For the first time worldwide, surgeons have removed a patient’s partial, non-functional hand and transplanted a donor hand at the same time. This landmark surgical case marks the third hand transplant at Duke and in the state of North Carolina.
Led by Dr. Linda Cendales, Director of the Duke Vascularized Composite Allotransplantation Program, a team of over 30 surgeons, anesthesiologists, operating room staff, residents, fellows, lab technicians, and transplant and research coordinators worked tirelessly over 14 hours to make the novel procedure a success.
"Mr. Benner is a very deserving patient," said Dr. Cendales. "We came together across missions, units, disciplines, and professions to achieve something no one else has done before and opened a new possibility to our patients. And we can all be proud of that."
A team of seven surgeons of the combined Division of Hand Surgery, a joint division between the Duke Departments of Surgery and Orthopaedic Surgery, performed the surgery. "It was truly a team approach with surgeons working to repair nerves, vessels, tendons, and bones under a time pressure," said Dr. David Ruch, Chief of Hand Surgery. "It requires incredible communication between surgeons, anesthesiologists, nurses, and transplant specialists. It is a great example of what makes Duke a special place to work."
Mr. Benner’s residual hand before
The transplant recipient, Mr. Daniel Benner, lost three of his limbs and a significant part of his right hand due to an infection 2 years ago. He underwent a thorough evaluation and was unanimously approved by the Review Committee to receive the transplant. After 3 days on the waiting list, Mr. Benner received his new right hand on Father’s Day and was discharged from the hospital 8 days later.
"Dr. Cendales and her team made me feel so comfortable through the whole process," said Mr. Benner. "For something so serious and so rewarding, it’s been a grateful feeling and everyone has made that experience a lot easier than what it could have been."
One month after the surgery, Mr. Benner can already make a fist and pick up small items during his daily 4-hour physical therapy sessions. He is excited about the new opportunities that await him with his new hand.
"I love playing catch, playing ball with my son. I was a baseball coach since he was a little kid. I love to cook so my wife doesn’t have to do it all. I can’t wait to get back and do that: fishing, playing ball with my son, and actually doing chores around the house."
Daniel Benner, Duke hand transplant recipient, in physical therapy at 4 weeks post-transplant
Mr. Benner looks forward to doing simple tasks as well, such as picking up a cup of coffee to drink from rather than drinking through a straw. "We bought so many different variations of mugs and I tried to hold them with my prosthetic and it would fall out and make a mess. I’m looking forward to doing something just that simple."
Currently, fewer than 30 hand transplants have been performed in the United States. Hand transplantation is a low-volume, high-risk procedure performed under research protocols. This type of surgery, known as vascularized composite allotransplantation (VCA), is complex and involves connecting bone, blood vessels, muscle, nerve, tendons, and skin.
The Duke Health team plans to perform two additional hand transplants as part of a clinical trial funded by the Department of Defense to test a new anti-rejection regimen designed to lessen the risk of immunosuppression. The study will benefit countless patients undergoing transplants.
Mr. Benner said the transplant was the best Father’s Day gift he could receive.
"On Father’s Day, nothing’s ever just taken lightly because it’s a special day for dads," said Mr. Benner. "But this will be a special day forever now for all of us, for my whole family. It definitely means a lot to us."
An Artist’s Rendering
Sketches of the hand transplant procedure by Duke medical illustrator Megan Llewellyn, MSMI, CMI.
Duke’s hand transplant program is led by one of the world’s leaders in vascularized composite allotransplantation (VCA), an innovative method of transplanting multiple tissues, such as a hand, as a functional unit. Our comprehensive approach guides our research on hand transplantation, which remains an investigational procedure. It is an option for people who have lost one or both hands.