World's first double hand transplant on child carried in US

The world's first double hand transplant on a child has been successfully carried out in an eight-year-old boy in the US, after a groundbreaking 10-hour surgery.
Earlier this month, a surgical team transplanted donor hands and forearms onto Zion Harvey who, several years earlier, had undergone amputation of his hands and feet and a kidney transplant following a serious infection.
"This surgery was the result of years of training, followed by months of planning and preparation by a remarkable team," said Scott Levin, Director of the Hand Transplantation Programme at The Children's Hospital of Philadelphia (CHOP), who led a 40-member multidisciplinary team of physicians, nurses and other staff.

Through a coordinated effort between Shriners Hospitals for Children and CHOP, Zion was evaluated as a possible recipient of the first paediatric hand transplant.
"The collaborative effort between these institutions was necessary to assemble the team and organise the players to orchestrate such a complex and demanding procedure that had never been performed on a child," said Scott H Kozin, chief of staff for Shriners Hospitals for Children - Philadelphia.
Before the surgery could be conducted, it was first necessary to locate a suitable donor, a function coordinated by Gift of Life Donor Programme, the nonprofit organ and tissue donor programme.

Following his latest surgery and after his upcoming rehabilitation, it is expected that Zion will finally get his wish to throw a football along with a myriad of other accomplishments to come.

Double hand transplantation is a complex procedure involving many surgical and non-surgical components. First, the potential recipient must undergo extensive medical screenings and evaluations before surgery.
In this case, the patient's previous medical condition, following sepsis at an early age, factored into the decision to perform the transplant.
"Zion's kidney transplant following his infection made him a candidate for transplant because he was already taking anti-rejection medication," said Benjamin Chang, co-director of CHOP's Hand Transplant Programme as well as associate chief of the Division of Plastic Surgery at Penn Medicine.

During the surgery, the hands and forearms from the donor were attached by connecting bone, blood vessels, nerves, muscles, tendons and skin.
First, the forearm bones, the radius and ulna, were connected with steel plates and screws. Next, microvascular surgical techniques were used to connect the arteries and veins.
Once blood flow was established through the reconnected blood vessels, surgeons individually repaired and rejoined each muscle and tendon. Surgeons then reattached nerves and then closed the surgical sites.
Zion continues to receive daily immunosuppressant medications to prevent his body from rejecting the new limbs, as well as his transplanted kidney.