A pioneering operation has given new hope to accident victims, writes Sarah Boseley
The world’s first arm transplant has been carried out by a multinational team, giving hope to those who have lost limbs in accidents and disasters all over the world.
Clint Hallam (48), a New Zealand-born businessman, woke up on the morning of September 24 with a forearm that had belonged to a Frenchman killed in a road accident. Hallam, described as a determined and courageous individual who had sought a new arm since his own was amputated in a chainsaw accident nine years ago, cried with joy, said Nadey Hakim, a British member of the team.
“We were all waiting for him to wake up. He was in tears, this morning, because he was so happy to see his live limb with the perfectly normal colour,” said Hakim.
The revolutionary operation took place in France, where eight of the best surgeons in the field, from Australia, France, Italy and Britain, gathered at short notice. They pipped to the post a team in Louisville, Kentucky, who were hoping to be first in the field by performing a hand transplant.
They were led by Earl Owen, the director of the Microsearch Foundation of Australia, where Hallam had gone for help, and Jean-Michel Dubernard, head of transplantation surgery at the Edouard Herriot hospital in Lyon, where the operation was performed. The two men are at the top of their fields in microsurgery and transplantation.
The breakthrough, said Hakim, who is head of transplantation at St Mary’s hospital, Paddington, United Kingdom, was in the development of drugs that can suppress the patient’s immune system almost perfectly and prevent rejection of the new limb. “It is only a year since we began using these drugs in London,” he said. What is not known at present is the long-term effect of the drug cocktail on Hallam.
The operation took more than 13 hours. Hakim, who had spent months preparing with the rest of the team, was phoned at 2am. Even so, he went in to St Mary’s to perform a kidney transplant at 4am before boarding a flight to Lyon for the operation, which began at 10am.
The donor limb, which was removed from the middle-aged Frenchman when his life-support machine was switched off and rushed to Lyon, was similar in size and colour to Hallam’s arm. The donor and recipient share the same blood group.
The surgeons first pinned together the forearm bones. Then the two arteries and the three veins were linked up. Once the blood supply was restored, the arm regained a normal colour. The tendons and muscles were matched and joined.
The longest job was to suture together the three main nerves in the lower forearm. Then the skin was stitched loosely in place and the arm positioned comfortably. Hallam is not yet allowed to try to move it, but physiotherapy will begin in a few days.
It will take over a year before the nerves in the fingertips begin to function, but Hakim hopes Hallam will gain nearly all, if not total, use of the right arm and hand.
Artificial lower limbs are now good enough to allow recipients to run, cycle and even ski, but nothing could satisfactorily replace the function of fingers.
Surgeons have long wanted to be able to transplant a hand, and Hallam’s progress will be eagerly watched. The determination of the businessman, who lives in Perth, Australia, with his wife and four children, is such that he has already offered to have the operation performed again in two or three years’ time should the graft not take properly.
Hakim accepted some people might find the transplant ethically difficult, but felt it was more acceptable than cloning. The team had been careful to ensure they got consent in writing from all parties.