She Got New Hands. But at What Cost?

After losing your hands, what would you be willing to do to tie your own shoes again, or brush a stray hair off your forehead? Would you risk kidney failure? It's one of the questions underpinning David Dobbs' lengthy piece in Wired on hand transplants, which are currently straddling the space between being experimental and being covered by insurance. The gulf between the two is a massive one: The Department of Defense grants that have paid for most of the trials are about dried up. "To keep money flowing, the field must now persuade the industry and government bodies that set health insurance and reimbursement standards that hand and face transplants are relatively safe, effective, and financially justified," Dobbs writes. In evaluating the cost, Dobbs looks at the eight hand transplant recipients who were part of a trial at the University of Pittsburgh.

One, Sheila Advento, lost both her hands and legs to the knee due to sepsis in 2003; in 2010, she got her new hands. Dobbs explains the science and the risks of the immunosuppressant drugs—which can cause diabetes, cancer, and kidney failure—she has had to take since. "Most people readily accept such risks to get a new heart, lung, or liver: When the benefit is life itself, most find almost any cost bearable. But a hand transplant sharply changes this calculus," Dobbs writes. That's what Advento is learning: In late 2017, blood tests raised concern about her kidneys. She ultimately learned they had only 25% of their function, and she'd need a transplant. She claims she was never told her kidneys could be ruined. Of the other seven patients, one died from complications, one had his transplant removed, and another feels they're useless. Read the full article, which delves into perceived shortcomings in the research that's been done on the transplant recipients. (More Longform stories.)