Dr. Warren Breidenbach, left, and Dr. Jon Jones Jr. answer questions Tuesday about the first hand transplant in the United States. (Reuters)

By John Schwartz
Washington Post Staff Writer
Tuesday, January 26, 1999; Page A2

Surgeons in Kentucky yesterday completed the first hand transplant ever attempted in the United States, attaching the left hand of a cadaver to the arm of a New Jersey man who lost his appendage in a firecracker accident 13 years ago.

The transplanted hand became pink and showed very preliminary signs that the connected blood vessels were doing their job following the 15-hour operation at Louisville Medical Center. But doctors cautioned that it was too early to tell whether the procedure was a success or how much use the recipient, Matthew David Scott, 37, would attain.

"In an ideal situation he would be able to make a fist," said Warren C. Breidenbach, who led the Louisville surgical team. "He would be able to pick up a tennis ball, pick up a glass, or open a door."

Breidenbach stressed, however, that "it would not be a normal hand . . . assuming he could play the piano before, he would not be able to play the piano afterward." Scott will probably never button his shirt collar with that hand, or use its fingers to pick up a penny.

The operation prompted criticism from other experts in the field, who questioned whether the benefits outweighed the substantial risks. Scott will have to take powerful, potentially dangerous anti-rejection drugs for the rest of his life.

Doctors rushed Scott into surgery Sunday night when the donor's hand became available. After giving Scott anesthesia, the doctors applied a special tourniquet to stop blood flow to his arm and dissected the arm to the bone. They connected the arm's exposed bones to those on the donor hand with metal plates. They then attached the tendons, testing each flexor tendon with a tug that twitches a finger. After attaching the tendons, the surgeons stitched tiny nerves together under powerful microscopes, then the arteries and veins.

After those connections were completed, the doctors released the tourniquet and made sure blood was flowing through the vessels before closing the skin.

Transplants involving internal organs have become almost commonplace, but medical experts say hands present special problems because they are made up of so many different types of tissue. A team of doctors from Louisville's Jewish Hospital, the private hand surgery practice Kleinert, Kutz and Associates, and the University of Louisville performed the surgery. The group, which has been working toward this procedure for three years, included reconstructive and transplant surgeons, immunologists, pathologists, pharmacologists, psychologists and basic science researchers.

The Louisville team announced last year that it was going to perform a hand transplant, but was beaten by an international team of surgeons in France who in September 1998 attached a cadaver's hand to the forearm of Clint Hallam, a 48-year-old Australian whose hand had been cut off in a New Zealand prison accident with a circular saw. Hallam has gained some movement in the hand.

Scott, who is left-handed, is married and has two children. He is clinical coordinator for Virtua Health System in Gibbsboro, N.J., and serves as assistant director for a paramedic training program at New Jersey's Camden County College. He had functioned for years with a prosthetic device at the end of his arm, but like many such patients was not satisfied with the results.

The surgery renewed medical debate over the advisability of attempting such pioneering procedures.

"Yes, we need to be doing this kind of surgery – that's clear-cut," said Vincent R. Hentz of Stanford University Medical School, president of the American Society for Surgery of the Hand. "The real question is, is now the proper time for this kind of procedure?"

Hentz said that surgical techniques and the drugs for immune system suppression have not improved markedly over the past 10 years, but that many in the profession expect both to jump forward in the near future. "Why not wait until this next generation, since the target audience for all this are basically well people? They have lost something, but they are not ill."

Scott's anti-rejection drugs – the same used in kidney transplantation – can cause widespread side effects that include high blood pressure, increased risk of infection, diabetes, damage to the liver and kidneys, increased risk of cancers and hand tremors. The doctors are using less aggressive dosing than they would for other organ transplants, reducing the risk of drug damage but raising the potential for Scott's body to reject the hand.

Breidenbach said the debate is good for medicine because "it allows the public, mainly prospective patients, to hear that debate" so that they don't have unrealistic expectations.

Doctors were exhausted after the long procedure, and Scott was groggy. Linda McGinity Jackson, a spokeswoman for the transplant team, said when she visited Scott's room "he gave me a thumbs up and smiled," she said, quickly adding that he gestured with his good hand.