Show of Hands - Australian receives first forearm transplant - Brief Article

IN SOME WAYS the forearm graft carried out by Jean-Michel Dubernard and Earl Owen at Edouard Herriot Hospital in Lyons, France, on September 23 was routine. First their surgical team anchored the arm bones with plates and screws, then sewed together the delicate ends of the veins and arteries. Stitching up nerves, muscles, and tendons followed. Finally, using skin grafts from the patient's arm and thigh, they carefully closed the skin. Such reattachments have been common for 15 years.

The operation made headlines, however, because the reattached forearm came not from the patient--Clint Hallam of Perth, Australia--but from a brain-dead donor. Hallam's arm had been severed below the elbow in an accident with a circular saw in 1984, and a subsequent attempt to reattach it had failed. Unhappy with a prosthesis--which allows only limited grasping and no feeling--Hallam had travelled to Lyons seeking a hand transplant. And so far it appears to have been a success, with no sign of rejection. Team member Nadey Hakim, a transplant surgeon at St. Mary's Hospital in London, estimates that Hallam will gain sensation and function in the forearm in about a year.

That's assuming new nerve fibers will grow normally from Hallam's upper arm to the tips of his fingers and that his body won't reject what is, after all, a foreign organ. Although it is possible that immunologically powerful stem cells within the bone marrow of the transplanted arm may actually help Hallam's body accept the graft, he still faces a lifelong regimen of immunosuppressive drugs. This treatment, with its attendant increased risk of infections and cancer, has led the American Society for Surgery of the Hand to question whether the benefits outweigh the risks.

But Hallam was well aware of the operation's drawbacks, says Hakim. "We asked this patient to sign a very informed consent, and he did say, `I do not want to live the way I live, and I'm ready to have the operation. And even if, God forbid, it fails, I'm ready to recover from it and two, three years later have another go.' "

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