Even without hands and feet, Zion always lived life to the fullest. He ran on prosthetic (artificial) legs, and he played video games using only his forearms. But he wanted to do other things his classmates did, such as throw a football and climb the monkey bars.  

Doctors had performed hand transplants on adults before, but never on a child. The structures inside a child’s hand and arm are smaller and trickier to connect. Doctors were also concerned about whether their young patient understood what would happen and if he could deal with the therapy that would be required afterward. Benjamin Chang, a surgeon who co-directed Zion’s surgery, says, “You have to make sure that he really wants to have this done, as opposed to the adults telling him, ‘This is what you should do.’ ”

Doctors had been reluctant to do a hand transplant on a child for another reason. A person’s immune system protects the body by attacking anything that seems to be a foreign invader—including donated organs or tissue. “The patient has to be on medication the rest of his life so his body accepts the transplant,” says Chang. “Otherwise, his immune system will reject it, because it’s somebody else’s tissue.” These immunosuppressant medications increase a person’s risk of developing infections and cancer. When a patient needs a life-saving transplant, such as a heart or kidney, it’s an easy choice. But since a person doesn’t need hands to survive, it’s harder to justify the risk—especially when it’s a child with a long life ahead of him or her. 

In Zion’s case, the infection that took his hands and feet also ruined his kidneys. Zion had received a kidney transplant from his mom, so he was already on lifelong immunosuppressant medication. “We can use exactly the same medication he needs for the kidney in order to keep his hands from being rejected,” says Chang.

Even after Zion made up his mind to have the transplant, doctors couldn’t simply schedule the surgery. Donor hands come only from someone who has died. If the operation proceeded, it would be because a grieving family had unselfishly decided to help another child in need. Odds were that it would take a long time to find a donor who matched Zion in size, skin color, and gender.  

Meanwhile, the medical team rehearsed the complex operation in cadaver laboratories, practicing on donors who had left their bodies to science when they died. L. Scott Levin, director of the hospital’s hand transplant program, says, “We wrote down the steps, similar to the way a pilot would have a checklist on how to take off and land.”

To the team’s surprise, only three months after Zion was placed on the transplant list, the call came that a donor had been found. Now the race to transplant the hands was on. “We had only about five or six hours to get blood circulation restarted,” says Chang. “Otherwise, the hands would be permanently dead.” Two doctors traveled to retrieve the hands, while others prepared Zion for surgery.

Four groups of surgeons, one for each of Zion’s forearms and each donated hand, followed the steps they’d rehearsed. “We opened up our patient’s arms and found all the bone, the tendons, the nerves, the blood vessels,” Chang says. “We did the same thing on the donated hands, and then we put everything together.” They connected the bones using metal plates and then connected the blood vessels to restore circulation. Zion’s new hands turned pink as his blood flowed into them. With circulation restored, the surgeons connected muscles and tendons so Zion could move his new hands, and nerves so he could have feeling in them (see Transplant Anatomy). The entire operation took nearly 11 hours. 

When Zion was wheeled out of surgery, he had two hands. Then he had to learn how to use them. He spent hours each day on physical and occupational therapy, learning to do the everyday things most people take for granted. He worked on moving his fingers and wrists and grasping objects. “The parts of his brain that control his hands were not as active as those of a child who has hands,” says Levin. “So his brain is trying to catch up with having hands.”

By the time Zion went home in August—just a few weeks after his surgery—he could play with action figures and had feeling in his palms. His reconnected nerves are still repairing themselves, so he may have to wait months for feeling to reach his fingers. He’ll continue with therapy for up to two years. “He’s doing more each day,” says Levin. 

The hospital staff threw a pizza party for Zion before he left. Zion thanked everyone there, but he didn’t forget those who weren’t there: He told his doctors that he wants to write a thank-you letter to the donor’s family.

Doctors will monitor Zion’s progress over the years. “We hope to apply what we learn to other children so this is not just a reality for one child,” Levin says, “but literally hundreds or thousands as time goes on.”