Double hand transplant: "It"s a small miracle, looking at what nature has allowed us to do"

It was a moment that mingled triumph with relief as the UK’s first double hand transplant patient awoke from a painstaking 12-hour operation with two new sets of fingers.

“It’s better than a lottery win because you feel whole again,” said Chris King as he recuperated at the Leeds General Infirmary. “They look absolutely tremendous,” he added. “They’re my hands. They really are my hands.”

But despite his joy at the successful surgery, the real test for King may just be beginning. Experience from previous such transplants suggests that the psychological challenges of bearing another person’s hands can be hard to cope with.

Clint Hallam, the patient who received the world’s first hand transplant 1998, claimed that he felt “mentally detached” from the new limb and had it removed three years later in a secret operation.

Nadey Hakim, a surgeon at Imperial College London who was involved in that operation, agrees that for some the psychological impact can be considerable.

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“For someone to use someone else’s hands to hold his wife, his kids – it is not easy,” he said. “I don’t think they will ever get used to it fully- they might claim they are used to it, but it is a very difficult task for anyone, even [for those which are] the strongest psychologically.”

King lost the four fingers of each hand in an accident three years ago. He received the double transplant in a lengthy operation conducted by a team of eight surgeons, led by Professor Simon Kay.

While around 80 hand transplants have taken place worldwide, King’s is the first double hand transplant to be carried out in the UK, and the first such procedure to be undertaken since the NHS launched its new hand transplant programme earlier this year.

Kay also carried out the UK’s first single hand transplant in 2012 when Mark Cahill, a former pub landlord, received a new right hand after his own became badly affected by gout and infection.

Cahill is enthusiastic about King’s operation. “I think it is fantastic, I am so happy for him,” he told the Guardian, adding that he hopes that the publicity will result in an increase in the number of donors to the hand transplant programme. “We have got plenty of people wanting hands, but not enough donors,” he said. That, he points out, could be down to the very visible nature of hands, which might make it especially hard for grieving families to give consent for donation. “I imagine it is heartbreaking,” he said.

Since his own operation, Cahill says that not only has he been able to carry out everyday tasks and drive again, but just six weeks ago used his new hands to give CPR to his wife after she suffered a heart attack. “I wouldn’t have been able to do it without my transplanted hand because my other hand was so deformed, I wouldn’t have been able to put any pressure on her,” he said.

As well as taking immunosuppressants, Cahill has been undergoing physiotherapy since the operation to improve the movement in his new hand. But, he says, he has not had any problems in accepting his new appendage.

“I think I was in a fortunate position,” he said. “I had [one] hand amputated and another one put on, so I was never without a hand. It is probably more difficult for people who lose a hand.”

Indeed, doctors stress that how patients feel about the operation is crucial. “The psychological point of view is very, very important,” said Professor Jean-Paul Meningaud of the University Hospital Henri Mondor in Paris. “Otherwise you can have a patient that [is] going to stop taking the treatment.”

For Hallam, the psychological implications post-transplant were apparently so overwhelming that he was unable to live with his new hand. In contrast to King and Cahill, Hallam had been without a hand for many years when he was selected for the operation. He lost it after an accident in prison – where he was serving a sentence for writing bad cheques. One minute he was climbing a ladder with a circular saw, the next he was sprawled on the flood minus his hand. Surgeons attempted to reattach it, but the limb lost sensation and dexterity and had to be removed.

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But Hakim rejects Hallam’s claim that he felt psychologically detached from the replacement limb after the later surgery .

“[The hand] was removed 2.5 years [after the transplant], requested by the patient, because he did not have the means to pay for his immunosuppressants,” he said. “The arm itself was in good condition until he stopped taking his anti-rejection medication.”

Other transplants have proved more successful. Another of Hakim’s patients, who underwent a double arm transplant in the US in 2000, is said to be doing extremely well. “He still has, after 16 years, an excellent function of both hands,” said Hakim.

But Meningaud, who has conducted a number of face transplants, as well as the world’s first face and double hand transplant, says the drugs used to prevent rejection are a cause for concern.

“You are going to suffer the side-effects of the immunosuppressant treatments your whole life,” he said, adding that such drugs put patients at increased risk of certain cancers as well as other health issues, while large doses to combat acute rejection can result in kidney damage.

Meningaud says his opinion on face transplants has changed over time, having seen problems with rejection, infection, and even a suicide attempt by a patient. “At the beginning I did not imagine the toll would be so important,” he said.

For King though, the operation has been life-changing. “I could shout from the rooftops and celebrate it big time, which is what I’m going to do,” he told reporters after the operation.

For the surgeons too, the procedure can bring feelings of awe. “You see a dead hand which is completely white, no blood supply to it, no viability, all of a sudden getting the colour of a normal hand. It is incredible,” said Hakim. “It is a small miracle which truly you are looking at in ecstasy, looking at what nature has allowed us to do thanks to modern surgery.”

Double hand transplant: "It"s a small miracle, looking at what nature has allowed us to do"