Dr. Tsu-Min Tsai, left with Kleinert Kutz and Associates and Dr. Joao Panattoni, fellow with the Christine M. Kleinert Institute perform vascular surgery on Donnie Rickelman's transplanted hand at the Jewish Hospital Hand Care Center on July 10, 2011. | Courtesy of Jewish Hospital; Kleinert, Kutz and Associates Hand Care Center; and University of Louisville.
Dr. Tsu-Min Tsai (left) with Kleinert Kutz & Associates and Dr. Joao Panattoni, fellow with the Christine M. Kleinert Institute, perform vascular surgery on Donnie Rickelman’s transplanted hand at the Jewish Hospital Hand Care Center on July 10, 2011. | Courtesy of Jewish Hospital; Kleinert, Kutz & Associates; and University of Louisville

For a few days after work last week, Donnie Rickelman, 41, started to remodel the bathroom in his Linton, Ind., home. He rolled up his sleeves, removed the toilet and ripped out the floor.

The seemingly mundane project was anything but: A few years ago, that endeavor would have been virtually impossible for Rickelman, because he had lost his left hand in an industrial accident in 1998.

In 2011, Rickelman was the seventh person to receive a hand transplant from the Louisville Vascularized Composite Allograft program. The program is a partnership of physicians, researchers and health care providers from Jewish Hospital, the Christine M. Kleinert Institute for Hand and Microsurgery, the Kleinert Hand Care Center and the University of Louisville.

After a recent check-up in Louisville, during which he received a clean bill of health, Rickelman told IL that after spending years as an amputee, having the use of both hands has made a tremendous difference, both in his professional and personal life.

He and his wife, Kelli, also encouraged people to become organ and tissue donors.

Meanwhile, a local doctor praised Rickelman for his dedication and said that the success of such a complicated surgery depends on many factors, including the patient’s willingness to work hard during the recovery.

The accident

Donnie Rickelman
Donnie Rickelman

On March 9, 1998, at age 23, Rickelman was nearing the end of his shift in an industrial facility when his left hand got caught and crushed in a steel splitting machine. At its narrowest, the machine left just 1/16th of an inch of space.

Instead of the metal going through the machine, Rickelman said his left hand went through it. He could not extricate himself, and neither could nearby co-workers.

“Once you’re in, you’re stuck,” he said.

Rickelman said he had to wait for 45 minutes for emergency crews to arrive.

The machine’s pressure kept the bleeding under control, he said. That changed when emergency personnel freed him from the machine. He was taken to a local hospital, then to a hand center in Indianapolis. Surgeons amputated the hand below the wrist.

Rickelman said that adjusting to life with one hand was tough, especially because his right hand had suffered some damage, too.

He could not work, which was a blow to his psyche, but even the simplest things, such as tying his shoes, were impossible.

Rickelman said people who have two hands don’t realize how often they use both hands, from putting on clothes in the morning to eating with knife and fork to operating a mobile phone.

“It’s a two-handed world,” he said.

“You say you can (do anything), but you can’t,” Rickelman said. “Your life will be different forever. You have to live a different way.”

Hand transplants in Louisville began in 1999, and Rickelman said he kept an eye on the developments. He had seen some of the successes and decided to see if he might be a candidate for the surgery. Doctors approved his request in 2008.

The surgery

On July 10, 2011, about 13 months after Rickelman had entered the donor network, the Louisville program found a suitable donor arm.

Doctors notified Rickelman and sent a group of medical professionals, the retrieval team, to secure the arm.

The retrieval team flew its precious cargo to the Louisville hospital. Medical staff prepped the patient for surgery. Two surgical teams went to work. One worked with the patient. The other on the donor arm.

The bone work came first. Surgeons connected the bones, and kept it in place with screws. Next, they connected the blood vessels, another critical step to provide the newly connected limb with life-preserving fluids. Tendons, nerves and skin followed.

Dr. Tuna Özyurekoglu, hand surgeon at the Kleinert Kutz Hand Care Center, said such surgeries come with significant risk. Some transplant patients, especially those with several amputated limbs, risk losing their life. Sometimes blood flow to the transplanted limb is interrupted, which can result in loss of the limb.

Even with successful surgeries, patients face the prospect of their bodies rejecting the new limb. And if that doesn’t happen, they still have to take immunosuppressants, which decrease their body’s immune response and expose them to greater risk for infections and cancer.

The procedure was paid through a Department of Defense research grant.

Donnie Rickelman smiles as (L-R) Drs. Joseph Kutz, Huey Tien, Christiana Savvidou, and Rodrigo Moreno prepare to re-bandage his arm three days after he received a new left hand at Jewish Hospital. | Photo courtesy of Jewish Hospital; Kleinert, Kutz and Associates Hand Care Center; and University of Louisville.
Donnie Rickelman smiles as Drs. Joseph Kutz, Huey Tien, Christiana Savvidou, and Rodrigo Moreno prepare to re-bandage his arm three days after he received a new left hand at Jewish Hospital. | Photo courtesy of Jewish Hospital; Kleinert, Kutz & Associates; and University of Louisville

Recovery

Rickelman said his first thoughts after surgery were simple.

“I had two hands again,” he said. “It’s been great every day since then.”

Some feeling came back almost immediately, he said, as if that part of his mind had been merely asleep and was awoken by the addition of the new limb.

“It’s like you never lost it,” he said. “It’s pretty amazing.”

But the months after surgery required hard work and dedication to physical therapy and exercises.

Rickelman said that movement came back almost immediately after the surgery, though regaining feeling in the entire limb takes years.

Dr. Tuna Özyurekoglu
Dr. Tuna Özyurekoglu

Dr. Özyurekoglu said nerve regeneration is a critical part of the outcome. The nerve has to find its path and grow into the donor hand to deliver information from the fingertips to the brain. The nerves grow about 1/32 of an inch per day. It usually takes about three or four months until the patient can feel the fingertips.

Rickelman spent three months after the surgery at the hospital, working with a physical therapist for three hours per day. That was followed by about nine months of nearly constant exercises Rickelman had to do by himself.

Özyurekoglu said that the surgical success, Rickelman’s age and his determination and attitude played crucial roles in his recovery.

“He’s the most determined person,” the doctor said. “He was really very dedicated to the physical therapy.”

Özyurekoglu said even he was surprised by the patient’s progress, especially when he saw him shuffling cards shortly after surgery.

“I was very impressed.”

Life today

Rickelman said the surgery changed his life in many ways.

His hand functions almost like a normal limb, he said, though sensation still continues to improve.

He now works in retail, selling clothes. But it’s the little things he notices most, such as being able to tie his shoes. Or wearing his wedding ring.

Rickelman and his now-wife, Kelli, got together a year before the accident and married in 2001.

Kelli Rickelman, a social worker, said the surgery has not changed her husband’s personality, but it has made him more independent. Having to depend on others had bothered him, she said.

Now, she said, he’s “definitely happier.”

Rickelman said this week that he considers his left hand his own and he does not think about the transplant much.

“Every day, things get a little easier,” he said.

He does think often about the sacrifice of the donor and the donor family, he said.

“It’s all possible because of organ donation.”

The need for more organ donors is rising, as the number of people on waiting lists continues to outpace — by far — the number of donors.

About 120,000 people, including 1,020 Kentuckians are on a waiting list for an organ transplant, according to the U.S. Department of Health and Human Services. Every 10 minutes, another person is added to the list.

And every day, 22 people die waiting for a transplant.

“There is a scarcity of organs,” said Shelley Snyder, spokeswoman for Kentucky Organ Donor Affiliates.

She encouraged all Kentuckians to declare their willingness to become organ donors when they get their driver’s license or sign up at the Kentucky Organ Donor Registry.

Courtesy of U.S. Department of Health and Human Services
Courtesy of U.S. Department of Health and Human Services

While 51.3 percent of Kentuckians and 60.2 percent of residents of Jefferson County are organ donors, Snyder said the share needs to be higher to meet the growing demand — only three in 1,000 people die in a way that allows for organ donation.

Many people who choose not to become donors do so because they mistakenly believe their lifestyle, illnesses or age would preclude them from becoming donors, Snyder said. The oldest donor in Kentucky was 84, she said, and saved three lives because of liver and kidney donations.

Snyder said that limb donations are not covered under the organ registry, which makes it important for potential donors to talk to their families about their wishes.

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Boris Ladwig
Boris Ladwig is a reporter with more than 20 years of experience and has won awards from multiple journalism organizations in Indiana and Kentucky for feature series, news, First Amendment/community affairs, nondeadline news, criminal justice, business and investigative reporting. As part of The (Columbus, Indiana) Republic’s staff, he also won the Kent Cooper award, the top honor given by the Associated Press Managing Editors for the best overall news writing in the state. A graduate of Indiana State University, he is a soccer aficionado (Borussia Dortmund and 1. FC Köln), singer and travel enthusiast who has visited countries on five continents. He speaks fluent German, rudimentary French and bits of Spanish, Italian, Khmer and Mandarin.