With the gift of hands comes feeling like ‘a whole human being’
Getting Luka Krizanac new hands took 16 years, a connection between a surgeon and his mentor, and surgeries on two continents.
When 29-year-old Luka Krizanac reflects on the long chapter of his life without hands, he emphasizes that it wasn’t an entirely sad one.
Those 16 years in Zurich, Switzerland, were filled with moments of beauty and personal fulfillment. Krizanac (pronounced: Kree-JAH-nahtz) took up drawing and painting, graduated from college and received a master’s degree in political science and business administration, got a job in banking, traveled with his family, and spent glorious summers by the sea in Croatia. Through the years, he had immeasurable support from his loving parents and brother. Yet, the loss of his hands at age 12 was a trauma and tragedy that robbed him of independence during those teen and early adult years. It’s hard to convey all the ways our hands contribute to feeling human, in Krizanac’s view.
“People usually struggle to understand how much they do with their hands. And I don’t mean just practical stuff, but basically surviving as humans, even in today’s modern world,” he said. “As much as you try to build the comfort and confidence without hands … you’re always with someone assisting you. As much as you love them, as much as you care about them, you never have the chance to do it on your own, which ties into the fact that you’re also not able to fully develop as a person.”
In the fall of 2024, Krizanac received the gift of new hands at Penn Medicine. Long before he regained sensation or functionality in the new limbs, he said, he began to feel like “a whole human being.”
Penn Hand Transplant Program Director and orthopaedic and plastic surgeon L. Scott Levin, MD, with plastic surgeon Benjamin Chang, MD, the program’s co-director, worked with four surgical teams for more than 10 hours at the Hospital of the University of Pennsylvania to connect donor forearms and hands to Krizanac’s upper arms.
Krizanac was Penn Medicine’s first bilateral hand and forearm transplant recipient since before the COVID pandemic and the first in the U.S. since 2021. His was the fifth such transplant performed by the vascularized composite allotransplantation team led by Levin and Chang.
Penn’s hand transplant program is one of only a few in the world. Levin established the program with liver transplant surgeon Abraham Shaked MD, PhD in 2009, as part of the Penn Transplant Institute, with support from liver, kidney, and pancreas transplant surgeon Matthew H. Levine, MD, PhD, and liver transplant surgeon Kim Olthoff, MD.
For Krizanac, the journey to receive hands spanned more than 16 years, a global pandemic, a fateful connection between a surgeon and his mentor, and surgeries on two continents.
A devastating loss
Krizanac was on the cusp of adolescence in 2008 when an improperly treated infection led to severe sepsis and multi-organ failure that almost killed him. Surgeons at another hospital amputated parts of both his arms and legs to save his life.
He learned early on to use prosthetic legs, and they served him well in daily life; he never thought about not having legs. But hands were a different story. Prosthetics didn’t come close to replicating the intricate movements and flexibility of the real thing.
“A lower leg is less complex than the human hand,” Levin said, noting that the lower extremity is primarily used for standing and walking. On the other hand, "you do 1,001 activities on a daily basis with your hands. Upper extremity prosthetics usually cannot provide that degree of function.”
Krizanac learned to eat, type, draw, and do many things for himself at home without prosthetic hands, and he reserved the prosthetics for when he left the house.
But Krizanac couldn’t hold a pen and take notes with a silicone hand or slip on a jacket without the prosthetics getting stuck in his sleeves. It wasn’t possible to run a silicone hand through his hair and not tear out the hair. Nor could he go to a cafe on his own and buy himself a coffee, with all the steps the trip entailed: Put on his jacket. Open his wallet. Hold the cup. Take off the lid to add a bit of cold milk. He required assistance for so many of the tasks many people rely on their hands to do without thinking.
“For everyone else, this is a daily thing that they don’t even think about. They forget about it the instant that they do it,” he said, thinking about the coffee shop. He mentioned the example, not because he cared that much about going out for coffee, but to illustrate the independence it represented.
A fateful connection
Not long after his illness, his mother read about a patient who received a hand transplant in Austria. He and his parents would sit in countless doctors’ waiting rooms, pursuing a hand transplant in their country and making no progress.
Meanwhile, in 2016, Levin traveled to Switzerland’s Balgrist University Hospital to give a lecture about the program he and Chang had built at Penn; at that point, they had performed two bilateral hand transplants, including the world’s first on a child, a collaboration between Penn Medicine and Children’s Hospital of Philadelphia.
The lecture Levin gave that day was named for Reinhold Ganz, MD—a pioneering hip surgeon and Levin’s mentor during a specialized orthopaedics fellowship in Switzerland in 1988. Ganz was in the audience as Levin spoke.
Two years later, when Krizanac’s family was facing roadblocks, Ganz called his former fellow:
I want to refer a patient to you.
Krizanac’s father, a nurse, was the operating room manager at the medical center where the renowned surgeon worked.
Getting a referral from his former mentor “was a tremendous honor, but also a tremendous responsibility,” Levin said. “He’s a remarkable guy and has done so much for thousands of patients.” Being given the chance by Ganz to perform the first vascularized composite allotransplant—the term for the transplantation of multiple tissue types as a single functional unit—of a Swiss patient was particularly meaningful.
Krizanac was 22 years old and had been living without hands for a decade.
“As you can imagine, especially as a kid, you are disappointed in doctors. You’re disappointed in health care. You feel betrayed by that,” Krizanac said. “But then, to encounter someone who is so dedicated to you, so dedicated to helping you and making your life better, this just changes your whole perspective on the medical field and what it means to be a patient.”
The Penn hand transplant team began the labor-intensive process of rehearsing for his transplant in Philadelphia. Unlike other surgeries, each hand transplant is customized to the patient. Attending surgeons, residents, fellows, and nurses rehearsed Krizanac’s surgery more than 12 times. They donated their time after-hours to rehearsals in the cadaver lab, continuing through the COVID pandemic so they’d be ready to go when a match was found.
A complication and a committed team
Krizanac’s belief in Levin and his team was cemented when he developed painful wounds on his knees and required reconstructive surgery before the hand transplants could go forward. Transplant recipients must take immunosuppressant drugs continuously to stop their bodies from rejecting the foreign limbs, and the immunosuppression would impair the wound-healing process on his legs.
In April 2021, Levin and Penn Medicine plastic surgeon Stephen J. Kovach, III, MD, co-director of the Penn Orthoplastic Limb Salvage Center, flew to Switzerland to perform reconstruction of Krizanac's lower limbs. They worked in two teams at the University Hospital of Bern, with Esther Vögelin, MD, and Radu Olariu, MD, the hospital’s co-director of hand and plastic surgery and co-chief of plastic surgery. The surgery took seven hours.
“Luka saw in our team was that we were committed to him for the long haul,” Chang said.
It wasn’t just that Levin was willing to cross an ocean for Krizanac. The surgeon treated him as more than a patient, he said.
“When I came out of the surgery for the legs, people would talk to me standing at the end of the bed. He would kneel to be the same height as me,” Krizanac said. “He’s a person who is very senior, who has a huge, huge amount of knowledge and talent; but when he speaks to me, he’s like, ‘What is worrying you? What can I explain? What has someone said that is unclear?’”
After a year of recovery, Krizanac was ready for hands.
The wait
Through the years, Krizanac remained hopeful that there was a light at the end of his tunnel—even if he didn’t know how long it would take to get there. But desperation set in at times, knowing there was a solution out there—but not knowing when, or if, it would come to him.
In the meantime, he tried to do as much as possible with the body he had.
“If you want to function in a life where you don’t have hands, and you start thinking about how it would be to live with hands, this can create a very depressing situation,” he said. “It was a balance of saying … ‘Maybe it’ll happen soon, maybe it’ll take more time than I think,’ but at the same time saying, ‘Okay, I’m stuck with this situation now,’ … so I try to enjoy myself in the meantime.”
Then, last fall, Levin and Krizanac agreed he should come to Philadelphia to wait for a donor. Krizanac was the only one on the national waiting list for a bilateral hand transplant, Levin said, and he was “the perfect candidate.”
But the days passed by. Finding the right set of arms and hands is complicated—in addition to matching blood and tissue types, they must also match for gender, skin color and tone, and size.
Krizanac and his family felt the ongoing support of not only Levin, but the whole transplant team, along with Levin’s wife, Helga, who is German. She baked German bread for Krizanac’s family each week and made them feel at home. Each day, the surgeon remembers asking her, “When is this going to happen? We must find a donor for Luka.”
Finally, after eight weeks, the call came. There was a match.
At 1:34 a.m., Krizanac went into surgery. Like all hand transplants, it was a complicated operation, involving four surgical teams—two on the donor limbs, and two on the recipient’s—working through the night to carefully connect the bones, nerves, arteries, muscles, and skin.
Feeling the weight of new hands
Transplant nurse Charlotte “Carly” Baker, BSN, RN, remembers a day, a couple of weeks after the surgery, when the physical therapy team put Krizanac’s new arms into slings and had him walk.
“He didn't let anyone rush him in the moment; it seemed like he wanted to soak it all in, as he felt where his new arms and hands were,” she said. “That moment is something that will stick with me forever, because I was very amazed at his ability to be really mindful.”
Just three weeks after the surgery, Krizanac could push up his glasses and scratch his cheek using his own fingertip. And less than a week after that, Levin received a video on his phone from Krizanac. It showed his patient using his phone with his new hand.
“That was really incredible … to get that video,” Levin said. “All the nights, all the rehearsals, all the anxiety, all the preparation—of course, it’s worth it.”
Levin emphasized that the outcome would not have been possible without the close collaboration with his Swiss colleagues—from Ganz’s referral of Krizanac to Vögelin and her team’s partnership, first for Krizanak’s leg surgery, and continuing through his ongoing physical therapy and recovery.
In fact, Vögelin visited Philadelphia for two weeks while Krizanac was waiting, hoping the right donor would be found during that time. Having performed research in the field of VCA, the Swiss surgeon hoped to attend the complex surgery of bilateral forearm transplantation, she said. While she couldn't be at the surgery, she was grateful for the time spent in Philadelphia with Krizanac, his family, and the whole Penn team, including Levin.
“Such international collaborations are very stimulating because of the exchange of knowledge in another environment,” Vögelin said. Being in Philadelphia “also established a relationship of trust for an optimal aftercare in Switzerland.”
Five months later, Krizanac leaned his head on his hand as he spoke—something he could never do with prosthetics. He could feel cold water on his hands. And he could almost put his jacket on without assistance.
He continues to undergo several hours of physical and occupational therapy each week to practice using his new hands.
“He has waited so long for his ‘new hands.’ We experience his devotion and motivation towards his rehabilitation with every visit,” Vögelin said, adding that Krizanac “has had an amazing recovery so far.”
Over the next few years, his nerves and muscles will gradually regrow into the transplanted hands to give him more feeling and function.
Krizanac knows he will achieve the independence he has longed for. For now, he said, resting his hand on his upper arm, “feeling full sensation, and just feeling fingers that are not made out of silicone, is still mind blowing.”