Aug. 16, 2000 -- In January 1999, surgeons at the Jewish Hospital of Louisville, Ky., made headlines when they performed the first hand transplant in the U.S. In this week's The New England Journal of Medicine, the Louisville Hand Transplant Team publishes its one-year follow-up report on the procedure and patient Matthew Scott's progress.
The question on everyone's mind is, "How's Matthew Scott doing?" The one-word answer is "great," according to lead hand surgeon and the report's co-author, Warren Breidenbach, MD. Breidenbach is a partner at Kleinert, Kutz, and Associates Hand Care Center, and an assistant clinical professor of plastic and reconstructive surgery at the University of Louisville.
The surgeons, led by Jon W. Jones, MD, formerly of the University of Louisville, report that despite three successfully treated episodes of rejection -- in which the body's immune system saw the hand as a foreign body and tried to attack it -- Scott can feel temperature, pain, and pressure in the hand and fingers. He can perform many functions with his transplanted hand that he had not been able to perform with his artificial hand, or prosthesis.
"On the scoring system that we use, between total absence of a hand  and the perfect hand , he is coming in at 55 points," Breidenbach says. "To put it in perspective, the best a prosthesis normally scores is in the 25-point area. His hand is not as good as a normal hand but superior to a prosthesis.
"Here's what he can do in functional terms: He can tie his shoe, but he has a trick motion; he can dress and feed himself; he can hold his children and hold a baseball bat and teach his son to play baseball," explains Breidenbach. "Here are some of the things he can't do: He can't button his shirt using one hand; he has difficulty picking a quarter up off the table without sliding it off the edge to get it. He can feel hot and cold, he can localize the fingers, but he doesn't have the ability to take a quarter and move his fingers in such a way that he can identify it."
Breidenbach adds, "He has weak strength. His grip strength is probably only 15% of the other side. So it is definitely an assist hand, it is not the dominant hand.
"He can look away and reach for something and have a sensation of where that hand is headed and a gross sensation of what he is picking up," Breidenbach says. "What he can't do, he could never look away, reach on a table, and identify small objects. He uses his visual acuity to help orient the hand more than you or I would because of decreased sensation." But Breidenbach says that sensation in the hand continues to improve.
"I think he has a hand attached to his body so he has something that he's probably very comfortable and happy with," James H. Herndon, MD, tells WebMD. "Function [is] still limited. We don't know if they will improve because this is only the second [hand transplantation] in the world." Herndon, who was not involved in the transplantation but wrote an accompanying editorial to the report, is the Partners Health Care Professor of Orthopaedic Surgery at Harvard Medical School in Boston and the chairman of the Partners Department of Orthopaedic Surgery.
Scott, at the time a 37-year-old paramedic, had lost his dominant left hand and lower forearm 13 years earlier in a fireworks accident. Although he was a diabetic who took shots of insulin, he was a nonsmoker who was in good health and showed no signs of complications that some diabetics get.
During the 15-hour operation, Scott received the hand and forearm of a 58-year-old deceased man that had been matched by bone size and skin tone. Before the operation, Scott was advised of all the risks associated with surgery and told about the drugs that suppress his immune system he'd have to take for the rest of his life to guard against rejection. Additionally, he had no guarantees of the result.
The fact that hand transplantation is a potentially life-threatening treatment for a non-life-threatening condition makes it a risky proposition and a controversial subject.
Herndon explains in his editorial that there are several areas of concern with this type of transplant. The primary issue is that of the body rejecting the hand. There's also the issue of the safety and effectiveness of immunosuppressant drugs. These drugs can have dangerous side effects and can lead to cancer, serious infections, and even death. Lastly, it's not known just how much function the hand will regain.
But in his editorial, Herndon acknowledges the physical and psychological importance of hands: Not only do we use hands to perform tasks, but we communicate with them, touch, and feel with them, and they are an essential part of our appearance and ourselves. Moreover, while an artificial hand can replace a hand mechanically, nothing can replace the lost sense of touch.
"I think the bottom line is that patients need to go in this with their eyes fully open on what they're potentially risking themselves for to have a hand, especially if they have another hand," Herndon says. "They really have to be conscious of the fact that they may get some life-threatening problems in the future because of it."