Sunday, April 20, 2014
FAIRFIELD-SUISUN, CALIFORNIA
99 CENTS

UNOS to oversee hand, face transplants like organs

Lindsay Aronson Ess

This photo taken Dec. 20, 2013 shows double hand transplant recipient Lindsay Aronson Ess working on her dexterity during a physical therapy session in Richmond, Va. Sure your liver or kidney could save someone's life. But would you donate your hands, or your face? Signing up to become an organ donor may get more complicated than just checking off a box on your driver's license. The government is preparing to regulate the new field of hand and face transplants like it does standard organ transplants, giving more Americans who are disabled or disfigured by injury, illness or combat a chance at qualifying for this radical kind of reconstruction. (AP Photo/Steve Helber)

WASHINGTON — Sure your liver or kidney could save someone’s life. But would you donate your hands, or your face? Signing up to become an organ donor may get more complicated than just checking a box on your driver’s license.

The government is preparing to regulate the new field of hand and face transplants like it does standard organ transplants, giving more Americans who are disabled or disfigured by injury, illness or combat a chance at this radical kind of reconstruction.

Among the first challenges is deciding how people should consent to donate these very visible body parts that could improve someone’s quality of life — without deterring them from traditional donation of hearts, lungs and other internal organs needed to save lives.

“Joe Blow is not going to know that now an organ is defined as also including a hand or a face,” said Dr. Suzanne McDiarmid, who chairs the committee of the United Network for Organ Sharing, or UNOS, that will develop the new policies over the next few months.

Making that clear to potential donors and their families is critical — “otherwise we could undermine public trust,” said McDiarmid, a transplant specialist at the University of California, Los Angeles.

“The consent process for the life-saving organs should not, must not, be derailed by a consent process for a different kind of organ, that the public might think of as being very different from donating a kidney or a heart or a liver,” she added.

These so-called “reconstructive transplants” are experimental, and rare. The best estimates are that 27 hand transplants have been performed in the U.S. since 1999, and about seven partial or full face transplants since 2008, said Dr. Vijay Gorantla, medical director of the University of Pittsburgh reconstructive transplant program.

But they’re gradually increasing as more U.S. hospitals offer the complex surgeries, the Defense Department funds research into the approach for wounded veterans — and as transplant recipients go public to say how the surgeries have improved their lives.

“These hands are blessed hands to me,” said Lindsay Aronson Ess, 30, of Richmond, Va., who received a double hand transplant in 2011. She had lost her hands and feet to a life-threatening infection in 2007.

Until now, deciding who qualifies for a hand or face transplant, and how to find a match and approach a potential donor’s family all have been done on an informal, case-by-case basis.

There has been no way to tell which hospitals’ techniques work best and how patients ultimately fare. There have been reports of two deaths related to face transplants in other countries, and some transplanted hands have had to be amputated. Patients must take lifelong anti-rejection medications that put them at risk of infections, cancer and other side effects.

In July, government regulations go into effect making hand and face transplants subject to the same strict oversight by UNOS, which manages the U.S. transplant program, as heart or kidney transplants. They’re part of a new definition of “organ” that also includes other body parts that doctors one day might transplant — from feet to voice boxes, maybe even the uterus. Unlike corneas, heart valves and other simpler tissues that are regulated by the Food and Drug Administration, these are all complex mixes of blood vessels, nerves, muscles and other tissues.

The rules mean potential recipients will be added to the UNOS network, for matching of donated hands and face tissue that are the right tissue type and compatible for skin color, size, gender and age. Transplants and their outcomes will be tracked.

Before then, the UNOS committee will have to decide such things as who’s first on the waiting list, and what special expertise a transplant center needs.

Then there’s the consent challenge. Some specialists say people should receive a list of body parts when they first sign an organ donor card — to specify exactly what they do and don’t want donated at death.

“Ethically it is the right thing to do so the potential donor has a choice,” said Pittsburgh’s Gorantla, who is closely watching how UNOS will tackle this issue.

But UNOS committee bioethicist Robert Veatch of Georgetown University said until now, next-of-kin have decided on donating a loved one’s face or hands, because previously registered organ donors probably had no idea that was an option. That’s even though some state laws preclude family from overriding a relative’s pre-death decision to donate organs or tissues.

“Some people who would be willing to consent to a kidney might get a little squeamish about a face,” he said.

The government projected fewer than two dozen people might be placed on a waiting list for hand and face transplants each year. But Susan Stewart of Association of Organ Procurement Organizations said ultimately, it will increase these transplants because finding a match will be easier.

Hand recipient Ess — the patient voice on the UNOS committee — also wants to ensure potential recipients are fully informed of the rigors and risks.

“It’s not just, ‘Attach some arms and let me go my merry way,’” said Ess, who still requires physical therapy and will always have to watch for signs of rejection. “It takes a lot of patience, it takes a lot of diligence and resilience.”

The Associated Press

The Associated Press

LEAVE A COMMENT

Discussion | No comments

The Daily Republic does not necessarily condone the comments here, nor does it review every post. Read our full policy

.

Solano News

Supervisor candidates vary on Plan Bay Area

By Barry Eberling | From Page: A1, 15 Comments | Gallery

 
Earth Day means cleanup Day for Suisun City

By Susan Hiland | From Page: A1, 5 Comments | Gallery

Hop to it: Couple lights up home, yard for Easter

By Amy Maginnis-Honey | From Page: C1

 
Bay Area makes growth plans

By Barry Eberling | From Page: A1, 2 Comments

Ranking the best Bay Area athletes

By Brad Stanhope | From Page: A2

 
The Edge hosts Easter egg hunt

By Adrienne Harris | From Page: A3

Alooma Temple keeps children in mind

By Adrienne Harris | From Page: A3 | Gallery

 
Fairfield author to speak at women’s expo

By Susan Hiland | From Page: A3

Piano scholarship competition set in Vallejo

By Susan Hiland | From Page: A3

 
The resurrection has changed the lives of Christians

By Perry W. Polk | From Page: C3

 
Armijo graduate completes basic training

By Nick DeCicco | From Page: C4

 
Understanding your health insurance

By Morgan Westfall | From Page: D4, 1 Comment

 
Record Store Day a commercial hit

By Adrienne Harris | From Page: A5 | Gallery

Easter egg hunt brings out the smiles

By Susan Hiland | From Page: A5, 2 Comments | Gallery

 
Dutch Bros. joins Fairfield coffee corridor

By Barry Eberling | From Page: B7, 7 Comments | Gallery

City sets plan to dispose of property assets

By Brian Miller and Karl Dumas | From Page: B7, 1 Comment

 
Fairfield police log: April 17, 2014

By Susan Hiland | From Page: A12

Suisun City police log: April 17, 2014

By Susan Hiland | From Page: A12

 
.

US / World

Counties tell Brown they need money for his law

By The Associated Press | From Page: A1, 1 Comment

 
San Francisco probe leading to entrapment claims

By The Associated Press | From Page: A6

Exhibit recreates Warhol’s 1964 World’s Fair mural

By The Associated Press | From Page: A10

 
NASA’s space station Robonaut finally getting legs

By The Associated Press | From Page: A10 | Gallery

Ohio couple married 70 years die 15 hours apart

By The Associated Press | From Page: A11 | Gallery

 
Documents detail another delayed GM recall

By The Associated Press | From Page: A11, 1 Comment

At barricades, Ukraine insurgents await Easter

By The Associated Press | From Page: A13

 
Official: 3 bodies retrieved from inside ferry

By The Associated Press | From Page: A13 | Gallery

13th body pulled from snow in Everest avalanche

By The Associated Press | From Page: A13

 
Costa Rican a celebrity after certified miracle

By The Associated Press | From Page: A14 | Gallery

.

Opinion

Government … for the government?

By Bill James | From Page: A8, 9 Comments

 
Editorial Cartoons for April 20, 2014

By Daily Republic Syndicated Content | From Page: A8

Question of the week: Will Flight 370 be found?

By Daily Republic | From Page: A8

 
Neighborhood speeders don’t get it

By Letter to the Editor | From Page: A8, 7 Comments

 
Why would a person do this?

By Letter to the Editor | From Page: A8, 3 Comments

Sound off for April 20, 2014

By Daily Republic | From Page: A8, 1 Comment

 
Jeb Bush, love, and today’s GOP

By Ruben Navarrette | From Page: A9, 1 Comment

 
 
.

Living

Today in History for April 20, 2014

By The Associated Press | From Page: A2

 
Community Calendar: April 20, 2014

By Susan Hiland | From Page: A2

Bill Nye says he underestimated debate’s impact

By The Associated Press | From Page: C3, 10 Comments

 
Book details lives of cloistered nuns

By The Associated Press | From Page: C3

Horoscopes for April 20, 2014

By Holiday Mathis | From Page: D4

 
Pete spends weekends at my house but he never invites me to his

By Kathy Mitchell and Marcy Sugar | From Page: D4

.

Entertainment

Flea of Red Hot Chili Peppers has book deal

By The Associated Press | From Page: C2

 
Tartt, Goodwin finalists for Carnegie medals

By The Associated Press | From Page: C2

New book on fracking illuminates pros, cons

By The Associated Press | From Page: C2

 
PUBLISHERS WEEKLY BEST-SELLERS

By The Associated Press | From Page: C2

TVGrid

By Daily Republic Syndicated Content | From Page: B11

 
.

Sports

A’s score 3 in 9th, rally past Astros 4-3

By The Associated Press | From Page: B1 | Gallery

 
Warriors beat Clippers 109-105 in playoff opener

By The Associated Press | From Page: B1 | Gallery

 
Kings, Sharks look to put Game 1 in past

By The Associated Press | From Page: B1 | Gallery

Stults, Padres hand Giants third straight loss

By The Associated Press | From Page: B1

 
Calathes suspension a reminder of supplement risk

By The Associated Press | From Page: B2

Raptors GM Ujiri uses profanity about Brooklyn

By The Associated Press | From Page: B2

 
Williams scores 24 as Nets beat Raptors 94-87

By The Associated Press | From Page: B2 | Gallery

Durant leads Thunder past Grizzlies 100-86

By The Associated Press | From Page: B2

 
Hawks take 1-0 lead by rolling past Pacers 101-93

By The Associated Press | From Page: B2

Federer beats injured Djokovic to reach final

By The Associated Press | From Page: B3 | Gallery

 
Indians set two new school records for track

By Daily Republic staff | From Page: B4

Wie shoots 67, wins LPGA LOTTE Championship

By The Associated Press | From Page: B4

 
Rapids, Earthquakes play to scoreless tie

By The Associated Press | From Page: B4

Travis Bowl Highlights

By Daily Republic | From Page: B4

 
Jimenez leads Langer by 1 shot in Greater Gwinnett

By The Associated Press | From Page: B4

Stars Recreation bowling results

By Daily Republic | From Page: B4

 
Donald shoots 66, takes lead at RBC Heritage

By The Associated Press | From Page: B4

Big names among prospective Buffalo Bills buyers

By The Associated Press | From Page: B4

 
Award-winning archery champ shoots with his teeth

By The Associated Press | From Page: B6 | Gallery

Survivors keep busy as Boston Marathon approaches

By The Associated Press | From Page: B6

 
.

Business

US delays review of contentious Keystone pipeline

By The Associated Press | From Page: B7

 
Why high oil prices are actually good for airlines

By The Associated Press | From Page: B7

Subscription sample boxes shake up beauty routines

By The Associated Press | From Page: B8

 
Girls from modest families get lift in technology

By The Associated Press | From Page: B12

Haunted house part of San Antonio apartment lofts

By The Associated Press | From Page: B13

 
Recalls this week: lanterns, exercise devices

By The Associated Press | From Page: B13

Review: Siri-like Cortana fills Windows phone gap

By The Associated Press | From Page: B14

 
.

Obituaries

Margaret Elizabeth Silva

By Susan Hiland | From Page: A4

 
Lloyd G. Hoffmeister

By Nancy Green | From Page: A4

Ramon Isidro

By Adrienne Harris | From Page: A4

 
Rogelio Tinoco-Zamudio

By Susan Hiland | From Page: A4

James Leroy Barbour

By Nancy Green | From Page: A4

 
William Paul Wehrly

By Nancy Green | From Page: A4

Sealwyn Shirley Brucefield Shepherd Malkiewicz

By Nancy Green | From Page: A4

 
.

Comics