Abstract
Background In 1964, faced with the challenge of traumatic amputation, a team of surgeons at
Clinica Guayaquil was convinced that the transplantation of a hand could significantly
improve function and quality of life for the recipient. With a current but basic understanding
of immunosuppression, the surgeons identified a recipient and waited for the correct
donor. A human hand transplant had never been performed to date.
Methods The surgeons' criteria for the recipient included a young healthy individual who
had sustained a traumatic amputation at the distal forearm level with full motion
of the proximal joints. Communication with receiving hospitals and military facilities
identified what they perceived to be a feasible donor for an allograft transplantation.
Consent was obtained from the family in conjunction with the local military medical
authorities and the clergy. Iced saline solution and Heparin irrigation were to be
used to prepare the donor extremity. The immunosuppression regimen, limited at the
time, consisted only of intravenous cortisone, Imuran, and a single dose of radiation.
Results A member of the Ecuadorian marine sustained a limited blast injury that amputated
his dominant hand but spared the forearm. He was transferred to the emergency department
of Clinica Guayaquil. A donor who had recently died in a nearby hospital was identified
not long after. A successful technical surgical transplantation was achieved. Consultants
from major hospitals around the world (including Peter Bent Brigham Hospital) convened
at the patient's bedside to observe the results. Despite all efforts, the patient
suffered an irreversible rejection at 21 days post-transplant.
Conclusion This was the first allograft transplantation of a hand. The surgeons embarked on
an intervention never tried before, firmly believing that better function and quality
of life would result. The bravery of this surgical team was commendable. This early
surgical endeavor opened the way for future successes in transplant surgery today.
Keywords
first hand transplant - hand - transplant
