Doctors transplant hand

Medical frontier: 'Frankenstein' operation takes science into new moral territory

IN A hospital in Lyons on Wednesday, Frankenstein met the Bionic Man. In what may prove to be an extraordinary scientific breakthrough - but which may also bring humankind to a new psychological and ethical frontier - the hand and lower arm of a dead Frenchman was attached to the body of a live New Zealander.

"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-hour surgery. The operation took medical science into 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 humankind 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.

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 successful - would provide hope to hundreds of thousands of people worldwide.

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 it. 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 doctors have no idea whether, or for how long, the drugs will suppress rejection. Mr Hallam will have 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."

The British member of the team, Professor Nadey Hakim, of Saint Mary's Hospital, London, is an immunosuppression expert. 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 ... An international team has moved medicine forward and I feel very privileged to have been part of it," he said.

The longest and most crucial part of the operation involved the joining of the three principal nerves of the forearm, 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; 21 tendons were connected.