First child hand transplant in U.S. announced in Philadelphia

PHILADELPHIA (WPVI) -- 8-year-old Zion Harvey told his doctors he wanted to throw a football.

It was almost impossible, because Zion had lost his hands and feet to an infection several years ago.

But he may get his chance.

Children's Hospital of Philadelphia announced Tuesday that the little boy received two new hands earlier this month in the first pediatric hand transplant in the U.S.

In addition, it was the world's first pediatric bilateral hand transplant.

The operation took 10 hours, involving a team of 40 doctors and nurses from Children's Hospital, Penn Medicine, and Shriners Hospital for Children in Philadelphia.

Zion has prosthetic lower legs and feet, and can walk, run, and move easily.

And even without hands, he learned to manage most tasks.

He was initially referred to Shriners Hospital for prosthetics.

However, doctors felt a transplant would give him even more possibilities.

Zion previously had a kidney transplant from his mother, so he is already taking anti-rejection drugs, something doctors say made him a good candidate for hand transplantation.

He will likely have to stay on those drugs for the rest of his life.

According to some doctors, children also need higher levels of the immunosuppressive drugs, because of their higher metabolism.

For Zion, there were 4 simultaneous operating teams, two focused on the donor limbs, and two focused on the recipient.

They had planned for a transplant for 18 months, and practiced again and again to improve the efficiency and decrease the time.

Doctors said they had about 5 hours from the time they got the new hands to attach them and get blood flowing again, or the hands would die.

To determine whether donor hands would be the right size, Dr. L. Scott Levin and a team member created sample hands with a 3D printer, based on CT scans of Zion's forearms.

They made hands 20% larger and 20% smaller, the range of sizes which would fit Zion.

When Dr. Levin went to check the potential donor, he took the 3D printed hands to compare to the size of the donor's real ones.

Dr. Benjamin Chang, on the hand transplant team at CHOP and Penn, says the surgery involved uniting 2 bones, 2 deep arteries, 4 veins, 10 nerves, and 22 tendons.

"To bring everything together so that they not only look like hands, but function as hands," Dr. Chang said.

In 2011, the Hospital of the University of Pennsylvania performed its first, and so far, only double hand transplant.

The recipient, Lindsay Ess, a woman then in her 20s, has overcome several rejection episodes, and continues to do well, living independently and driving her own car.

Dr. Levin says there are currently 2 adults awaiting hand transplants in the Penn Medicine program.

In 2013, Boston Children's Hospital announced it was creating the first pediatric hand transplant program, however, it hasn't yet performed a transplant.

The Boston program has set 10 as the lower age limit for transplants, feeling that is the age children can understand the operation and the time commitment to physical therapy needed for maximum mobility.

Instead of the standard 'consent' form hospitals generally use for adult patients, that program uses an 'assent' procedure, in which the operation and after-effects are explained in simple kids' language.

The children are also told 'nobody will be mad if you say no.'

Zion spent a week in the intensive care unit after the operation, and now undergoes intense hand therapy several times a day to improve his hand function.

He'll likely spend a few more weeks in CHOP's rehabilitation unit, then go home to Owings Mills, Md.

In 1999, Matthew Scott of South Jersey received the world's first hand transplant during an operation at Jewish Hospital in Kentucky.