After 15 hours of surgery last month, doctors in Louisville, Kent., gave amputee Matthew Scott a new hand. The procedure marked the first hand transplant in the United States and the second in the world; Duke experts expressed reservations about the historic event.
Speaking publicly yesterday for the first time since the operation, Scott said he is looking forward to tackling everyday tasks.
"I have to, literally, retrain my brain to think differently with my left hand than I do with my right," he said.
During the marathon operation, surgeons attached bones, then tendons, muscles, blood vessels and finally nerves. Although Scott cannot feel his new hand, he can move his fingers slightly. Doctors hope he will eventually build a relatively firm grip.
While this operation is unique, Dr. James Urbaniak, Virginia Flowers Bake Professor of orthopedics and vice chairman of the department of surgery, said that the Medical Center performs about 50 reattachments of limbs per year-1,500 in the past 25 years.
When asked about a transplant, he said, "Currently, I don't know of any special circumstance where I would recommend it, and essentially all of my colleagues who perform similar reconstructive surgery would agree."
He added that a reattachment of a hand at the wrist level has been done at Duke with "excellent long-term functional results." The procedure takes seven to 10 hours and requires bones to be reattached with screws and plates, whereas blood vessels and nerves are reattached with ultrafine needles and sutures.
Scott may still reject the hand, as most rejections come within the first three months after the operation. He is taking strong immunosuppressive medication to prevent such rejection.
Julie Tart, a liver transplant coordinator, said that such immunosuppressive drugs can result in a wide variety of side effects depending on the type of drug used.
These side effects can be increased appetite, hair growth, stomach problems and cancer. Since the immune system kills mutant cells, when it is suppressed mutant cells can multiply, causing cancer.
The first transplant was done in France in November 1998. The patient's hand has not yet been rejected, and he can grip objects relatively well.
The family of the donor of the hand wished his identity to remain a secret. The Feb. 1 issue of Newsweek magazine, however, reported that the donor was a murderer who committed suicide in prison the day before the operation.
The operation has raised some ethical questions. Scott must take medication for the rest of his life, drugs that will shorten his life span. Medical ethicists question the worthiness of transplanting such nonvital organs.
"The fundamental question is, whose decision should it be?" said Dr. Jeremy Sugarman, associate professor of medicine. "If the patient can afford it, it raises a different set of questions."
He went on to say, "In a rational scheme that allocates resources, [this transplant] doesn't square well."
Urbaniak said he was, "confident that within the next decade or two the immunologists will have developed less toxic and safer immunosuppressive drugs which will justify extremity transplantation as a recommended procedure in selected patients."
Scott lost his left hand in a firecracker accident in 1985.
The Associated Press contributed to this story.
Get The Chronicle straight to your inbox
Signup for our weekly newsletter. Cancel at any time.