Surgeon gets go-ahead to carry out world's first full leg transplant

Pedro Cavadas has no time for vanity surgery. The poor and those maimed in war or by landmines are his first priority, he tells Alasdair Fotheringham

Pedro Cavadas is a remarkable man. The Spanish plastic surgeon works up to 14 hours a day on patients needing reconstructive microsurgery. They are mainly those rejected by other hospitals as inoperable or those – such as the patients he flies in from developing countries – for whom the cost of plastic surgery would be beyond their wildest dreams. Later this year, he will put himself and his not-for-profit medical organisation in the full glare of publicity by performing the world's first full upper-leg transplant.

Prosthetic limbs have developed to the point where most amputees with injuries below the knee do not need to risk a transplant. But for thousands requiring whole-leg amputations – many caused by traffic accidents and landmine explosions – this operation represents a first glimpse, however distant, of a possible return to their previous lives.

"There's nothing written about this. We're moving in uncharted waters," says Dr Cavadas. "We're going to be the first because nobody else out there is researching this field. But it really doesn't matter who does the operation, me or another surgeon. The important thing is that it gets done.

"If I was doing this out of vanity, it would be far too dangerous. Surgery done as a way of boosting your ego tends to end up with a dead body on the operating table."

Ego trips notwithstanding, the operation is not without risks, and the formal go-ahead required from Spain's National Transplant Association (ONT) came in May after the probable patient, a car-accident victim, had consented to the operation. The search is now on for a donor.

The most important condition, which will make such a ground-breaking operation possible, according to the 44-year-old surgeon, has already been satisfied. "It's all come about thanks to our work on lower-leg surgery. We've discovered enough from that to make it possible to carry out a full-leg operation, and to feel confident about it."

Getting the 35-strong team of immunologists, anaesthetists, nurses, auxiliaries and recovery personnel in the right place at the right time is no small task, either. The operation will be carried out in the Hospital Universitari La Fe in Valencia, with Dr Cavadas and his team of surgeons doing the scalpel-wielding and leg-welding.

Technically, Dr Cavadas says, it is irrelevant whether the replacement limb comes from a male or a female donor. "Aesthetically, having a limb from a person of the same sex is better, but with regard to the actual operation, it doesn't make any difference."

What will is the long, hard grind of rehabilitation behind closed hospital doors. It has been estimated that nerve endings in arms normally regrow and reconnect at around a rate of just one millimetre per day. But when it comes to upper-leg transplants, it could be different. No one yet knows.

The psychological element of the patient getting used to a new limb is, according to Dr Cavadas, the least of his team's worries. "We don't even employ a psychologist here. The sensation of liberation is so great that, in terms of re-adaptation, there's no point. The operation alone is all that is necessary."

The surgeon admits he is no saint. "I'm no Mother Teresa of Calcutta," he says. "I don't believe in God – He's freed me of that necessity – and I can be a bad bastard like everybody else. But I do think that the act of giving is hugely important and is one of the biggest pleasures you can get in life.

"Giving is something we've forgotten about in the Western world. The vast majority of people are obsessed with how to keep huge amounts of money they don't need. It eats them up unnecessarily."

A trip to Africa in the mid-1990s was partly what shaped Dr Cavadas's outlook. It's one he sticks to, travelling with a medical team to northern Kenya and southern Ethiopia for eight weeks each year to help the most needy.

Dr Cavadas is scathing about using immensely profitable plastic surgery for artificial "improvement" of physical features. "I've never done that kind of operation and I never will. It's a ridiculous act of vanity and typical of the Western world bloated with money."

However, he does recognise that Spain is generous in one way. It has the highest percentage in the world of organ donors and transplants: 4,028 operations were carried out in 2009, and, according to EU figures, its number of donors is almost twice the European average. Dr Cavadas says this is "entirely due to the work of the ONT. They've done a lot of excellent campaigning over the years to raise people's consciousness."

Two of the most recent face transplants, out of the nine carried out in the world so far, were done in Spain, including the first full facial transplant this spring. Dr Cavadas himself carried out the world's first full-hand transplant for a woman, in 2006.

And by the end of this year, in an operating room in Valencia, another major step forward in the area will have been taken, after which Dr Cavadas can get back to his normal work, undisturbed.