First hand transplant in the UK.

Lets have a big hand for the surgeons!

Alright readers here’s something cool for you today! I decided to write about this story due to my large interest in transplantation surgery as I hope to one day become a Cardiothoracic Surgeon. Hope you enjoy.

After a donor was found on boxing day, surgeons informed their first hand transplant patient that he would be undergoing a hand transplant. Currently there is no section for limbs on donor registration forms so next-of-kin of the donor must be consulted individually by the hospital. On the 27th of December 2012, Mark Cahill, a 51 year-old-pub landlord from West Yorkshire, has been the recipient of the UK’s first hand transplant after undergoing the 8-hour operation at Leeds General Infirmary by Prof. Simon Kay, Consultant Plastic and Hand Surgeon and Professor of Hand Surgery at the University of Leeds. Mr Cahill says the main thing he wants to do once feeling returns is to hold the hand of his grandson for the first time. Mr. Cahill and Prof. Kay are seen below.

Now what makes Mr Cahill’s operation unique is that his was the first that involved removing the damaged hand first then replacing it with the donated hand. The operation was deemed a success for now as it was confirmed that he was able to wiggle his fingers. Mr Cahill had lost the use of his right hand (as well as a little in his left) after having suffered severe gout for 20 years and having to have the infection cut out causing paralysis for 5 years. Gout is a disease in which a defect in uric metabolism causes an excess of the uric acid and its salts (urates) to accumulate in the bloodstream and the joints respectively. The results are attacks of acute gouty arthritis and chronic destruction of the joints and deposits or urates in the skin and cartilage.

Hand transplantation is a complex procedure which can simplified down to 5 simple steps which are; bone fixation, tendon repair, artery repair, nerve repair and vein repair. Its complexity can be seen simply from how long an average procedure takes which is 8-12 hours. Whereas by comparison a typical heart transplant only takes 6-8 hours. Full success is very rare and it will be 18 months before the operation could be considered a success in which Mr Cahill could have:

  • a strong grasp
  • good sensibility
  • good ability to feel
  • a precision pinch

A simplified diagram of the procedure can be seen below:

How the remarkable surgery was conducted

The downside however…

It’s not all good news but then again when is medicine and surgery ever all good news. Unfortunately this procedure has made Mr Cahill required to be kept in isolation due to the high risk of infection and need psychological help to accept the hand as his own due to this kind of graft being visible unlike transplanted internal organs such as kidneys and lungs. He also has the agonisingly long wait to see whether or not his body will reject it and will have to take immunosuppressive drugs to stop his body from rejecting or destroying the hand and these will cause him to have a weakened immune system and put him at risk of severe suffering from even minor infections.

Also due to only the removal and replacement part of the procedure currently being successful and the serious risk of infection and likely event of the body rejecting the new hand, the procedure can be seen as a debatable success. But like all transplantations, its success depends on the compatibility between the graft (the new hand) and the recipient. Its likelihood of success is at least supported by the fact that it was an allograft (organ graft between two members of the same species) which lies between autografts (same person) and xenografts (different species) in likelihood of success.

It has been argued by Prof. Robert Winston, Professor of Science at Imperial College of London, that the recipient could end up with “a dead hand at the end of an arm” but his claims have been dismissed by the hospital as ‘overly negative’.

And now for some history!

There have already been 70 hand transplantations in the United States, France and Austria and these are just a part of the great surgical area of organ and tissue transplantation and are leading the way for other transplant operations such as the face, abdominal wall and larynx. Here are some milestones in transplantation surgery for you future surgeons:

  • 1905- Dr Eduard Zirm grafted corneas from an 11-year-old boy onto Alois Glogar in the Czech Republic. One eye failed but the other was successful allowing him to see.
  • 1954- First successful kidney transplant took place between identical twins in Boston.
  • 1967- First successful heart transplant performed in Cape Town, South Africa by Dr Christiaan Barnard.
  • 1983- First combined heart and lung transplant performed in the UK.
  • 1994- NHS Organ Donor Registration set up.
  • 1998- Clint Hallam receives a hand transplantation in Lyon, France but has it removed after two years.
  • 2005- First partial face transplant performed in Amiens, France on Isabelle Dinoire who was given a new nose, chin and lips.
  • 2010- First full face transplant carried out in Barcelona, Spain. Entire facial skin and muscles were given (including cheekbones, nose, lips and teeth).
  • 2012- Most extensive face transplant ever performed in the world carried out in Maryland, USA on Richard Norris who was given a whole new face including jaw, teeth and tongue.

Hope you enjoyed this post. Stay posted!

Matt