Dr. McCabe was also a member of the surgical team that performed the world’s first hand transplant in 1999 at the Louisville Jewish Hospital in Kentucky. Dr. McCabe returned to Canada in 2012 – he is originally from Dresden, Ontario – to lead the Hand and Upper Extremity Transplant Program and the Hand Program at Toronto Western Hospital.
“It was an opportunity to come home,” says Dr. McCabe. “I had remained friends with many of the surgeons, some of whom I know from medical school and when I was previously working in Toronto. It was a chance to be a part of a really talented team.”
When we got the call that there was a match, it was amazing."
Finding a Match
The 49-year-old female patient, a nurse, lost her arm below the elbow in an accident several years ago. To become a candidate for the procedure, she underwent a rigorous physical and psychological evaluation. Finding an appropriate donor match was equally rigorous.
“Any type of transplant is complicated in that you have to ensure there is a physiological match between the donor and recipient to lessen the likelihood of rejection,” said Dr. McCabe. “With a hand transplant, you have the added complexity of aligning aesthetics, like size, colour, gender and age.”
In this case, the team and patient waited months for an appropriate donor. “When we got the call that there was a match, it was amazing.”
The Moment of Truth
What followed was an incredibly complex procedure requiring a wide range of experts completing the pre-transplant, transplant and post-transplant phases. In addition to the Hand Program, orthopaedic surgeons from the Arthritis Program played a vital role, as did specialists from UHN’s Multi-Organ Transplant Program and Sick Kids Hospital, and the Trillium Gift of Life Network that oversaw the organ donation process.
The procedure itself lasted over 14 hours.
“When we ‘turned on’ circulation to the newly attached hand and it became pink it was an incredible moment in the operating room,” recalled Dr. McCabe. “There was an immense amount of work – by our team and the patient – that had gone into that moment. It’s incredibly satisfying.”
Early Signs of Success
Post-surgery, the patient’s rehabilitation began right away as she was fitted with a custom-made splint and began exercises that encouraged motion of the joints to avoid stiffness. She has a weekly appointment at the Hand Rehabilitation Centre, which she augments with her own program at home.
“The patient is doing really well and it’s amazing to watch the improvement week to week,” says Dr. McCabe. “She already has some evidence of nerve-regeneration and she is starting to move her hand and wrist. She even has some feeling at the top of the transplanted limb.”
Although it is still early, all signs point to the patient’s body accepting the new forearm and hand.
“Her own nerves are now growing into the transplanted arm,” says Dr. McCabe. “The fact that the nerves are showing signs of regeneration gives us great hope that she will continue to improve and gain greater motion and strength.”
A ‘Life-Saving’ Procedure
As a source of inspiration, the patient can view videos posted online of Matthew Scott, who underwent the world’s first successful hand transplant. At the time of the procedure, based on previous attempts made around the world of limited success, Scott’s newly transplanted hand was not expected to function for more than a year.
Seventeen years later, Scott’s abilities with his transplanted hand continue to improve. Today, in addition to completing various dexterity tests, he can almost read Braille, a task that tests touch sensitivity that many patients who have had their own hands re-attached find very challenging.
For Scott, who Dr. McCabe still keeps in touch with, it was a life-changing procedure. In his words: “When I came to Louisville, I was a little broken, and this saved me. The years since then have been nothing less than spectacular for me. It was life-saving.”
What the Future Holds
Advances in immunosuppression and stem cell science hold great promise for the development of new innovations in hand transplant. Dr. McCabe would like to continue to perform more procedures and drive forward research in the field so he can bolster his case to the Ministry of Health and Long-term Care that hand transplants should be fully covered by the province.
“The hand is the most injured part of the body, and in severe cases, where someone loses one or both hands, we have the opportunity to make that person feel whole again,” says Dr. McCabe.
There are currently two candidates for transplant that have made it through the rigorous screening process and are waiting for their procedure. One of whom is missing both arms.
Dr. McCabe has applied for government funding to support their cases and if that is not successful, he may turn to alternative funding sources, including private donors.
To support the work of Dr. Steven McCabe in the Hand and Upper Extremity Transplant Program, please contact Anette Larsson at anette.larsson@uhn.ca or 416 603 5800 ext. 4059.
