The University of Pittsburgh joined the field in 2002, with the hiring of Andrew Lee to lead its new program. In less than two decades, there were dozens. Hand transplant teams started in Innsbruck, Paris, Pittsburgh, Los Angeles, Boston, and other cities. In 1999, Warren Breidenbach became the first US surgeon to perform a VCA transplant when he gave a new left hand to Matt Scott, a 37-year-old who’d lost his to a firecracker. Once this breakthrough arrived and the Lyon team gave their patient a new hand, doctors and major hospitals worldwide began to add VCA units. It had taken two decades to find the right levels of immunosuppressants. Solid-organ transplants had been common for almost 20 years by the time doctors and hospitals started performing VCA. Is taking dangerous drugs for the rest of one’s life worth the satisfaction of tying a shoelace or moving a strand of hair from a child’s face? Such deeply personal questions test the boundaries of medical ethics. But a hand transplant sharply changes this calculus. Most people readily accept such risks to get a new heart, lung, or liver: When the benefit is life itself, most find almost any cost bearable. Such transplants, now routine, have saved or extended more than 750,000 lives in the US. Most transplant patients are now treated with a three-drug cocktail that includes cyclosporine or tacrolimus along with steroids and a second, gentler anti-rejection drug. With those drugs, five-year survival rates for organ transplant patients jumped. A similar drug, tacrolimus, followed a decade later. Organ transplants did not become viable as routine treatment until around 1980, when an anti-rejection drug called cyclosporine was introduced. Unfortunately, the side effects of early anti-rejection drugs were severe, and mortality rates were high. In the 1960s, researchers began developing immunosuppressant drugs and launching transplant programs. But by demonstrating that immunological tolerance could be acquired, Medawar had given the field hope. In studies on mice, they found that if they introduced an eventual organ donor’s cells to the recipient in utero or just after birth, the mouse would develop an acquired tolerance-a diplomatic ploy to have the foreign flesh accepted as kin.Īlas, as a practical matter, introducing a future human donor’s cells in utero or infancy so one could later get a timely transplant from them would require superhuman prescience. In experiments on animals in the 1940s and ’50s, however, Medawar and his colleagues discovered a mechanism for preventing immune rejection of transplanted organs. It does so by turning its immune system against any foreign body-an obvious obstacle to accepting another person’s organ. The body has a fierce need to protect itself. Starzl, who had done the first human liver transplant in the early 1960s, was acclaimed as “the father of transplantation.” Starzl himself insisted that the rightful owner of that title was a zoologist named Peter Medawar, who at midcentury had helped solve transplantation’s central puzzle-one not surgical but immunological. Starzl Transplantation Institute at the University of Pittsburgh, the man for whom it was named was 84 years old and still a presence there. When Sheila Advento arrived at the Thomas E. They wanted her body, undistracted by mind or maintenance, to focus on the fight ahead. The ER team blasted her with antibiotics and fluids and eased her into an induced coma. Her body was shutting down, starting with the limbs. An infection in her bloodstream had unleashed an inflammatory storm. Her last memory before blacking out was someone lifting her hand to put one of those white clips on her dusky blue finger. In the car, Sheila had trouble breathing. Sheila, she said, I have to take you to the hospital. Peachie, who was a nurse manager at New York University’s Langone Medical Center, took one look at her daughter and knew she was in trouble. When her mother, Peachie, looked in around dinner time, she found Sheila lying on the bathroom floor. Family members took turns checking on her. She trudged to a basement bedroom to lie down. She was starting to think she had the flu. They ate cheeseburgers and adobo and raised Pabst Blue Ribbon and San Miguel to toast one another, independence, good health, and freedom-almost all of which Sheila, who was 26, was about to lose.įor days she’d been having headaches. Sheila and her mom were there, along with Sheila’s boyfriend, sister, and brother-in-law-a slice of a huge extended family, many of whom, like Sheila and her parents, had immigrated to the US from the Philippines. It was July 6, 2003, and her mother’s house in northern New Jersey was filled with people.
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