Eighteen months after surgery, doctors say the world's first double hand transplant in a child can be considered a success. Zion Harvey, who was eight years old when the operation took place, can now write, dress and feed himself, and even throw a baseball, including opening pitches for both the Orioles and the Dodgers. A new study in The Lancet Child & Adolescent Health recounts the full story of his groundbreaking treatment for the first time.
Harvey contracted a sepsis infection at age two that required the amputation of his hands and feet; he also required a kidney transplant from his mother, Pattie Ray. He adapted to life with the help of special equipment, but doctors suggested a more radical solution: surgery. His family agreed. His mother wanted him to be able to cut his food and brush his teeth, while Harvey wanted to climb monkey bars and use a baseball bat.
Though it would be the first such surgery performed on a child, doctors thought Harvey had one advantage. Deciding to go forward meant weighing the potential benefits against the risks and consequences, one of which being that Harvey would need postoperative immunosuppression to keep his body's immune system from rejecting his new hands. But immunosuppressive drugs can increase the risk of infections, diabetes, and cancer. Harvey, however, already needed immunosuppression because of his kidney transplant—it removed one negative consequence from the equation.
After careful physical and psychological evaluation, doctors decided he could proceed. It would be a complex process, one that had previously only been used for single-limb transplants between identical twins and in adults. A teenager who'd received a donor limb had severe complications and died soon after surgery.
In July 2015, a matching pair of donor hands became available. Four teams of doctors at Children's Hospital of Philadelphia, in collaboration with Penn Medicine, worked on Harvey for nearly eleven hours, carefully attaching bones and blood vessels, nerves and muscles, tendons and skin. With the blood vessels between Harvey's arms and the donor hands knitted together, then palms and fingers began to turn pink, showing the blood was flowing from his heart into the new appendages.
But completing the complex surgery was only the beginning. Within days, Harvey was able to move his fingers; soon after, he started occupational therapy, exercising his new hands with video games and finger puppets. Within six months, he could feel touch; he practiced with a knife and fork, and could grasp a pen to write. He was using scissors and crayons at eight months and, within one year post-op, he could swing that baseball bat.
Functional brain imaging shows his brain has developed pathways for controlling his hands, and for receiving feelings of touch back from them. He and his mother have also received psychological support, including from a psychologist and a social worker who helped him deal with the transplant and prepare to go back to school.
There have been minor setbacks, including eight periods when his body rejected the hands. Immunosuppression drugs worked, and he's still being treated with four of them, though doctors hope to dial back their use as soon as possible not only because they leave him vulnerable to infections but also because one steroid he's taking can affect growth and bone health.
Harvey's doctors say his progress proves that double hand transplant is possible, even in children—though it remains a difficult process requiring intensive support. "Our study shows that hand transplant surgery is possible when carefully managed and supported by a team of surgeons, transplant specialists, occupational therapists, rehabilitation teams, social workers and psychologists," Sandra Amaral, an attending physician at Children's Hospital of Philadelphia and lead author of the paper, said in a statement. Thanks to all those factors coming into near-miraculous alignment, a kid who didn't have hands less than two years ago can swing a baseball bat today.
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