Question
How can we improve the success of hand transplants?
Answer
There are many factors that can increase the success rate of hand transplants. Prior to surgery, the client is screened both medically and psychologically to make sure they are a good candidate. Obviously, the client needs to be in good health. They also need to undergo psychological testing to make sure that they are also mentally healthy and able to withstand the surgery and rigorous therapy that follows. They also need to be asked about their satisfaction with their lives and what their expectations are. Generally those who are satisfied with their current situation and are only seeking the surgery to enhance the quality of their lives have far better outcomes.
Once the surgery occurs, the client usually spends at minimum 3-4 weeks in the hospital. Occupational therapy plays a vital role in the client's recovery by allowing the client to choose valued activities to work on in therapy. Occupational therapists work on ROM, strengthening and functional use of the transplanted limb. They also provide orthotics as needed.
The client also receives anti-rejection medications after the surgery. To prevent rejection of the donated limb, these medications are usually taken the rest of their lives. However, there is some promising new research to reduce the use of these medications or stop them all together (Chimerism- donor cells are injected, ie. bone marrow, to reduce the rejection by the host body) as they can cause significant side affects.
Clients are trained in the signs of rejection so that they can immediately seek medical attention. These are: increased edema, red spots that do not blanche and skin breakdown at the joints. They are also encouraged to take the following precautions: take medications as prescribed, avoid injury to transplanted limb and avoid alcohol.
Overall, the best indicator of success is patient satisfaction. An occupational therapist can help find and modify meaningful activities for them to pursue during this rehabilitation process, thus increasing their overall satisfaction and success.
