so how’s your kidney doing today you’re
probably not thinking about your kidney
you’re probably thinking about your
bladder but not your kidney most of who
you are is not what defines who you are
most of who you think you are is what
others think you are which in fact you
would hope is who you really are
so who are we most people would say that
we are what is conveyed through our
faces our beliefs our celebrations our
emotions we communicate with our hands
in ways that are explicit any ways that
are implicit and we also communicate
with our voices
usually aided by our hands on our face
this is what most people would say
that’s what we are
so who are they who do they think they
are what voice is given to the voiceless
and how does she communicate and what
can we do for them it turns out quite a
lot I entitled this dog human
transplantation because that’s what I
think we see a really is the field that
I’m involved is in is called
vascularized composite
allotransplantation which is the
transplantation of peripheral tissues
like skin muscle bone nerve with the
vascular supply as a functional unit
like the hand I was born in Bogota
Colombia my first language is a first
language in Spanish and when I finished
high school I won a scholarship by merit
to do it my my international
baccalaureate outside my country and I
chose to go to imbibe and Swaziland in
one of the three kingdoms in Africa I
was the first Colombian at that college
and we were 350 students from 72
different countries I change language I
changed countries I change continents I
change hemisphere and I changed the
structure that I was used to studying I
went on to finish my medical school in
Mexico City and I’ve always been very
interested in doing research
I like understanding and answering
questions in a scientific way so the
last year of my medical school I chose
to do it in immunology or a mythology
and a patient was who inspire me to
think for the first time about a hand
transplant at the time I didn’t know
anybody
who
than a hand transplant I hadn’t heard
about a hand transplant I hadn’t spoken
with anybody about how transplantation
and years later I was fortunate to be in
the first hand team that performed the
first hand transplant and the second
hand transplant in the United States but
like any mere field like any new field
we have scientific questions why were
the animals to study these stitches how
do we talk to each other when we do our
research and how how can can we can we
communicate our findings
what anti-rejection medication do we use
what is the life how is the reason
benefit ratio and the safe
implementation of this field in this
country and what are the functional
outcomes and these have been the areas
that I have been focusing in my career
so we establish an animal model in
rodents to study the mechanisms of how
all these tissues behave after
transplantation we also establish a
nonhuman primate model that follows the
high ethical requirements for
experimentation and these animals even
in the case of graph loss when we
transplant the skin and the bone and the
tendon and the nerve they do not lose
any function but it allows us this model
allows us to test biologic that are very
specific to human with human specificity
which is the only way to do it with this
model we have been able to study not
only the behavior of the tissues but we
have been able to study a new medication
that we have learned from
transplantation that works in hynny
transplantation that is called Bella
Tasha we have been the first to show
that this medication prevents rejection
in non-human primates in this type of
transplant and have also been the first
to show that this medication prevents
rejection
in human hand transplantation in
patients that have received hands we
didn’t have a common language in which
to report our results so we gather
investigators from around the world who
had performed a clinical BCA
and through consensus discussions we
develop a scoring system to report
rejection in the skin and now is a
common language that all teams around
the world use to report their results it
is important to do this with real
careful thought I was fortunate to be
the inaugural committee chair for the
American Society of transplant surgeons
and we put forward recommendations to
add this type of transplant under the
definition of solid organ
transplantation and the final rule came
out and now I serve in the committee at
unis developing the guidelines for a
safe implementation of this type of
transplant in the country this is one of
the most complex things you could ever
imagine
these is clinical research at its finest
and the only way to do it is based on
our very strong multidisciplinary
approach and we have a Duke and people
ask me how big is your team and my
answer is half of Duke University
this is a low-volume type of research or
application we also collaborate
nationally we lead the consortium on VCA
we collaborate with five outstanding
institutions around the country who also
have a preclinical and a clinical
setting for the study of ECA so we stick
to good scientific principles but we
shouldn’t lose track of what these can’t
really do as an example let me share
with you one of my cases miss el who has
given me consent to share the story miss
l lost her left hand on both her lower
extremities when she was four months old
when she turned 21 she was getting ready
to go and celebrate with her friends her
21st birthday and as she wrote to me my
prosthesis broke again and she couldn’t
go out she went onto the website a three
o’clock in the morning on that Saturday
and sent me an email looking for an
option to change her life I spoke with
her the very same day she went through a
very thorough evaluation and after
months she went on the waiting list and
after months of being on the waiting
list a gracious family donated a hand
for her it took us 19 hours to do the
surgery
and every time I do this and I can do
this a million times I will never stop
feeling thrill when I see someone’s hand
come back we match for skin pigmentation
sex blood type and size they go through
extensive therapy and she used to spend
hours looking at her new body image and
I used to think I wonder what she’s
thinking I don’t know what she was
thinking but she allowed us to learn
that for somebody who loses the hand at
four months of age and gets a hand
husband at 21 years old the area in the
brain where that hand was represented
initially that they didn’t have a
presentation for 21 years
it comes back after 54 days
[Applause]
she went like all these patients through
a very extensive rehabilitation
occupational therapy so the therapies
used to do his/her therapy from Monday
through Friday and because the studies
have shown that the more occupational
therapy they do within the first three
to six months the better the outcome I
used to do her therapy on Saturday
mornings
that gave us a very nice opportunity to
also learn about each other and it was
time you know in our conversations to
learn she learned that I like brownies
and when the therapist asked her what
was the activity that she wanted to
translate to in anticipation for going
back home
the first occupational activity she made
brownies for me
needless to say these are the most
special brownies I’ve ever tasted she
now uses her hand in distinctively she
has played golf for the first time in
her life she has played baseball for the
first time in her life she has played
the guitar for the first time in her
life if you ask her who she was he was
not her kidney it was not her liver it
wasn’t even her hand it was her ability
to do what she wanted to do and how she
felt about herself at the end of the day
that’s why we’re here and that’s why we
do research
[Applause]
probably not thinking about your kidney
you’re probably thinking about your
bladder but not your kidney most of who
you are is not what defines who you are
most of who you think you are is what
others think you are which in fact you
would hope is who you really are
so who are we most people would say that
we are what is conveyed through our
faces our beliefs our celebrations our
emotions we communicate with our hands
in ways that are explicit any ways that
are implicit and we also communicate
with our voices
usually aided by our hands on our face
this is what most people would say
that’s what we are
so who are they who do they think they
are what voice is given to the voiceless
and how does she communicate and what
can we do for them it turns out quite a
lot I entitled this dog human
transplantation because that’s what I
think we see a really is the field that
I’m involved is in is called
vascularized composite
allotransplantation which is the
transplantation of peripheral tissues
like skin muscle bone nerve with the
vascular supply as a functional unit
like the hand I was born in Bogota
Colombia my first language is a first
language in Spanish and when I finished
high school I won a scholarship by merit
to do it my my international
baccalaureate outside my country and I
chose to go to imbibe and Swaziland in
one of the three kingdoms in Africa I
was the first Colombian at that college
and we were 350 students from 72
different countries I change language I
changed countries I change continents I
change hemisphere and I changed the
structure that I was used to studying I
went on to finish my medical school in
Mexico City and I’ve always been very
interested in doing research
I like understanding and answering
questions in a scientific way so the
last year of my medical school I chose
to do it in immunology or a mythology
and a patient was who inspire me to
think for the first time about a hand
transplant at the time I didn’t know
anybody
who
than a hand transplant I hadn’t heard
about a hand transplant I hadn’t spoken
with anybody about how transplantation
and years later I was fortunate to be in
the first hand team that performed the
first hand transplant and the second
hand transplant in the United States but
like any mere field like any new field
we have scientific questions why were
the animals to study these stitches how
do we talk to each other when we do our
research and how how can can we can we
communicate our findings
what anti-rejection medication do we use
what is the life how is the reason
benefit ratio and the safe
implementation of this field in this
country and what are the functional
outcomes and these have been the areas
that I have been focusing in my career
so we establish an animal model in
rodents to study the mechanisms of how
all these tissues behave after
transplantation we also establish a
nonhuman primate model that follows the
high ethical requirements for
experimentation and these animals even
in the case of graph loss when we
transplant the skin and the bone and the
tendon and the nerve they do not lose
any function but it allows us this model
allows us to test biologic that are very
specific to human with human specificity
which is the only way to do it with this
model we have been able to study not
only the behavior of the tissues but we
have been able to study a new medication
that we have learned from
transplantation that works in hynny
transplantation that is called Bella
Tasha we have been the first to show
that this medication prevents rejection
in non-human primates in this type of
transplant and have also been the first
to show that this medication prevents
rejection
in human hand transplantation in
patients that have received hands we
didn’t have a common language in which
to report our results so we gather
investigators from around the world who
had performed a clinical BCA
and through consensus discussions we
develop a scoring system to report
rejection in the skin and now is a
common language that all teams around
the world use to report their results it
is important to do this with real
careful thought I was fortunate to be
the inaugural committee chair for the
American Society of transplant surgeons
and we put forward recommendations to
add this type of transplant under the
definition of solid organ
transplantation and the final rule came
out and now I serve in the committee at
unis developing the guidelines for a
safe implementation of this type of
transplant in the country this is one of
the most complex things you could ever
imagine
these is clinical research at its finest
and the only way to do it is based on
our very strong multidisciplinary
approach and we have a Duke and people
ask me how big is your team and my
answer is half of Duke University
this is a low-volume type of research or
application we also collaborate
nationally we lead the consortium on VCA
we collaborate with five outstanding
institutions around the country who also
have a preclinical and a clinical
setting for the study of ECA so we stick
to good scientific principles but we
shouldn’t lose track of what these can’t
really do as an example let me share
with you one of my cases miss el who has
given me consent to share the story miss
l lost her left hand on both her lower
extremities when she was four months old
when she turned 21 she was getting ready
to go and celebrate with her friends her
21st birthday and as she wrote to me my
prosthesis broke again and she couldn’t
go out she went onto the website a three
o’clock in the morning on that Saturday
and sent me an email looking for an
option to change her life I spoke with
her the very same day she went through a
very thorough evaluation and after
months she went on the waiting list and
after months of being on the waiting
list a gracious family donated a hand
for her it took us 19 hours to do the
surgery
and every time I do this and I can do
this a million times I will never stop
feeling thrill when I see someone’s hand
come back we match for skin pigmentation
sex blood type and size they go through
extensive therapy and she used to spend
hours looking at her new body image and
I used to think I wonder what she’s
thinking I don’t know what she was
thinking but she allowed us to learn
that for somebody who loses the hand at
four months of age and gets a hand
husband at 21 years old the area in the
brain where that hand was represented
initially that they didn’t have a
presentation for 21 years
it comes back after 54 days
[Applause]
she went like all these patients through
a very extensive rehabilitation
occupational therapy so the therapies
used to do his/her therapy from Monday
through Friday and because the studies
have shown that the more occupational
therapy they do within the first three
to six months the better the outcome I
used to do her therapy on Saturday
mornings
that gave us a very nice opportunity to
also learn about each other and it was
time you know in our conversations to
learn she learned that I like brownies
and when the therapist asked her what
was the activity that she wanted to
translate to in anticipation for going
back home
the first occupational activity she made
brownies for me
needless to say these are the most
special brownies I’ve ever tasted she
now uses her hand in distinctively she
has played golf for the first time in
her life she has played baseball for the
first time in her life she has played
the guitar for the first time in her
life if you ask her who she was he was
not her kidney it was not her liver it
wasn’t even her hand it was her ability
to do what she wanted to do and how she
felt about herself at the end of the day
that’s why we’re here and that’s why we
do research
[Applause]
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