World's first pediatric double-hand transplant performed at CHOP

Surgery took a 40-person team 10 hours to complete

After 18 months of planning, a team of 40 surgeons, nurses, and other clinicians from the Children's Hospital of Philadelphia (CHOP), Penn Medicine, and Shriners Hospital for Children-Philadelphia have performed the first pediatric bilateral hand transplant.

The procedure took place at CHOP in early July, but members of the surgical team spoke publically about the surgery for the first time Tuesday.

Patient details

Eight-year-old Zion Harvey of Baltimore was two when he underwent surgery to have his feet and hands amputated because of a fast-moving infection. He also received a kidney transplant from his mother two years later.

Zion later received prosthetics for his feet, and he had learned to adapt to life without hands, teaching himself how to eat, write, play video games, and perform many other day-to-day tasks independently.

Pattie Ray, Zion's mother, says she talked in-depth with her son about the hand transplant procedure, and felt the risks were no greater than those associated with a kidney transplant. But, she says, she let Zion make the final call on whether to go through with the surgery. "Who was I to deprive him of the opportunity," she said.

Zion was referred to Shriners because of its specialization in pediatric orthopedic care and was later jointly evaluated by doctors from CHOP and Shriners to become the first pediatric hand transplant recipient.

Medical first: Hospital could perform first double arm transplant

According to Benjamin Chang, co-director of CHOP's hand transplant program,  Zion was a good candidate to receive the hand transplant because he was already taking anti-rejection medication from his kidney transplant.

Shriners Chief of Staff Scott Kozin says, "The collaborative effort between these institutions was necessary to assemble the team and organize the players to orchestrate such a complex and demanding procedure that had never been performed on a child."

Penn Medicine physicians performed the first adult dual hand transplant in 2011.

How the procedure worked

The Philadelphia-based Gift of Life program found the donor hands by discussing the potential for donating with families who had recently lost children. The donor family in Zion's  case has chosen to remain anonymous.

The surgical team—which included nurses, anesthesiologists, and radiologists, as well as orthopedic, plastic, and reconstructive surgery specialists—was divided into four separate teams, two focusing on the donor's limbs and two focusing on Zion .

During the surgery, physicians connected the forearm bones, radius, and ulna with steel plates and screws, then used microvascular surgical techniques to connect the arteries and veins. Blood flow was then established via the reconnected blood vessels, and surgeons repaired and attached each individual muscle, tendon, and nerve.  In total, the procedure took 10 hours to complete.

Johns Hopkins performed double-arm transplant on soldier who lost four limbs

After the procedure, Zion  was transferred to CHOP's pediatric ICU for one week and a medical unit after that. He now resides in the inpatient rehabilitation center where he undergoes hand therapy multiple times per day. Zion still takes anti-rejection medication daily, and CHOP doctors say he will likely spend several more weeks in the rehabilitation unit.

L. Scott Levin, CHOP's hand transplant program director, says Zion's spirit throughout the process has been inspiring. "There hasn't been one whimper, one tear, or one complaint," he says. CHOP Surgeon-in-Chief N. Scott Adzick adds, "This boy is nothing short of miraculous."

When asked by reporters how he felt about the experience, Zion replied in one word: "Happy."

CHOP President and CEO Madeline Bell notes the total cost of the procedure has yet to be determined. "It will be in the hundreds of thousands of dollars, [but] I can tell you the family will not be charged," she says (George, Philadelphia Business Journal, 7/28; Matheson, AP/Washington Times, 7/29; McCullough, Philadelphia Inquirer, 7/29).

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