Former pub landlord Mark Cahill became the first person in the UK to have a hand transplant 10 years ago. Now Professor Simon Kay, who leads the Leeds-based transplant team, is looking forward to the day when it becomes a routine procedure.
However, he has acknowledged that one of the biggest barriers is the understandable difficulty many families have when asked about donations from recently-deceased relatives. Here are some key points about hand transplantation:
Leeds is the only hand transplant centre in the UK
The UK Hand Transplant Unit, at Leeds General Infirmary, is the only centre in the UK which undertakes hand transplants. The clinical team is 30-strong and have other roles in the hospital. They all volunteer to work when a donor hand becomes available for someone on the waiting list. The unit is commissioned by NHS Blood and Transplant.
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How many hand transplants have been done and who are the recipients?
Including Mr Cahill, eight people have had 12 transplants. Six of the eight have had double transplants. Prof Kay said that this may not sound many in 10 years but there were two significant breaks in that time – one related to an NHS reorganisation and the second due to the Covid pandemic.
Two of the recipients are women and six are men. The reasons for them needing a transplant vary from industrial accidents to blast injuries, severe infections and the autoimmune disease scleroderma. All the transplants carried out so far in the UK are considered successful.
Among the patients who have been publicly identified are Mr Cahill, who is from Halifax, West Yorkshire; Chris King, from Doncaster, South Yorkshire, who was the second recipient and the first person in the UK to have a double transplant; Corinne Hutton, from Glasgow, who was the first women to have a double transplant and the first from Scotland; and Steven Gallagher, from North Ayrshire, Scotland, who is believed to be the first person in the world to have a double hand transplant due to scleroderma.
Most hand transplant patients self-refer to the Leeds unit, often after being told there is nothing more that can be done for their condition.
What are the main differences between hand donations and those involving kidneys or livers?
Prof Kay said that if a kidney fails there are a lot of potential donors and, if you donate a kidney, there are lot of potential recipients. This is very different with hands. Families are often understandably reluctant. And hands are not a selection people can make on the organ donor register.
Unlike with a kidney, it is crucially important what a donated hand looks like, and matches have to take into account skin tone, gender, age, markings, etc. For this reason, the team is more likely to compromise on immunological concerns rather than the physical characteristics, because it is so important that the patient accepts the new hand.
Prof Kay said there are so few offers they cannot wait for the perfect donation. He said: “Nobody rejects a kidney psychologically, they’re just grateful to have it. Nobody cares what their kidney looks like.
“But a hand has to match the person, it has to be right, you have to feel ownership of it. So we spend a lot of time with psychology, making sure we understand the patient’s needs, so they understand what they’re getting.”
But he said: “When they do agree, it’s always a wonderfully courageous and very, very generous thing to do for another person.”
How are recipients prepared for the process?
A transplanted hand can be rejected for psychological reasons as well as immunological reasons and this is why so much attention is paid to mental preparation and the physical look of the donated hand. Double transplant patient Corinne Hutton said: “They did a huge amount of psychological testing – IQ testing, puzzles, that kind of thing – with me before and that kind of confused me, I wasn’t really sure why I was doing that.
“I realise now how much effort it took, how much problem-solving it took and how much soul-search and digging-deep it took when things got bit rough and hard. So, I guess they prepared you for that.”
The importance of psychological preparation is exemplified by the world’s first transplant patient – New Zealander Clint Hallam – who had the operation in France in 1998. He refused to comply with his therapy regime because he could not accept the hand and it had to be removed three years later.
New patients at the Leeds unit have to wait a year before they are considered suitable for transplant surgery and, during this time, the psychologist is seen as one of the key members of the team. The patients also undergo thorough immunological testing.
How are donors identified?
Patients are consulted during their year waiting, about what they are prepared to accept in terms of physical characteristics. For example, they are asked whether they are prepared to accept a hand with tattoos or scars.
These details are available to the specialist nurses working for NHS Blood and Transplant whose job it is to approach bereaved families about organ donation. Hand donors must be brain dead in an intensive care unit but with a heart that is still beating through supported respiration. They must also be within two hour’s road travelling time of Leeds.
A senior member of the unit is always available and, if a hand becomes available, a team from Leeds is dispatched to the hospital where the donor has died. This is different from the way other transplantation works. The retrieval team leader makes the final decision on the ground about whether the hand is suitable.
The donor’s hand is replaced with an artificial limb.
How many people are currently waiting for a matching donor?
Five people are currently at the stage where they have gone through the year-long testing and could have a transplant as soon as a donor hand becomes available. Prof Kay said an offer of donation is made about every three weeks but the vast majority are not suitable.
Who performs the procedure?
Prof Kay says hand transplantation needs a huge array of specialties and no one surgeon has all the skills. The volunteer team of 30 is assembled once a donor hand has definitely been identified.
At the earliest stage of the process in a double transplant, four surgical teams are needed to work on each of the patient’s hands and the two donations.
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