Erin Core, R.N., B.S.N., worked with the doctors and their first patient to prepare for the procedure.
What kind of preparations did you have to make for the UCLA's first hand transplant?
As the transplant coordinator for our new UCLA Hand Transplant Program, I coordinated the whole process between the large multidisciplinary team of physicians and the patient. Although we were modeling our program after solid organ transplant, not everything about organ transplantation fits the bill 100 percent with transplanting a donor hand. Because of my experience with liver transplants, I knew what it meant to set up a case. Kodi Azari, M.D., the program's surgical director, performed five such transplants at the University of Pittsburgh, but the majority of our surgical team had never done a hand transplant before. To make sure everyone knew what to expect, we did a practice run on a Saturday in December and the whole surgical, anesthesia and nursing came in. The whole surgical team came in, opened the trays in the operating room and set everything up as if it were the real thing. We also went to individual organ procurement agencies to educate them about the process and the protocols we created. We wanted to make sure they would get a signed consent from the donor family, since they might not have anticipated something like this when they agreed to organ donation. We wanted to make sure we didn't cause the donor family any further trauma.
How does a hand transplant differ from other organ transplants?
Hand transplants are different than solid organ transplants in that you have to have a visual match as well as blood-type matching. If a donor organ is a little bigger or smaller than the recipient's, it's not visible. But with a hand transplant, success is measured in both function and appearance. The team developed parameters that would make for a good match. We looked at things like hair growth patterns, skin tone, whether the hand had freckles or not. Dr. Azari took 12 different measurements of the hand to provide to the organ procurement organization for matching purposes. The surgeons had to be able to match bones, blood vessels, nerves, tendons and skin. The technique is similar to surgical replantation of a hand except that there are two pieces that don't go together and the surgeons have to be very precise to make them fit.
What did you most enjoy about being part of the hand transplant team?
It was important for me to have a close relationship with the recipient. If it was midnight and there were concerns or questions, she knew she could call me. Since the surgery, I continue to see and communicate with Emily daily. It is rewarding to have that bond with someone going through such a life-changing event. The best part has been seeing Emily grow from talking about "the hand" to what she now calls "my hand." She has been here almost three months and is getting ready to go home. I'll miss her when she's gone.
What was it like on the day of the surgery?
On March 4, Lifesharing (the organ procurement organization) called and said they had a donor. We reviewed the donor details with Dr. Azari and had a team meeting. Then we called the patient and told her we had a potential donor. Emily said she was ready, so I had pre-arranged for her to fly to Los Angeles and arranged the procurement team to fly to San Diego to recover the donor hand. After Emily prepped for surgery, which began at midnight and ended at 2 p.m. the next day, I helped set her up in the OR and showed her her new hand. We were all up for 36 hours. It was exhausting, scary and exciting, but it was an amazing experience and incredibly awesome to be a part of the team.
When did you know you wanted to be a nurse?
I was a candy striper when I was in high school. My mother recently reminded me that I signed up when I was 14 years old - as soon as I was old enough to do it. I just always knew I wanted to be a nurse.
How did you become interested in transplant coordination?
When I worked in the ICU as a bedside nurse, I met a lot of families who wanted to make the gift of organ donation for their loved one. I admired the families who donated, who made that choice in the middle of their horrifying grief and loss, to give another family a chance. When the opportunity came up to be part of the new hand transplant program at UCLA, I really wanted the job. I had been in liver transplant for four years and I was ready for something different. I was interested in the challenge.
Do you think of your own hand differently now?
Yes. Your hand is your third eye. It's how you can reach into your purse and pull out a pen, how you turn the light on in the dark or grab a cup of water at your bedside in the middle of the night. I don't have to see my keys to grab them. I can just touch them in my pocket and know they're there. A prosthetic hand can't do that.
What are your hobbies?
I was an avid skier until I broke my thumb last year. I love cooking, camping and being outdoors. I also like to go for long walks.
To view a hand transplant video, visit www.handtransplant.ucla.edu