Taking Five

Dawn Scott bends to kiss her husband, Matt, as he sits in a chair at Louisville, Ky.’s Jewish Hospital. “He has such a beautiful face,” she says lovingly. He doesn’t contradict her—though to be fair he is preoccupied with another part of his anatomy: his heavily bandaged left hand.

“It’s amazing,” says Scott, 37, whose left arm, for the first time in 13 years, doesn’t end at the wrist. After undergoing the nation’s first hand transplant, the onetime paramedic from Absecon, N.J., who had his dominant hand blown off by a firecracker in 1985, is gazing on fingertips that only days before belonged to a brain-dead stranger. If all goes well, Scott will be able to pick up most objects and perhaps even button his shirt or tie his shoes, which he can’t do easily with the prosthesis. And aside from the psychological boost, he should have some sense of touch.

“This is just a fledgling attempt,” admits Dr. Warren Breidenbach, 52, head of the 17-member surgical team that performed the 14½-hour procedure. In fact, the world’s first known try at a hand transplant took place in Ecuador in 1964, but after two weeks the recipient’s body rejected it. No other attempts were made until last September, when New Zealander Clint Hallam received a hand in Lyons, France, so far without major complications. “If we can make transplantation of the hand viable,” says Breidenbach, “we can do the breast, face, jaw, knee or elbow.”

If Scott’s transplant provides new hope for the maimed, it is also a little eerie: wearing an outward part of another person—not a hidden heart or kidney, but the instrument of gesture, caress and even, through fingerprints, identity. But above all, the transplant is a gamble. The odds are 30 to 50 percent that Scott’s immune system will reject the transplant in the first year. And even if he clears that hurdle, he must spend the rest of his life on immunosuppressive drugs, leaving him open to any number of life-threatening infections and illnesses. Moreover, Scott has diabetes, which the drugs make more difficult to control. Some in the medical community question the wisdom of endangering his life for what they call a cosmetic measure. “It’s definitely experimental surgery with high risks,” says Dr. Bill Cooney of the Mayo Clinic, president-elect of the American Society for Surgery of the Hand. “We just pray that this young man has a successful outcome—by success, I mean survival.” Arthur Caplan, director of the University of Pennsylvania’s Center for Bioethics, wonders if the surgery should have been reserved for a double amputee. “If one hand is missing, most people do okay with a prosthesis,” he says. “[In this case] telling someone he might be dead in seven or eight years from the drugs is a little harder to justify.”

Scott, whose wife is a nurse and who is himself a supervisor for a New Jersey health-care company, understood the risks. But though his battery-powered prosthesis allowed him to work, to him that wasn’t the point. “No matter how good they make the prosthesis, it is not real,” he says. “It is not flesh and blood and bone, and that’s what I want back.” Dawn, 34, frets about complications—and the possibility of rejection. “It would be almost like losing his hand all over again,” she says. “That would be more devastating in a lot of ways.”

The first time was traumatic enough. After a night of partying on Dec. 23, 1985, Scott went to a friend’s house, where he found an M-80 firecracker. After lighting it with his cigarette, he started to carry it outside when it went off in his hand. “I saw the devastation and the blood,” he says. “Immediately I believed the life I’d known was over.”

The hand was beyond saving, so Scott agreed to amputation. Recuperating at the home of his mother, Mary Lou, he suffered phantom pains, but even worse was the anguish. “I had all those feelings of rage and depression,” he says. The handless arm was “a constant, something I looked at every day and hated.” After three months he was sufficiently healed to wear the prosthesis, which opens and closes when forearm muscles are flexed. “I had to learn how much pressure to apply when I pick something up,” says Scott. He practiced on eggs, breaking dozens before he got it right.

Scott went back to work, starting as a dispatcher, then returned to the field. (His scariest challenge was the first time he delivered a baby with one hand. “I was absolutely sure I was going to drop that kid,” he says.) He met Dawn in 1986; they married in 1992 and have two sons, Ian, 7, and Jeremy, 2.

They were vacationing in London when Dawn read of the Louisville surgeons’ plans to attempt the country’s first hand transplant. The next day Matt called and was granted an interview—along with some caveats. “We asked Matt, ‘What if you die?’ ” says Breidenbach. “He understood what we were talking about.” Scott was then placed on a waiting list for a donor hand of compatible size, bone structure, skin tone and blood type. The call came at 2 a.m. on Jan. 24; by 11:30 the Scotts had flown from Philadelphia to Louisville, and Matt was being prepped for surgery.

The donor’s heart was still beating when surgeons removed the hand, which was brought in a cooler to Jewish Hospital. At 3:36 p.m. the operation began. Screws and titanium plates were used to attach the bone, then Breidenbach hooked up the blood vessels. Thirteen years had passed since they had carried blood to a hand, and there was no guarantee they would work. “Vessels don’t do well when you ask them all of a sudden to start spitting out blood,” Breidenbach explains. “And you don’t have anything if the blood doesn’t flow.” The surgeons were elated as Scott’s newly attached hand flushed pink. When Scott’s atrophied tendons proved too short to support the hand, microsurgeon Tsu-Min Tsai supplemented them with tendons from the feet. “If you are in trouble, you call Dr. Tsai,” says Breidenbach. “He’s a human sewing machine.”

As of early this month, Scott could flex his wrist and curl his fingers, and though it may be a year before he has feeling in the hand, his circulation is excellent. Ahead lie months of therapy and a life clouded by uncertainty but so far not by regret. “This is a risk I need to take,” Scott says simply, “because it is what I want.”

Richard Jerome

Giovanna Breu in Louisville