Pioneers: My Left Hand

Atlantic County paramedic Matthew Scott, the first recipient of a successful hand transplant, opened up the possibility that all body parts are replaceable.

SITTING ACROSS FROM HIM AT HIS OFFICE on the campus of Camden County College, where he heads the paramedic-training program, I find it exceedingly difficult to avoid staring at Matthew Scott’s left hand. While the differences between his hands are not immediately noticeable — except for the relatively limited dexterity of his left — the more one looks, the more apparent they become. The left hand appears older than the right. Its fingers seem a bit longer. The nail beds are also longer, and more elegant. The veins running beneath the skin’s surface are of a different thickness, and a different shade of blue. Different, too, are the tiny hairs sprouting from it, in texture, length and thickness. The skin is a slightly different shade of pink from that on the right side. This is because Matthew Scott’s left hand is not his own. Eight years ago, it was removed from another man’s arm and attached to Scott’s, in the first successful human hand transplantation in history.

His doctors had offered him a 50 percent probability that he would lose the hand in the first year. In terms of its functionality, Scott, 45, tells me it’s turned out better than he or his doctors ever anticipated: Though he still relies on his right for fine-motor work, his new hand is far more effective than his prosthetic was, and he can hold objects and throw a ball with his sons and tie his shoes and even type, albeit not well and extremely slowly, as well as experience hot and cold and pain, and distinguish between smooth and rough surfaces.

Scott says his desire to replace his hand — he lost it in an accident more than two decades ago — was straightforward: “I was incomplete. It was just something I needed to do to fix what I had done.”

But it hasn’t been easy. The body is programmed to protect itself by dispersing antibodies to seek out and destroy foreign cells, and though the episodes cleared up relatively quickly, Scott’s body thrice rejected the hand in the first year, a year during which he remembers being “sick as a dog every single day.” Even today, eight years later, rejection remains a possibility, and every day for the rest of his life he must take 12 pills that might cause serious health problems over the long term, including increased susceptibility to infection and a variety of diseases, even cancer.

And there are other issues. Over the 45 years since a surgeon first successfully transplanted a human kidney, transplant medicine concerned itself almost solely with the vital organs inside the body. Not only was it scientifically impossible to transplant external parts, but the consensus among ethicists was that the harvesting of a human body’s parts should occur only in the most extreme circumstance — to save a life. And so when surgeons attached the hand of another to Matthew Scott’s left arm eight years ago, they spirited forward a strange new era in transplant medicine. Body parts from penises to breasts to wombs have been transplanted as a result of Scott’s success. According to Scott’s doctor, human heads might not be far off.

TWO NIGHTS BEFORE Christmas 1985, when Matthew Scott was 24 and a first-year paramedic, he was hanging out with two longtime buddies in Maple Shade. The three were drinking heavily and roughhousing with one another. A powerful bootlegged M-80 firecracker appeared. It ended up in Scott’s possession. Standing in the hallway of the house, on his way out the door, in an act of some combination of bravado and drunkenness and sheer idiocy, he held the fuse to the embers of the cigarette burning in his mouth. There was a huge white spark. The fuse burned orange and maniacally. With his friends following him down the hallway, he pivoted into the kitchen. The firework exploded at once. Pieces of his left hand flew like shrapnel across the room, embedding themselves in walls and the refrigerator.

Thirteen years later, on a Saturday evening in January, the beeper Matthew Scott wore on his waistband beeped. Despite his instinct to reach first with his left hand, he lifted the beeper with his right. Research suggests that “handedness” is determined genetically and reveals itself at an early age — ultrasounds have recorded 15-week-old fetuses already favoring particular thumbs to suck. (Approximately 90 percent demonstrate right-handedness, which corresponds roughly to the population at large.) Matthew Scott had been able to retrain himself, in actuality trick his own brain, to carry out every function — writing and typing an e-mail and tapping out boredom on a tabletop and rolling open the car window and throwing coins in a toll basket and picking up a phone and bathing himself and touching his wife — with his right hand. He had also been able to deal with the ineffable sensations he continued to feel all those years later at the end of his left arm, as if his hand was still there — phantom pain — even if his subconscious still refused to believe it, refused to recognize the battery-powered metal hand that attached to a plastic mold of his forearm that strapped around his left elbow and was good for little more than grasping: In his dreams, his left hand was always there. So it was that on that night in 1999 when the little black box on his waistband began beeping, Matthew Scott took it up with his right hand. He recognized the area code: Louisville, Kentucky, home to some of the world’s most daring transplant researchers.

Fifty-eight-year-old Glenn William Johnson, a Kentuckian, a sheet-metal worker by trade, military veteran, husband and father of three daughters, had lived a difficult life. He’d served 10 years in prison in Michigan after killing a man in a barroom fight in 1986. His son had committed suicide years earlier. On January 23, 1999, he, his wife and his girlfriend apparently were arguing at the Johnson home. The gun he was holding fired, striking his wife in the hand. He and his girlfriend went to another room, where he fired a bullet into his temple. Before his body stopped breathing, emergency responders stuck a tube down his throat and connected it to a ventilator, so that despite the fact that his cognitive function had been obliterated, his heart kept on beating, suffusing his organs with oxygenated blood. He was, medically speaking, brain-dead. Representatives from the Kentucky organ donation foundation approached the family and asked first whether they would agree to share Johnson’s organs. Next, they asked whether they’d consider donating his left hand as well.

With scalpels and eventually a saw, surgeons removed the hand above the wrist, taking a few additional inches of bone and all the tendons, blood vessels and nerves. The chilled hand was brought into the operating room in Kentucky where Scott lay unconscious, his left arm opened at its base to expose the bone, muscle and sinews inside. The surgeons first lined up the two pieces of bone and joined them with metal plates — a process similar to buttressing in carpentry. Under microscopes, they went about the painstaking work of attaching each and every tendon, artery, blood vessel and nerve. Lastly they melded the flaps of skin from the hand and arm, and unclamped the vessels, watching as the graft turned pink and warm.

After 15 hours of surgery by a team of more than two dozen surgeons, Matthew Scott opened his eyes in a recovery room. In the fog of the waning anesthesia, he looked toward his left arm. Through the bandages peeked Glenn Johnson’s fingers.

EIGHT YEARS LATER, Scott — a divorced father of two sons — has mostly been granted the wish he asked of the media when he was discharged from the hospital back in 1999: that his anonymity be restored and his story “become a footnote in medical textbooks.” Still, when I speak to the man considered the father of hand transplantation, Warren Breidenbach — Scott’s doctor from Louisville — he compares his patient to the astronauts of the first space flights.

“There really was no good evidence that this was going to work; there was no real way to know whether this would end in disaster,” Breidenbach says. “It’s like the first time you build an airplane, and then you have to get into it and see whether in fact it will fly.”

Success in organ transplantation eluded medicine for thousands of years, until 1954, when a Boston surgeon transplanted a kidney from one identical twin to another. This breakthrough, coupled later with the development of immunosuppressant drugs that discourage the body’s impulse to destroy foreign cells, enabled doctors in the ensuing decades to transplant a wide variety of internal organs, including hearts, lungs, livers, pancreases and intestines. Still, attempts to transplant external body parts, so-called composite-tissue parts, made little headway, due to the complex network of skin, muscle, bone, vessels and nerves contained within such grafts, and the high potential for rejection for each component. At the same time, animal research, primarily limited to primates because of their genetic closeness to humans, was at a standstill; primates consistently died after their transplants, almost always from the very high doses of immunosuppressants thought necessary to avoid rejection.

But Breidenbach and his colleagues at the University of Louisville made a radical, if seemingly simple, breakthrough in their five-year research leading up to Scott’s transplant: Primates seemed to require higher doses of immunosuppressants than humans, who, they hypothesized, might preserve their grafts by taking the same types and levels of immunosuppressants prescribed to kidney recipients. Breidenbach had consistent success transplanting the limbs of pigs, and his team began searching for prospective human candidates. In Scott, they found one who understood the risk and was willing to do everything they asked — Breidenbach’s “ideal pioneer.”

Scott’s hand transplant and the more than two dozen around the world since have enabled a whole host of composite-tissue transplants that, to invoke the narrator in Mary Shelley’s Frankenstein, seem to have “pursued nature to her hiding-places.” Consider the Frenchwoman mauled by her Labrador retriever who in 2005 received part of the face of a suicide victim. Fingers, noses, esophagi, uteruses and fallopian tubes for women who can’t bear children, jaws, even penises for young men injured in industrial accidents or war — all have either been transplanted or are imminent. Breidenbach says most doctors have yet to fathom the ramifications.

“If I could wave a magic wand tomorrow and transplant any composite tissue with minimal risk,” he says, “everyone who’s getting an artificial knee now would have a real knee. Any woman who’s lost a breast might have a real breast. Burn patients who now have to have skin grafts from their own body, which scar and are terribly painful, would be treated with draping the total body skin of someone else.” Breidenbach says the technology could be used in cancer treatment as well, allowing doctors to replace cancerous organs and the areas around them with a donor’s parts.

Then he takes it a step further: “It’s possible to transplant a head.” He says there has already been some success with animal head transplantation, and that research on spinal-cord regeneration will make it possible in the not so distant future to take a human’s head and attach it to another’s body, connecting the arteries, veins, neck bones and spinal cord. In other words, in one sense at least, life eternal.

All of these procedures raise considerable moral issues. Penn bioethicist Art Caplan says there is a question whether a donor should sacrifice body parts for a “quality of life” health issue. While he supports Scott’s decision in this particular case, Caplan also wonders, for that matter, whether these types of transplants are worth the toll they exact on the recipients. “You’re talking about giving powerful drugs that cause cancer, kidney failure and other problems,” he says. “Normally the risks are not controversial, because if your heart is failing or your liver is failing, the prospect of death makes risk less important.”

When I ask Scott about this, he pulls out his prosthetic hand from underneath his desk — “I know it’s weird that I keep this,” he says — and passes it to me, suggesting part of the answer is contained therein. “There was just always this feeling that I had damaged myself,” he says. Working as a paramedic, he learned to cope. But the daily inability to do the simplest things, like simultaneously carry a package and turn a doorknob, like hug a person with both arms while tied into his prosthetic, got to him. Plus, hands “convey emotion, they convey feelings to people.”

ONE YEAR AFTER his transplant, during a checkup in Louisville, Matthew Scott met the family of Glenn Johnson.

Scott had questions. He wanted to know more about his hand, about the idiosyncrasies he’d noticed and studied over the past 12 months. He pointed to a scar that runs up his left palm. How had it happened? Johnson’s family told him it was from Glenn Johnson’s days as a sheet-metal worker.

At some point in the meeting, Scott offered Johnson’s family the opportunity to touch their loved one’s hand. “They weren’t going to ask me to do that,” he says. “But I said, ‘Please, feel it, see how good it is, see what it’s doing for me.’” They did.

I apologize to him in advance before I ask Matthew Scott whether I can touch his hand. Without hesitation, he says yes. He pushes the sleeve of his sweater up, revealing the tan cuff-like discoloration of skin above his left wrist.

I reach out with my own hand to touch a hand sliced eight years ago from the arm of a dead man. It is a hand that helped define another man’s existence, a hand that formed 60-some years ago in a mother’s womb and grew first into a boy’s and then into a man’s, a hand that hauled and handled how many cold sheets of metal over the years, a hand that made love to a wife, that picked up and caressed the children they made, a hand that one day killed a man, that stroked the bars of a prison cell for 10 years, a hand that finally reached up and took his own life — a hand sliced eight years ago from the arm of a dead man, bathed in cold saline and then attached to the arm of another man now sitting across from me in a tiny office overlooking a snow-dusted New Jersey community college campus lit up in the brilliant light of winter.

Inside his chest, Matthew Scott’s lungs inflate, his heart beats. Warm blood pumps into the hand beneath mine.