World’s first bilateral hand transplant on a child: Zion’s story

L. Scott Levin, MD, FACS: We have some good news for you.

Zion Harvey, Patient: Close up, far away. Close up, far away.

Pattie, Mother: Call Zoe, Zion.

Zion Harvey, Patient: Zoe. Close up.

Pattie, Mother: Come on, come on.

Zion Harvey, Patient: I wasn’t, I wasn’t always like this. When I was 2, I had to get my hands cut off because I was sick.

I don’t know what a child hand looks like. It could be this color, or this color. I don’t know.

Christine McAndrew, PA-C: How to make a muscle.

L. Scott Levin, MD, FACS: Over here, let me see how strong you are.

Christine McAndrew, PA-C: We have followed Zion for probably about a year-and-a-half now, and done extensive evaluations to see if he was a good candidate for hand transplant.

Zion Harvey, Patient: So, when I get this hands, I will be proud of what hands I get. I will be proud.

Pattie, Mother: I will be too. Because they’re going to be your new hands. You excited?

Zion Harvey, Patient: And if it gets messed up…

Pattie, Mother: It’s not going to be messed up. You excited?

Zion Harvey, Patient: I don’t care because I have my family.

Benjamin Chang, MD: As far as we know it’s never been even attempted in a child. One of the things that’s unique about Zion is that he already had kidney transplants. He’s on medication for rejection. So essentially we could piggy back off that same medication. Our concerns about doing these hand transplants in anybody is that once you do it, the patient has to stay on life-long medications so they don’t reject. And those medications increase the risk of infection, and they also increase your risk of having some cancer develop later on in life. And so for a child that’s a very, very difficult decision.

L. Scott Levin, MD, FACS: Stand up straight. Let me see your arm. Now, I want you to make a fist for me, like this. Good, relax.

When I met Zion, I said, “Why do you want hands? Zion why do you want hands?” He’s a very, very intelligent young man. He said, “I want to swing on the monkey bars.”

Zion Harvey, Patient: My grandmother says I’m smarter than a lot of grownups. I’m really smarter than a lot of grownups.

L. Scott Levin, MD, FACS: You know that’s sort of a milestone for a lot of kids. And why shouldn’t he be like another child and, you know, our hope is over time that indeed he will be able to do that.

Zion Harvey, Patient: And that’s a TV camera. He wants to know if he’s on TV.

Pattie, Mother: This is just like another hurdle that he jumps. He’s jumped so many hurdles. He’s so amazing. This isn’t the first amazing thing that he’s done. He’s been doing amazing things since he’s been sick. I don’t know many adults that can handle half of his life on a-day-to-day basis.

Zion Harvey, Patient: Like sometimes, I just think some of my classmates, they don’t mean to say mean things to me, but it just slips out. So either, either somebody says something to me, and then I just figure it slipped out and they didn’t mean to say it. Everybody has their own way to thinking things.

Pattie, Mother: It’s true.

L. Scott Levin, MD, FACS: Each year there are only 15 children, based on the databases, that would even be eligible to donate hands. And then it comes down to the organ procurement organizations approaching families at a terrible time, the loss of a child. Just stop and think about that. So the fact that he was put on the waiting list for hands in April, and three months later this came along. That in and of itself is a remarkable story.

Pattie, Mother: Chrissy called me and she’s like, “OK we have a match.” I’m like, “Stop playing, Chrissy.” She’s like, “No, I’m serious.”

Benjamin Chang, MD: We have about 12 surgeons. And, you know, a whole bevy of nurses, at least eight nurses, circling in and out. And then a team of anesthesiologist. I think at least three or four of them that will be working throughout the night. So, it’s a large team.

L. Scott Levin, MD, FACS: There’s an expression in surgery, “Preparation is the only shortcut you need.” And particularly in surgery and in highly complex operations, you know, we prepare.

Benjamin Chang, MD: So we’re about to get started. Zion has just come into the room. And they’re starting to put intravenous lines in and get ready for the surgery. We’ll prepare the donor limbs and the recipient’s sites, and then do the actual transplantation. So, expect to be here all night, but hopefully at the end we’ll have two hands on two arms.

L. Scott Levin, MD, FACS: OK, hi

Nurse: Good to see you, doctor.

L. Scott Levin, MD, FACS: How are you? Ready?

Nurse: Good.

L. Scott Levin, MD, FACS: We’ve rehearsed. We know our steps. We know each other. We know what we have to do today. And I think everybody assembled here has committed to this patient and making this a reality for this little boy. We can have complications. We can fail. We can have troubles. But we’re not planning on it. So, everybody is familiar with their particular role. And I just want to say in advance, we’ll do our best and we’re all here together.

This is a new arena of reconstructive surgery. It’s a new arena in transplant surgery. This gives new hope not only to the adults, but particularly children. There are ethical issues and questions about the implications for that, but that deceased child’s hands and expression, if you will, will live on in Zion. And that’s a pretty profound thing when you think about it.

Benjamin Chang, MD: In the beginning of the operation, we actually had four teams operating at the same time. And each of them had specific things they were supposed to do. So they had to find all the structure. Put pre-made tags on for every single structure that we’d have to repair. And they would have to sew those onto the nerves, blood vessels, tendons, etc. L. Scott Levin, MD, FACS: It’s one thing to sew adult vessels, which in and of themselves are small and they require this kind of skill. But the highest echelons of reconstructive microsurgery take place in children, small children. And my colleagues who participated in the microvascular aspects of the care are just the best in the world.

Benjamin Chang, MD: The blade goes here, so we’re going to have to cut this really short.

L. Scott Levin, MD, FACS: Blood is going across the hook-up here. And you can see the hand right here starting to pink up. You see the capillary refill? You see that? See it’s white when I touch it, and then it pinks up. And now that’s starting to get out to the level of the fingers.

Pattie, Mother: How’s my baby?

Nurse: Zion’s doing great. He’s doing well.

Benjamin Chang, MD: Just came out to give you an update. So we’ve gone through a lot so far. You know, we broke this thing in down into four different parts. We’re on this last part here. So at this point, the hands have already been attached, so the bones are back together. And Dr. Levin and the other microsurgeons are working on putting the arteries and veins together.

You ought to really make sure that this was going to work for our patient and work for a lifetime, not just a year. For us this is not really just a technical exercise. It’s really trying to, you know, restore a better level of lifetime function for these patients.

L. Scott Levin, MD, FACS: I think all of you who know about microsurgery, and all of you do know that we’re not out of the woods, and this is sort of just the first step. And we have to be very vigilant, and we have a whole protocol on how to take care of this little guy, but from the bottom of my heart, thanks.

We have some good news for you. Your little guys has two hands.

Christine McAndrew, PA-C: Hi, Zion

L. Scott Levin, MD, FACS: And so, what might we say about Zion Harvey in 10 years or 15 years? What might we say about this? I hope he is the first of literally hundreds or thousands of patients that are going to be afforded this operation.

Therapist: All right, up, up, up, up, up, nice. No hands, that’s all you.

Therapist: Don’t let me get it.

Pattie, Mother: Don’t let him take it.

Therapist: Don’t let me get it.

Pattie, Mother: Tug of war.

L. Scott Levin, MD, FACS: He’s in no better place than in The Children’s Hospital of Philadelphia to make sure he gets through this and does well.

Zion Harvey, Patient: Me and Zoe want a puppy.

Pattie, Mother: Where’s the puppy gonna live?

Zion Harvey, Patient: In my room, where else?