First transplant of hand made possible because of unique clinic

Plastic surgeon devoted to limb replantation behind medical feat by W Hospital

A midsize hospital in Daegu has successfully performed Korea’s first hand transplantation recently. W Hospital, a clinic specializing in hand replantation as designated by the Ministry of Health and Welfare, is the institution that made the stunning accomplishment.

It was surprising enough that a Korean hospital has finally performed a limb replantation. Even more astonishing for the domestic medical community was that a midsize provincial institution had done it, beating large hospitals in Seoul. Experts familiar with this sector say, however, turning the impossible into possible might have been unthinkable had it not been for W Hospital.

Plastic surgeon tries his hand at hand transplantation

At its center is Dr. Woo Sang-hyun, CEO and president of W Hospital, who has stuck with this area for 18 years. A plastic surgeon by trade, Woo took part in the first hand transplantation in the United States in 1999, held at the world’s largest hand microsurgery specialty hospital, Christine M. Kleinert Institute. Through this experience, Woo took one step closer to the hand transplantation, which he had dreamed of performing since his days as a professor at Yeungnam University Medical Center (YUMC).

Woo has since prepared for hand transplantation. Unlike other private hospitals that focus solely on patient treatments, all the staffs at W Hospital are “eager in their studies” as well. They hold three or more conferences a week and received countless awards at microsurgery symposiums. The staff’s clinical experiences are without a peer either. There is no doubt W Hospital is the best microsurgical institution in Korea. Woo has also performed the sham operation of hand transplantation several times along with the hand reconstruction team.

“Once a donor came forth, we had countless meetings about the surgical process and performed several sham operations,” Woo said in a recent interview with The Korea Biomedical Review. “The surgery, once it begins, must progress seamlessly. We’ve made preparations to avoid confusions and ensure each member can fulfill his or her role. We’ve simulated the entire process, ranging from removing the patient’s arm to preparing the prosthetic.”

Woo has also worked hard to create social conditions to perform hand transplantation. In March 2010 the Ministry of Health and Welfare acknowledged hand transplantation as a new medical technique, and in 2016, selected hand transplantation as a new medical technique that represents Daegu, 350 km southeast of Seoul. W Hospital also signed a memorandum of understanding with YUMC in 2010 for the transplantation surgery. Under the Internal Organ Transplant Law, only hospitals designated by the ministry as the medical institutions for organ transplantation can conduct hand transplantation surgery.

Woo (left) prepares for surgery by separating tendons and nerves from the donor’s arm. (Courtesy of W Hospital)

W Hospital’s hand reconstructive microsurgery team moves as one

They made all the preparations, but there were no donors. At the news of a would-be donor who was brain dead, Woo and his team rushed to the hospital only to return empty-handed, as the patient’s guardians changed their minds.

On Feb. 1, a donor finally appeared: a man in his 40s declared brain dead. W Hospital’s hand reconstructive microsurgery team moved swiftly to enter into preparations to operate, divided into two units. For a transplanted arm to work properly, they must connect veins and nerves, let alone bones and muscles, perfectly.

“The two teams marked the sinews, nerves, arteries and veins of the arms of the donor and patient, respectively. It was a complicated surgery wherein we must find and connect two arteries, five veins, five nerves and 25 tendons,” Woo said. “What if we ask the patient to move his thumb after the surgery, and they move a different finger instead?”

After finishing all the preparations, Woo and his 10-member began the transplantation surgery on at 4 p.m. on Feb. 2 at a surgery room of YUMC. They moved as one and completed the surgery in 10 hours. There had been only about 70 such operations in the world. The midsize hospital in Daegu accomplished the micro-replantation surgery of highest difficulty level that even Japan, a global medical power, had not succeeded.

The patient who received about 5 centimeters of the arm below the wrist is recovering rapidly. He will throw the first ball at the opening game of the 2017 pro baseball between the Samsung Lions and the KIA Tigers in the Lions’ home stadium in Daegu.

Woo said a successful hand transplantation consists of three steps. Properly connecting arteries and veins constitutes a biological success, and the technical success comes once the nerves and tendons move after being connected. Ordinary reconnecting surgeries end here, but patients who undergo hand transplantation surgeries must take immunodepressants consistently. If they stop, a transplantation rejection occurs and may lead to the amputation of the transplanted arm. A hand transplantation patient should take a similar amount of immunosuppressants to that of a kidney transplant receiver. The patient, known by just his surname of Sohn, is adapting to all these steps and recovering.

Woo’s reckless challenge is still in progress

Although he prepared for hand transplantation surgery for 18 years, Woo said the entire process was a “reckless challenge” and felt like a “miracle.” People may think everything went smoothly, but Woo said he felt like he was walking on the ice every moment because there was little public awareness or legal precedents about hand transplantations available.

“Arm, a complex organ, is not included in the organ transplantation law. In Korea, people tend to regard only internal organs such as heart and liver as transplantable. Had we not succeeded, our hospital would have had to close. Each and every process of this surgery was the first in this country. Some even criticized it as being illegal. It was a reckless challenge, and the fact that we succeeded appears little short of a miracle.”

Woo said he could not sleep well even after the successful surgery because he had to monitor the patient’s condition. Despite the enormous pressure, Woo said he could not stop there, considering all other patients are waiting.

“People who lose their arms live the rest of their lives in shock. Our doctors are not worse at hand reconstructive microsurgery than their U.S. counterparts. I think it would be a dereliction of duty as a doctor to decline hand transplantation surgery because of the lack of legal procedures or insurance coverage while we have the skills,” Woo said.

Thanks to his attempt, Korea became a country where composite organ transplantation is possible. Woo also dreams of a simultaneous two-arm surgery on a single receiver and transplanting two arms from the same donor to two different receivers. Walking this path together with his junior doctors is his dream. Of course, legal and institutional improvements concerning this area must also improve at the same time.

“I hope more young doctors will show interest in areas like arm and other composite organ transplantations. It’s a field worth the challenge. To make it possible, the government should amend the reform health insurance system, creating the infrastructure for invigorating these surgeries.”

Thanks to his foolhardy adventure, another miracle may occur in the not so distant future.

Woo Sang-hyun (center in the front row) and his hand reconstruction microsurgery team pose for a celebratory shot after successfully completing their hand transplantation surgery in February at Yeungnam University Medical Center. (Courtesy of W Hospital)

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Starting today, doctors here in the nation can perform hand and arm transplants.

A change that will help improve the lives of many.
The Korea Centers for Disease Control and Prevention released detailed standards and procedures for both transplants and donations.
Back in 2000 the government legalized transplants for life-saving organs like hearts and lungs.
Now, arms and hands become the 14th body parts to be approved.
To sign up for a transplant, a patient needs to wait six months after their wound is treated, and submit a letter from a psychiatrist.
The procedure will be carried out first on those who need both hands and arms.
As for donors, they must have suffered brain death, and have previously been willing to donate at least one life-saving organ like their heart, lungs or kidneys.