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Iraq War Vet Receives Rare Double Arm Transplant

January 29, 2013 at 12:00 AM EDT
Former solider and Iraq war veteran Sgt. Brendan Marrocco is the recent recepient of a double arm transplant, which took place at Johns Hopkins Hospital. Marrocco lost all of his limbs during a roadside bomb attack in the spring of 2009. Gwen Ifill talks with Dr. Jaimie Shores, director of hand transplantation at Johns Hopkins.

GWEN IFILL: Finally tonight: the story of the first U.S. veteran to receive a double arm transplant.

Doctors at Johns Hopkins Hospital in Baltimore, where the surgery was performed last month, released details of the operation today and the reaction from the patient himself.

GWEN IFILL: For 26-year-old Brendan Marrocco, a retired Army sergeant, it was a moment four years in the making.

SGT. BRENDAN MARROCCO, U.S. Army: It feels amazing. It’s something that I was waiting for, for a long time. And now that it finally happened, I — I really don’t know what to say, because it’s just such a big thing for my life. And it’s just fantastic.

GWEN IFILL: In 2009, then Private Marrocco lost both arms and both legs in a roadside bombing outside Baghdad. Then, just over a month ago, he received a rare double arm transplant. Today, he was discharged from Johns Hopkins Hospital in Baltimore.

Dr. W.P. Andrew Lee led the team that performed the 13-hour operation.

DR. W.P. ANDREW LEE, Johns Hopkins Medicine: Only six other patients have undergone successful double hand transplants in the U.S., and Brendan’s surgery was the most extensive and complicated arm transplant performed.

GWEN IFILL: Sergeant Marrocco said he is already seeing signs of progress.

BRENDAN MARROCCO: I don’t really have feeling or movement in the hands yet, but we will get there. I can move my elbow. This was my elbow, the one I had before. I can rotate a little bit. This arm is pretty much not much movement at all.

GWEN IFILL: His doctors cautioned it will be slow going, maybe a year or longer, before Marrocco can fully use and feel his new arms.

In the meantime, the patient played down any talk of going for a double leg transplant.

BRENDAN MARROCCO: Arms is certainly enough for me. I hated not having arms. I was all right with not having legs. Not having arms takes so much away from you out of even your personality. You know, you talk with your hands. You do everything with your hands, basically. And when you don’t have that, you’re kind of lost for a while.

GWEN IFILL: Marrocco said, ultimately, he hopes to swim and compete in a marathon using a hand cycle.

More now about the surgery, the road ahead for Sergeant Marrocco and the bigger picture for future treatment. That comes from a key member of the Hopkins team, Dr. Jaimie Shores, the clinical director of hand transplantation at the hospital.

Dr. Shores, thank for joining us.

We know that this operation was rare. We hear that he’s one of only seven people in the U.S. who have had a double hand transplant. How risky was it?

DR. JAIMIE SHORES, Johns Hopkins Medicine: Well, we feel that we have been able to minimize the risks because we do so many rehearsals and we did such an extensive preoperative workup on it to make sure that we mitigate any negative aspects to the operation to lower them and make it as safe as possible.

But there is always risk with any sort of operation like this. If you look at the number of hand transplants that have been performed in the U.S., though, the rate of not having the hand survive the operation within just the first few days is extremely low.

I think there have probably only been two cases where hand transplants have been lost out of probably 22 attempts in the United States that we know of.

GWEN IFILL: You said you did rehearsals. Tell us about that. How many were there and how does that work?

JAIMIE SHORES: Well, we did several. And what we do is we — based on the preoperative workup that we do for Brendan, we go to the anatomy lab and we have cadavers that we use to try to study what we think is the best way to transfer nerves, muscles, provide bony fixation to dissect out the blood vessels and transfer those as well.

And then we also rehearse the best way to try to procure the arms from the donor and preserve them. And so we had a large group of surgeons that we rehearsed four or more times with. And …

GWEN IFILL: When you say large group, you’re talking about how many people?

JAIMIE SHORES: Well, ultimately, there were about 16 of us involved in the operation. But during the rehearsals, we had even more, probably closer to 20.

And we would take every single rehearsal, and we would modify and refine our operative technique, so that he we had things down. And then everybody that participated in the operation is assigned a specific job. They know what their role on the team is and they know exactly where to go and what to do.

GWEN IFILL: I’m sorry to interrupt. You’re talking nerves and bone and tendons and muscles and skin and another donor arm, limb. This sounds extremely complicated.

JAIMIE SHORES: Well, it’s — it is a bit complicated. But that’s why we do so much in-depth planning and so much rehearsing. We want to take all the guesswork out of it to make it as safe as possible.

GWEN IFILL: Now, he said that — today that he couldn’t feel anything yet. It’s been about a month since the surgery. But how long does it take for things to begin to regenerate, for feeling to be restored, for mobility to be restored?

JAIMIE SHORES: Yes, so, the mobility will probably start earlier for him because the muscles that move his elbows are his own muscles on both arms. The right arm, we’re not allowing him to move very much right now because we want the — where we put the muscles that flex the elbow and extend the elbow into the tendons that anchor into the bones of the arm that we have reattached there to heal.

But his left arm, the elbow flexors and straighteners are all his own. And so they work well.

GWEN IFILL: So, he had had a prosthesis on that arm before, right?

JAIMIE SHORES: He had a myoelectric prosthesis, that’s correct.

But the problem is the nerves. The nerves are sort of the rate-limiting factor for every kind of transplant. And nerves take about a month to start regenerating. And then they grow at a rate of about an inch a month in healthy young people. And so if you count the number of inches from where we transplanted his arm all the way out to his fingertips, we’re talking about a few years of nerve regeneration that we’re going to have to wait for until he has good sensation there.

If you look at the progress that hand transplants throughout the world have made, what we see is that every single year, even after they have had their transplants for five years or more, they seem to still recover more and more sensation.

GWEN IFILL: In fact, one of the doctors today was saying that at least one other transplant recipient was using chopsticks at this stage.

JAIMIE SHORES: That’s correct. The only other above-elbow transplant that’s been performed in the U.S., which we performed about almost three years ago, is still acquiring more and more function. He has not yet plateaued. And so we expect that Brendan will do the same for years. He will keep getting better and better.

GWEN IFILL: Let me ask you a very basic question.

We have done a lot of coverage here, and everyone has been following very closely the incredible leaps and bounds that have been made using prostheses, and the mobility which has been restored especially to victims of IEDs and other traumatic injuries in wars. Why not continue to build on that technology? What is the advantage of transplantation?


We actually still are building on that technology. And we here at Johns Hopkins even participate in a program that capitalizes on that led by a surgeon named Albert Chi called targeted muscle reinnervation.

But we think that, for certain people, that technology and using really advance robotics is a better option than other patients. And so we try to decide that on a case-by-case basis. The higher the amputation, the poorer the nerve regeneration is going to be. And we have a feeling that those patients, at least right now, are probably better candidates for more advanced robotic arms.

But for people like Brendan, who have lower amputations, if you sit and talk with them, they will tell you how much they dislike their prosthetics, because they’re uncomfortable, they’re heavy. They sweat like crazy inside of them. And they have to have somebody help them take them on — or put them on, take them off.

And so — and they don’t have any sensation. And so when you put all those things together, if you look at how much most prosthetic users actually wear and use their prostheses, the best recorded use rates are usually about 50 percent of the time. And so having a hand that doesn’t come off, but also has sensation, that’s comfortable, you know, that weighs as much as a hand should seems to be what the body wants.

GWEN IFILL: Dr. Jaimie Shores of Johns Hopkins University Hospital, thank you so much.