High Five for a New Hand

By Janice M. Horowitz

It was miraculous enough in early 1999 when doctors in Louisville, Ky., transplanted a left hand from a fresh cadaver to Matthew David Scott, then 37, who had lost his own hand in a fireworks accident 13 years earlier. The surgery--an exacting task that required joining dozens of nerves, blood vessels, muscles, bones and tendons--was a success, if only because the transplanted hand wasn't immediately rejected by its new host.

But hooking hand to arm was the easy part. Getting the improbable graft to do the work of an ordinary hand was another matter. Now, it seems, that hurdle has been surmounted too.

Last week the Louisville team reported in the New England Journal of Medicine just how well Scott, a paramedic, is doing. Within three months of the surgery, he went public with his new hand, gripping a baseball with the aid of a brace and flinging a first pitch at a Philadelphia Phillies game. Within eight months, he could distinguish between hot and cold, a sure sign that the nerves were regenerating. Today, thanks to hours of grueling physical therapy, he is capable of more challenging tasks like driving a car, tying shoelaces and, most important, lifting his kids. Though such skills as picking up a dime and writing are still out of reach, his warm, transplanted hand performs better than the best cold prosthesis. "The hand is absolutely part of me now," says Scott. "This is the greatest thing that's happened to me."

Scott's is the first hand transplant of its type in the U.S. and one of only eight worldwide. (Reattaching a patient's own severed hand is far more common.) So far, his transplant team, led by Dr. Warren Breidenbach, at the University of Louisville School of Medicine, and Dr. Jon Jones, now at the Carolinas Medical Center in Charlotte, N.C., seems to have overcome the most formidable challenge of such a procedure--long-term limb rejection. While immune-suppressant drugs have improved the success rate of all kinds of organ transplants, the arm is composed of several different tissues, which trigger different degrees of rejection reactions. Doctors have been fighting them all with an intensive, three-pronged drug attack that includes steroids, which Scott is required to down every day for life.

Being given a new hand is not for everybody. Doctors took great pains to match Scott's new hand with his other one. Both are male and similar in color and size. Still, carrying around an extremity that isn't one's own can be psychologically unsettling, even more so than using a lifeless prosthesis. "It requires someone who is completely unable to accept a prosthesis, someone who simply can't incorporate it into his body image," says Jones. Patients must also live with the knowledge that their newfound dexterity may decline over time if rejection sets in. Perhaps most troubling, though, is the drug regimen. The pills, steroids in particular, are known to increase the risk of infection, diabetes, kidney disease and cancer. Still, for a man in the prime of life to have a new working hand--and finally be able to wear his wedding band--it may be well worth such risks.

--By Janice M. Horowitz