Limb transplants add potential to ‘quality of life’ donation

Sue Guinn Legg • Feb 4, 2013 at 10:42 AM

Last week’s news of the double-arm transplant received by Brendan Marrocco, the 26-year-old Iraqi war veteran who survived the loss of all four of his limbs in a roadside bomb explosion, focused the world’s attention on the growing potential of transplantation that is emerging with advances in medicine.

With those advances, the significance of organ and tissue donation is also expanding and what long been referred to as the “gift of life” is growing to include more transplants focused on improving quality of life.

Joy McCray, a public relations and education specialist with the local office of Tennessee Donor Services, said TDS acknowledges that limb transplantation “is a wonderful opportunity for the recipient, and major breakthrough for amputees.”

While Tennessee’s Donate Life registry supports organ, eye, tissue and bone donation, McCray said transplant centers sometimes reach out to organ procurement organizations with special needs for limbs. “We recognized that donor information is highly confidential and this is a unique and special donation, facilitated by long-term planning between the transplant team, recipient, donor family and local organ procurement organization.”

But most importantly, McCray said, TDS continues to encourage everyone to sign up to save lives online at DonatelifeTN.org or by calling 915-0808 for assistance. “Through the caring decision of our community to register to be donors, we are able to save and enhance lives across the U.S.,” she said.

Dave Lively of Kingsport, whose 22-year-old son, Adam, donated his organs and tissues to more than 50 transplant recipients, said he has thought a lot about Marrocco, “how it would be for him to go through life without his arms and his legs and how other people helped him.”

“I think it’s wonderful. I just hope it works out good for him,” Lively said.

While Adam Lively’s heart, liver and kidneys saved multiple lives, his father said his corneas went to a man and a woman in the Knoxville area. “Today both of those people can see,” he said. “Anything we can do to encourage people to consider donation, the better. We encourage everyone we know to.”

In speaking to the media, Marrocco’s medical team at Johns Hopkins Hospital said the bone marrow he received was from the same person who donated his arms. The team emphasized the marrow played a key role in preventing a rejection of his the new limbs with minimal use of anti-rejection medications that weaken patients’ immune systems and cause long-term side effects including increased risk of cancer.

Dr. Andrew Lee, the plastic surgery chief at Johns Hopkins who led Marrocco’s surgery, pioneered the unique bone marrow approach. In Marrocco’s case and in other limb transplants Lee has performed in conjunction with bone marrow transplants from the same donor, patients have done well using only one anti-rejection medication rather than the combination of multiple anti-rejection medications limb transplants typically require. His work is being funded by the federal Armed Forces Institute of Regenerative Medicine, a network of research hospitals and universities around the country, and more limb transplants using the donor’s bone marrow are planned.

Dr. Todd Horton, a former Navy surgeon and director of Hand and Upper Extremity Surgery at Johnson City Medical Center, has been reattaching dismembered hands since 2005. Horton is very excited about several aspects of Marrocco’s case, beginning with advances in body armor and resuscitation technology that allowed Marrocco to become the first person to survive the loss all four limbs.

“Fantastic,” Horton said emphatically about the soldier’s survival.

But as a hand surgeon, he said he is even more awed by the success the John Hopkins surgical team had in transplanting a whole arm above the elbow and by Lee’s research in immuno-suppression that is keeping Marrocco’s new arms viable.

While the ability to reattach limbs is not new, Horton said “the technology is becoming much more successful.” Transplanting limbs involves the same basic processes of attaching bone, muscle, tendons, blood vessels, nerves and skin, but with the added risk of that the graft of each those different types of tissues, particularly bone, will reject its host.

“What Andrew Lee has done is allowing the transplant to be successful. That’s what’s so spectacular.

“Beyond the spectacular stuff they do at John Hopkins,” Horton said, donated tissues are essential to the everyday work of orthopedic surgeons at Johnson City Medical Center and hospitals all over the world.

“After the hearts and kidneys and all the crucial, life-saving organs are flown away .... they go back and get all the little things, the tendons and bones we use every day for routine stuff, just taking care of broken arms and legs.

“When a bone is sheared away or a ligament is missing, we go to the tissue bank and get the tissue grafts we need to splice that back in. We do that every day.

“Everybody should be an organ donor for all of their tissues,” Horton said.

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