Dr. Klapheke did his residency at Mayo, located in Rochester, MN, and has worked with transplant patients throughout much of his career. He served as the attending psychiatrist at Jewish Hospital Transplant Center in Louisville, KY, for the first patients to receive hand transplantations in the United States.
Solid organ transplants – of the kidney, liver, heart and lungs – have become almost commonplace. Virtually everyone knows someone who has received such a transplant and communities often have support groups who help transplant patients cope with the physical and emotional aspects of their condition. But “composite tissue” transplants – of the face, hand and larynx—are innovative and unique, meaning doctors and patients must confront more unknowns and uncertainties as to how to assess candidates and anticipate outcomes.
Candidates for hand transplantation have experienced the physical and psychological trauma of amputation, and frequently even those who have adjusted extremely well still feel incomplete, Dr. Klapheke said. They may raise mirrors in their homes to avoid seeing the missing hand, and they talk openly of missing the wonders of human touch (hugging loved ones with both hands) or even “the little things” like buttoning a shirt or throwing a ball with their children.
Innovative transplants can have a futuristic or even “science fiction” aspect for patients that psychiatrists must address with patients. For example, unlike a transplanted kidney, a transplanted hand is constantly visible to the patient, who notices the new limb’s different skin, texture and coloring. In assessing candidates for hand transplantation, the patient’s coping skills and level of personality organization (potential for psychological regression in the face of marked stress) must be carefully assessed.
As part of Grand Rounds, Dr. Klapheke presented the case of a health care professional who experienced a traumatic loss of his hand. The patient was assessed pre-transplant as having a well integrated sense of self despite the amputation, but he still felt “damaged” and longed to feel “whole again.” After the transplant he was delighted and felt full ownership of the new hand, but four days after his surgery, the media breached confidentiality and reported that the transplant donor had died while in prison for manslaughter. Now the patient, whose job had been to save lives, had the hand of a man who had killed two people. “I was obviously even more concerned about how well the patient would be able to integrate this new hand into his sense of himself,” Dr. Klapheke said, but the patient was able to immediately respond to the news story by stating, “It’s okay. This is my hand now. It is my blood that courses through it, and I control what it does. It is my hand.”
After the transplant and rehabilitation, this patient carried his son onto the baseball field and with his new hand threw out the first pitch at a professional game featuring his favorite team, the Philadelphia Phillies. Over ten years later, he has continued to demonstrate psychological resilience and remains delighted with “my (new) hand.”