How doctors' friendship got a French woman her new hands in Philly

Three years ago, French surgeon Laurent Lantieri, a face-transplant pioneer, had all the necessary approvals and government financing for the marathon operation that would give a 25-year-old woman from  Paris two new hands.

Neither he nor his eager young patient, Laura Nataf, foresaw the roadblock that would prompt them to turn to the University of Pennsylvania Health System, where the 28-year-old woman had a double hand transplant in August.

"Everything was in place in 2013," recalled Lantieri, chief of plastic and reconstructive surgery at the Georges Pompidou European Hospital in Paris. "We even had the money to do it. But no one was active to find a donor. For three years, there were no potential donors."

Speaking from Paris on Monday, Lantieri said he still does not fully understand why the French agency that coordinates organ transplants, the Agency of Biomedicine, failed in Nataf's case. France's socialized medical system has paid for hand and face transplants, while private insurers in the U.S. continue to consider such nonessential procedures elective and experimental.

In any case, the delay led Lantieri's hospital to balk.

"The hospital said, 'We don't want to fund it,'" Lantieri said. "If a hospital says no, then we have to take the patient off the transplant list."

Nataf  lost both hands and both feet  when she was a 19-year-old college student studying hospitality management. The amputations saved her from a life-threatening bloodstream infection, but the prostheses that replaced her limbs did not look or function like the real tissues. While completing her bachelor's degree, she consulted Lantieri about the possibility of hand transplants, she said last week when Penn issued a news release about her surgery.

During the mysteriously long wait for donor hands in France, Lantieri had a visit from a colleague and friend: L. Scott Levin, the orthopedic and plastic surgeon who established and leads Penn's hand transplant program. Many years earlier, the two trailblazing doctors had met at a medical conference, and eventually collaborated on seminars to train the next generation of doctors in complex composite transplantation -- so-called because it involves attaching blood vessels, bones, nerves, and soft tissues.

"Scott and his wife came to Paris and had dinner in my apartment" while Nataf was waiting for donor hands, Lantieri recalled. "I asked Scott how long the wait would be in the U.S. He said maybe three months."

That's exactly how long Nataf was on the waiting list at Penn, which works with Gift of Life, the nonprofit that recovers and distributes organs in the Philadelphia region. Previously, Penn had done one other adult double hand transplant.

"So basically, this is a story of friendship between Scott Levin and me,"  said Lantieri, who worked beside Levin as they led a team of 30 doctors, nurses, and anesthesiologists in the 81/2-hour procedure.

Both Levin and Lantieri said the financing for their transcontinental leap of faith was still being worked out.

"To be frank, it's still not clear," Lantieri said. "I'm struggling with the French health system to get reimbursement. We didn't have a clear answer" about reimbursement before Nataf's wait ended.

Only about 80 people worldwide have undergone hand transplants since the first in 1963. But Lantieri bristled at the notion that the procedure is experimental. Composite transplants remain controversial because patients must take anti-rejection drugs -- which put them at risk of infection and complications -- even though their replacement tissues are not life-saving.  Patients also must commit themselves to long, arduous physical therapy to gain full use of new hands.

"It is not experimental. That is nonsense," Lantieri said. "Patients can work and become independent and be useful to society."

As an example, Lantieri pointed to one of Levin's successes: Zion Harvey of Baltimore, the world's first pediatric double hand transplant. In August, the 9-year-old  celebrated the first anniversary of his operation at the Children's Hospital of Philadelphia. He was considered a suitable candidate because he was already taking anti-rejection drugs to protect his transplanted kidney. (Like Nataf, Zion lost his limbs because of a life-threatening infection, but in his case it also ruined his kidneys.)

"Look at Zion. Look at that boy," Lantieri said. "The way he can pitch for his Baltimore team and have a normal childhood. That is sufficient for me to say it's the right thing to do."