"To achieve a transplant of the human hand is a myth which has haunted the mind of mankind since the dawn of time," said a statement from the eight surgeons - French, Australian, British and Italian - who performed the 13-hours of surgery. As the doctors conceded, the operation took medical science into entirely new moral territory.
A hand is not a vital organ; the risk to the patient is less than in a heart transplant. But the hand is part of the personality of human kind and a specific hand part of the personality of an individual human being. The doctors recognised that, for the first time in transplant surgery, there was a risk of psychological and emotional rejection by the patient, as well as physical. They also recognise that they are acting at the limits of scientific knowledge and medical skill.
The reattachment of severed hands and arms is now a regular occurrence; but the problems of overcoming the body's system of immunity, or rejection of alien substances, has prevented any serious attempt to attach a donor hand.
The doctor who led the team, Professor Jean-Miche Dubernard, of the Edouard- Herriot hospital in Lyons, said the operation - if ultimately successful - would provide new hope to hundreds of thousands of people worldwide who had lost hands in wars or work accidents or through congenital defects.
It appears that there was some element of medical competition involved in the secret gathering of surgeons in Lyons. A hospital in Louisville, Kentucky, announced in July that it expected to perform a similar operation by the end of the year.
It will be 18 months before Clint Hallam, 48, of Perth, Western Australia, knows whether he can use his new right hand, if his body does not physically reject the transplant long before then. The team used the most recent American and Japanese drugs to suppress the body's immune system, previously used on animals. But Mr Hallam, who lost his own hand in a chain-saw accident nine years ago, was warned that he was a guinea-pig.
The medical team has no idea whether, or for how long, the drugs will suppress rejection. The patient will have regular courses of anti-immune drugs for the rest of his life but also psychological treatment.
"Mr Hallam is a very determined and balanced man," the doctors said. "His courage and determination have enabled him to accept the role of pioneer in what could become a new era of surgery."
The British member of the Lyons team, Professor Nadey Hakim, of Saint Mary's Hospital, London, is an expert in immunosuppression. He said yesterday he was hopeful that Mr Hallam would gain full use of his arm. "You have to dare in medicine or it does not advance and what we have done here is to dare. An international team has moved medicine forward and I feel very privileged to have been part of it," he said. "At the moment we are at the very early stages and the patient is not allowed to move the limb, but the operation went extremely well.
The doctors worked in relays from 10am to 11.30pm, with Professor Dubernard supervising the preliminary work on the patient and donor and Professor Earl Owen, director of the Australian Institute of Microsurgery, in charge of the transplant.
The longest and most crucial part of the operation involved the joining of the three principal nerves of the fore-arm, by the microscopic sewing together of scores of nerve endings. The two bones of the lower arm were joined to the new lower arm and hand with metal plates and screws; two arteries and three principal veins were linked up, using the most advanced micro-surgery tested in similar operations to restore a patient's own hand or arm. Twenty-one tendons had to be connected to restore muscle use.
The donor of the hand will remain anonymous, as French law demands. The hospital said only that he was a middle-aged man, who was brain-dead as a result of an accident; that his family had given permission; and that a false hand would be fitted to his body before burial.Reuse content