Hand Transplant Declared Successful

Six months after receiving the world's first hand transplant, 48-year-old Clint Hallam of New Zealand has a strong grip and feeling in several fingertips. His surgery was a success, Hallam's doctors report in this week's issue of The Lancet.

Hallam's operation has helped fuel a rising demand for limb transplants, says Earl Owen, a transplant surgeon at the Microsearch Foundation of Australia in Sydney. Some amputees adjust well to prosthetic devices, but others feel incomplete without a flesh and bone limb. Because doctors have successfully reattached severed hands, Owen reasoned that attaching a donor hand might also be feasible. On 23 September 1998, Owen and an international team including surgeon Jean-Michel Dubernard of Edouard Herriot Hospital in Lyon, France, transplanted a hand from a 41-year-old brain-dead man onto the right arm of Hallam, who lost his right hand in a 1984 circular saw accident when he was in jail.

To prevent rejection of the transplant, doctors gave Hallam drugs that suppressed his immune system. Such drugs increase the risk of skin cancer, diabetes, and a type of lymphoma, but Owen says Hallam's only significant side effect so far was a "touch of diabetes" that went away once his drug doses were adjusted. His arm shows no signs of rejecting the new hand, and nerves linking the two have begun regenerating. Hallam now has sensation in his palm, two fingertips, and the back of his fingers, and his muscle activity is steadily improving.

The team expected that living with somebody else's hand might pose psychological problems, especially because--unlike a transplanted kidney or heart--a limb is always visible. But Owen reports that Hallam appears to have fully accepted the hand as his own from the start. Such an attitude is essential, says transplant surgeon Jon Jones of the University of Louisville in Kentucky, a member of the U.S. team that performed a second hand transplant in January. That operation is also deemed a success, but Jones warns that it is too early to put too much faith in the operation. "It could be we were just lucky the first two times," he says. Both the European and U.S. teams are planning more operations. "If we can provide immunosuppressants that have minimal risk, then this surgery could become very widespread," Jones predicts.

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