Going Out on a Limb

By Frederic Golden

Pioneering surgeons used to wait until after the operation before claiming their 15 minutes of fame. Not anymore. In Louisville last week a team of doctors announced their intention to perform "the world's first successful hand transplant"--using a limb from a fresh cadaver--before lifting a scalpel or even picking a patient.

As expected, the statement elicited a flurry of second opinions. "It would be revolutionary," said Dr. Neil Jones, chief of hand surgery at UCLA Medical Center, who acknowledged that the Kentucky doctors are among the best in the business. But would the transplant take? "Based on what we know of their animal research," he says, "I'd say they're premature." Dr. Andrew Palmer, president of the American Society for Surgery of the Hand, characterized the announcement as "driven as much by marketing as by betterment of the patient."

The Louisville doctors, of course, knew they would probably run into a buzz saw. Not so much over the surgery. That will be tedious and exacting, requiring the joining of dozens of nerves, blood vessels, tendons, muscles and bones, but it's the sort of delicate operation that hand surgeons have been doing for years. The big question, when a borrowed hand is involved, is rejection. While new immunosuppressant drugs are improving the success rate of all kinds of organ transplants--from hearts and lungs to kidneys--a body part composed of as many different tissues as the hand poses special immunological challenges. A similar transplant was attempted in Ecuador in 1964, but the donor hand was rejected within two weeks.

Still, the Louisville team is optimistic. Heartened by their animal experiments, in which flaps of bone, tendon and muscle were attached to young pigs for up to three months, the doctors convinced their review boards at the University of Louisville and Jewish Hospital that a hand transplant was, as the team's chief surgeon, Dr. Warren C. Breidenbach of Kleinert, Kutz and Associates Hand Care Center, put it, "the next logical step."

Even so, it may take months to find a suitable patient (18 to 65 years old) and donor. For the recipient the benefits must clearly outweigh the heavy risks; he or she must be willing to accept the likelihood of limited function and feeling in the new limb, a lifetime of medication, the ever present threat of infection and, finally, what San Francisco neurologist and hand therapist Dr. Frank R. Wilson calls the heavy psychological burden of being reminded daily that "an important part of your anatomy is not your own." It won't be an easy decision for patient or doctors.

--By Frederic Golden