CHOP Doctor Changes Boy’s — And World’s — Future

They are words that every anxious parent longs to hear from the family’s physician. “We have some good news for you,” said Dr. L. Scott Levin to Pattie Ray after more than 10 hours of surgery. “Your little guy has two hands.”
Zion Harvey, of Owings Mills, Md., can now play with action figures and scratch his nose with his index finger. Eventually, he wants to be able to swing from the monkey bars on the playground.
This may seem normal for a typical 8-year-old boy, but Zion will be doing it all with new hands.
He received the world’s first pediatric bilateral hand transplant in late July, led by Levin.
“When I get these hands, I will be proud of what hands I get,” Zion said in a video provided by the Children’s Hospital of Philadelphia.
“I will be too,” said his mother in the video. “This is just another hurdle that he jumps — I don’t know many adults who could handle half of his life on a day-to-day basis.”
Levin met Zion and Pattie 18 months ago when they were referred to Levin and his surgical team by Shriners Hospitals for Children in Philadelphia. From the beginning, Levin and his team planned a program for Zion to successfully execute the transplant.
When Zion was 2, he developed sepsis, a life-threatening infection that resulted in the amputation of both his hands and legs below the knee. According to WebMD, sepsis usually occurs in elderly, babies or people with very weak immune systems. It can be contracted through bacterial infections as simple as a scraped knee to more serious problems like pneumonia.
The infection also damaged his kidneys to the point that when he was 4, he received a kidney transplant from his mother.
Although he’s been in and out of hospitals for most of his life, Levin said Zion was actually a perfect candidate for this surgery because he already received a kidney transplant, meaning he was already on the medication to prevent rejection from his kidney, thus lowering the possibility of post-operative complications.
Levin is the chair of the Department of Orthopedic Surgery and a professor of surgery in the Division of Surgery at the University of Pennsylvania Pearlman School of Medicine.
He established the Hand Transplantation Program at CHOP with Abraham Shaked, a prominent Israeli transplant surgeon. Together, they successfully completed their first adult hand transplant in 2011.
For children, the likelihood of receiving a hand donor of similar size, blood type, skin color and gender is very small — around 15 donors a year. But after just three months of being on the waitlist, Pattie Ray got the call.
The 40-person surgical team practiced diligently on cadavers several times prior to Zion’s transplant surgery.
“There’s always a risk when you do something for the first time,” Levin said. “We planned for success; we didn’t plan for failure.”
The surgery was indeed a success. Levin said it will take a few months before he can see the full benefits and use of Zion’s hands, but he is healing well.
Levin said Zion is a remarkable young boy who is wise beyond his years. He has faced a lot of challenges in his young life and had to adapt to much more than most people ever have to, but Levin said he has always been a confident, intelligent and resourceful kid.
“As a general rule, we say children may be different, but they’re not disabled,” and Zion “has clearly demonstrated that,” he said.
Before attending medical school at Temple University, Levin worked in the emergency room at Duke University Medical Center as an orderly while earning his undergraduate degree, during which the field of replantation surgery was just forming.
While mopping the floors of the ER, Levin recalled watching patients with amputated parts go in for surgery and come out with reattached limbs, which was his first exposure to microvascular surgery.
Levin later completed his residency at Duke University Medical Center for general orthopedic and plastic surgery training, where he also became the chief of plastic surgery in 1995.
The first hand transplant in the U.S. was in 1999 at Louisville Jewish Hospital and successfully completed by Dr. Warren Breidenbach, a mentor of Levin’s.
Although he did not know him, his grandfather was an otolaryngologist who specialized in ear, nose and throat (ENT) disorders, with a practice in Philadelphia. He also took care of World War I soldiers, and was awarded the French Medal of Honor.
After hearing about his grandfather’s interesting life for most of his own, Levin said, “next thing you know, I’m in med school.”
He is also committed to advancing hand surgery in Israel. He’s trained several Israeli doctors who do fellowships at the University of Pennsylvania Pearlman School of Medicine under his guidance.
Several of his past fellows now practice replantation surgery in Israel.
“I’ve tried to build a bridge to Israeli reconstructive surgery and Israeli microsurgery,” he said. “This exchange is the greatest joy I can have.”
Levin has lectured on the field of replantation several times in Israel. He views some of his closest colleagues as family, such as Dr. Batia Yaffe, a hand surgeon in Israel who cared for bombing victims.
Levin has had thousands of patients over the past 25 years that he’s operated on, but he said the most rewarding work is giving an adult or child hands so they can be independent and socially integrated.
“If you can do something good for other people, that’s the greatest gift that you can give someone.”
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