support team to facilitate logistics for families and children through evaluation, wait listing, the pre- and post-operative period, and rehabilitation and recovery

Our expert team

The team of attending surgeons who completed the first pediatric bi-lateral hand transplant at CHOP’s Hand Transplant Program had almost 200 years of collective surgical experience.

CHOP’s surgeons, who regularly operate on the tiniest of patients, are also among the best in the world at performing microvascular surgery: This type of surgery — in which sutures finer than a human hair are used to connect arteries, veins and nerves under a microscope — is required to perform hand transplantation.

The team is led by director L. Scott Levin, MD, FACS, who is also chairman of the Department of Orthopaedic Surgery at Penn Medicine and professor of surgery (Division of Plastic, Reconstructive and Oral Surgery) at the Perelman School of Medicine at The University of Pennsylvania. Dr. Levin is a world-renowned expert in the field, having performed Penn’s first bilateral adult hand transplant in 2011.

The hand transplantation procedure also requires the expertise of dozens of non-surgical healthcare professionals in order to support patients and families through the entire experience. These include attending physicians, nursing staff, anesthesiologists, occupational and physical therapists, social workers and psychologists. A 40-member multidisciplinary team participated in the first hand transplantation at CHOP. The Hand Transplantation Program offers cohesive, coordinated care that’s unavailable at other pediatric hospitals. 

Who we treat

The goal of the Hand Transplantation Program is to help children who have undergone unilateral or bilateral amputation of arms or hands to regain function and independence.

The team first conducts an extensive evaluation of every child and family interested in the procedure over the course of several months. Before placing a child on the waiting list for a hand transplant with the United Network for Organ Sharing (UNOS), the risks of surgery and immunosuppression are weighed against the benefits of improved extremity function. For this reason, the team evaluates several factors in every child that is seen, including:

  • Other medical conditions
  • Level of function with and without prosthetics
  • Level of support from family and caregivers
  • Psychological profile
  • Ability to cope during the lengthy recovery and rehabilitation process

If the team feels your child fits the criteria, they will begin the process of being listed for transplantation. Not every child evaluated will be a candidate for surgery.

What you can Expect

During hand transplant surgery

A VCA hand transplant is a lengthy procedure lasting 10-12 hours or more. For patients receiving transplants, hands and a part of the forearms will come from a deceased donor whose hands will be matched to your child. Once an acceptable match is identified, a team of surgeons reattaches the bones, arteries, veins, tendons, muscles, nerves and skin.

After hand transplant surgery

After surgery, your child will remain in the Hospital for monitoring by the transplant team and surgeon over a period of several weeks. The transplant team will monitor your child’s recovery process, including managing pain, recognizing complications, providing education, and initiating hand therapy as your child begins to use the new hands. The transplant team will also provide you with instructions on post-transplant care, treatment/medications, and lifestyle changes.

After discharge from the Hospital, your child will have frequent, regular follow-up appointments with the transplant team. Our team will update the primary healthcare provider about your child’s progress and provide recommendations for home care. Your child will continue to participate in hand therapy daily to regain function for several months to a year. You and your child will have access to the transplant team to answer any questions you may have.

Immunology and transplantation

A barrier to offering hand transplantation to more children (and adults) are the risks that are associated with immunosuppression — drug therapy that is critical to preventing rejection of transplanted tissues. Wayne Hancock, MD, PhD, FRCPA, an immunologist at The Children’s Hospital of Philadelphia and Hospital of the University of Pennsylvania, is studying alternative methods to control rejection in transplant recipients.

With funding from the Department of Defense and the Wyss Foundation, Dr. Hancock’s focus is on modification of the T cells in a patient’s immune system to change the way these cells respond to foreign tissue. Though currently in an early stage, this research, undertaken in conjunction with Dr. Scott Levin and surgeon Matthew Levine, MD, PhD, may lead to new therapies and guide the future development of the Hand Transplantation Program and its patients. In particular, finding an alternative to a lifetime of immunosuppression will allow the medical team to offer these life-changing transplants to many more children.