0:00:03 > 0:00:06SIRENS WAIL
0:00:06 > 0:00:08Arriving in this emergency ambulance
0:00:08 > 0:00:14is a donor limb for Britain's first-ever hand transplant.
0:00:14 > 0:00:16Will prep, thanks.
0:00:16 > 0:00:18We have a limb. It's on the way.
0:00:18 > 0:00:21After a nationwide search lasting more than a year,
0:00:21 > 0:00:24over 30 people came forward,
0:00:24 > 0:00:26eager to have the pioneering surgery.
0:00:26 > 0:00:28In this film,
0:00:28 > 0:00:30we'll meet four potential patients,
0:00:30 > 0:00:33all of whom are desperate to make it through the tough selection process.
0:00:33 > 0:00:37How would you feel about a white hand like mine?
0:00:37 > 0:00:40We have to be clear about that, cos once you've got it, you've got it.
0:00:40 > 0:00:44For one of them, this transplant will transform their life.
0:00:44 > 0:00:49The difference it will make to us is beyond words, really.
0:00:49 > 0:00:52I'll be able to do things like normal again.
0:00:52 > 0:00:55When you tell people, they think, "Someone else's hand?!"
0:00:55 > 0:00:59You wouldn't say that if you had somebody's heart, kidney or liver.
0:00:59 > 0:01:02I want to just live again. Just live again.
0:01:02 > 0:01:05But will they all be suitable?
0:01:05 > 0:01:08We've now had the faxed reports through from the lab,
0:01:08 > 0:01:12telling us the match of the recipient.
0:01:12 > 0:01:15And which candidate will ultimately be the one
0:01:15 > 0:01:18to receive this new hand and make British medical history?
0:01:18 > 0:01:20Right, we're in business.
0:01:21 > 0:01:24Let's go.
0:01:38 > 0:01:42It's the early hours of the morning at Leeds General Infirmary
0:01:42 > 0:01:43and Professor Simon Kay
0:01:43 > 0:01:48briefs his team ahead of a landmark operation.
0:01:48 > 0:01:50The patient will be anaesthetised
0:01:50 > 0:01:53when the retrieval starts. Dan is calling me.
0:01:53 > 0:01:55OK?
0:01:55 > 0:01:57Grainne will lead the limb team.
0:01:57 > 0:01:59And I'll lead the recipient team,
0:01:59 > 0:02:02but I'll interchange between them,
0:02:02 > 0:02:05so that I have the overall picture. Is that all right?
0:02:05 > 0:02:08This operation has been two years in the planning.
0:02:08 > 0:02:11But it's still a daunting prospect,
0:02:11 > 0:02:14even for a microsurgeon with Professor Kay's years of experience.
0:02:14 > 0:02:18Like a pilot doing a solo
0:02:18 > 0:02:20on final approach...
0:02:21 > 0:02:24..it's fine being up there but now you have to land it.
0:02:24 > 0:02:26It is quite nerve-racking.
0:02:28 > 0:02:30I think the obstacles now
0:02:30 > 0:02:33are all technical, and it's
0:02:33 > 0:02:38possible for any microsurgical process to fail.
0:02:38 > 0:02:43You should never say it, but I think we have the basics covered.
0:02:43 > 0:02:46We'll see. We haven't done it before.
0:02:47 > 0:02:50There have been around 80 successful transplants
0:02:50 > 0:02:53carried out around the world.
0:02:53 > 0:02:55Now it's down to Professor Kay
0:02:55 > 0:02:59and the team to prove it can be done in the UK.
0:02:59 > 0:03:01With the surgeons on standby,
0:03:01 > 0:03:04a call comes in from the donor retrieval team.
0:03:04 > 0:03:06Will prep, thanks.
0:03:06 > 0:03:14Cheers, Dan, bye. We have a limb. It's on the way.
0:03:16 > 0:03:18Establishing a hand transplant programme
0:03:18 > 0:03:22has been a long-term aim for Professor Kay.
0:03:22 > 0:03:25The people who talk against hand transplant
0:03:25 > 0:03:29almost always don't know what life's like without a hand.
0:03:29 > 0:03:32It's a pretty poor life -
0:03:32 > 0:03:34how do you button your shirt like that?
0:03:34 > 0:03:36Or put your socks on? You just can't do it.
0:03:42 > 0:03:44You have to be a very hard-hearted Jeremiah to say
0:03:44 > 0:03:48it's not worth the cost of a kidney transplant to do that.
0:03:48 > 0:03:51You have to really not have much humanity about you, I think.
0:03:53 > 0:03:55A hand is what makes humans special.
0:03:58 > 0:03:59I'm a lot older now,
0:03:59 > 0:04:02and it's the last major thing I want to see working in Britain
0:04:02 > 0:04:06before I throw in the towel and live in a tent.
0:04:09 > 0:04:12Stand by, camera two to start off with.
0:04:12 > 0:04:1513 months earlier...
0:04:15 > 0:04:17Stand by, everyone.
0:04:17 > 0:04:20..and Professor Kay's search for candidates begins
0:04:20 > 0:04:22with a nationwide media campaign.
0:04:22 > 0:04:25Tonight, pioneering surgery.
0:04:25 > 0:04:28Plastic surgeons across the country have been asked to identify
0:04:28 > 0:04:35'possible patients for what is an extremely complex operation.'
0:04:35 > 0:04:38We were over in Belfast,
0:04:38 > 0:04:40and your mum and dad was with us.
0:04:40 > 0:04:44Yeah, my mum and dad said, "Have you ever heard about the LGI?
0:04:44 > 0:04:49"It's wanting to do Britain's first hand transplant."
0:04:49 > 0:04:52I just went, "Dean, I know this is for you."
0:04:52 > 0:04:55Nightclub DJ Dean Smahon
0:04:55 > 0:04:57lost both legs, his right hand
0:04:57 > 0:05:00and three fingers on his left
0:05:00 > 0:05:06after contracting septicaemia two years ago. He was lucky to survive.
0:05:06 > 0:05:08I was in such pain.
0:05:08 > 0:05:10Pain that I'd never experienced before.
0:05:10 > 0:05:13His blood pressure was incompatible with life.
0:05:13 > 0:05:17All his organs failed and he had black hands, black feet.
0:05:17 > 0:05:20They tried their best to save them
0:05:20 > 0:05:21but it was just too severe.
0:05:21 > 0:05:26This left hand...the right hand was particularly bad.
0:05:26 > 0:05:28You can see all the scars along here.
0:05:28 > 0:05:29Right along here.
0:05:29 > 0:05:32Without functioning hands, day-to-day
0:05:32 > 0:05:35life for Dean is extremely difficult.
0:05:35 > 0:05:39This is where it gets really awkward, because
0:05:39 > 0:05:43sometimes I'll have a good day and sometimes it'll be a bad day.
0:05:43 > 0:05:46You can just imagine me trying to tie this up.
0:05:46 > 0:05:49It's a non-starter, you just can't.
0:05:49 > 0:05:53I've been told to not do this and I keep doing it all the time.
0:05:53 > 0:05:57I just grab it with my mouth and...
0:05:59 > 0:06:01..do it like that.
0:06:01 > 0:06:03That's when things get frustrating.
0:06:03 > 0:06:07When you do all this, you start heating up in this before you go out,
0:06:07 > 0:06:09so I'm usually a ball of sweat.
0:06:09 > 0:06:13Dean puts a brave face on - for me, himself and everybody else.
0:06:13 > 0:06:16But I think that element of feeling trapped
0:06:16 > 0:06:18is psychologically
0:06:18 > 0:06:21such an awful, awful feeling to have.
0:06:21 > 0:06:25You want to do something so simple and you can't do it.
0:06:25 > 0:06:28I could never have imagined the emotions
0:06:28 > 0:06:30and feelings I experience by just not having a hand.
0:06:30 > 0:06:34Of waking up in the morning and looking down at that.
0:06:34 > 0:06:37No matter how strong I am or portray to be,
0:06:37 > 0:06:39there's always a sadness in there.
0:06:39 > 0:06:42That eats away at you, no matter what.
0:06:42 > 0:06:44He won't be able to pick me up.
0:06:44 > 0:06:48He won't be able to hold my hand
0:06:48 > 0:06:50or dance with me
0:06:50 > 0:06:53or walk on the beach properly or give me a massage.
0:06:53 > 0:06:56It's always an element of sadness.
0:06:56 > 0:06:59You can't get that back, can you?
0:07:07 > 0:07:10Today is Dean and Kirsty's first meeting with Professor Kay
0:07:10 > 0:07:12and the transplant team.
0:07:13 > 0:07:16The thought of having the hand, actually,
0:07:16 > 0:07:19is very exciting.
0:07:19 > 0:07:22I think it's mixed emotions. I'm quite nervous
0:07:22 > 0:07:25about such dramatic surgery. Dean's been through so much already.
0:07:25 > 0:07:27But obviously I'm quite excited
0:07:27 > 0:07:30of how life-changing it could be, as well.
0:07:33 > 0:07:36Let's have a look at this. Wiggle a thumb for me.
0:07:38 > 0:07:40You have a useful hand on the left side,
0:07:40 > 0:07:43but it's not enough to live your life with,
0:07:43 > 0:07:45to do the things you need to do.
0:07:45 > 0:07:49So I think you would be somebody we would consider,
0:07:49 > 0:07:54purely from a physical point of view, for a transplant.
0:07:55 > 0:07:57There's a lot of other stuff we have to go through
0:07:57 > 0:07:59to decide whether you're suitable...
0:07:59 > 0:08:03from our point of view, and a lot of stuff you have to go through
0:08:03 > 0:08:06to decide if we're suitable from your point of view.
0:08:06 > 0:08:08One thing not in Dean's favour
0:08:08 > 0:08:10is the amount of blood transfusions he had
0:08:10 > 0:08:12following his illness.
0:08:12 > 0:08:15The more transfusions, the more sensitive the body,
0:08:15 > 0:08:18increasing the chances it could reject a donor hand.
0:08:18 > 0:08:21And Dean's had a lot of transfusions.
0:08:21 > 0:08:25We need to make sure that he doesn't have any antibodies
0:08:25 > 0:08:28to the donor limb we'd be seeking out for him.
0:08:28 > 0:08:31Every candidate will face similar blood tests.
0:08:31 > 0:08:33The higher the levels of antibodies,
0:08:33 > 0:08:36the lower the percentage of the population that will be
0:08:36 > 0:08:39suitable donors.
0:08:40 > 0:08:42Bloods will go off to the lab. They will keep a profile
0:08:42 > 0:08:45of him, and when we identify a donor,
0:08:45 > 0:08:48those two samples will be merged
0:08:48 > 0:08:53and if there's any kind of overlap where one doesn't match the other,
0:08:53 > 0:08:57it would invalidate the transplant for him and he wouldn't be offered that one.
0:08:57 > 0:09:00He has taken quite a lot of blood transfusions in the past
0:09:00 > 0:09:03and his response to that will be important.
0:09:05 > 0:09:08It would be disappointing if it came to that.
0:09:08 > 0:09:11If everything else is ticking the right boxes
0:09:11 > 0:09:14and then we've been told. "You're not, unfortunately, suitable
0:09:14 > 0:09:17"because of your transfusions,"
0:09:17 > 0:09:19then it would be very disappointing.
0:09:19 > 0:09:22But hopefully, it will not come to that.
0:09:22 > 0:09:24Fingers crossed.
0:09:25 > 0:09:28As well as being a good tissue match for potential donors
0:09:28 > 0:09:30and physically suitable,
0:09:30 > 0:09:33anyone hoping to make it onto the transplant shortlist
0:09:33 > 0:09:36must also be psychologically prepared to cope with such
0:09:36 > 0:09:38dramatic surgery.
0:09:39 > 0:09:43Hands are very unusual. They are very, very visible.
0:09:43 > 0:09:45They're as visible as the face, really.
0:09:45 > 0:09:49The importance of the hand far outweighs
0:09:49 > 0:09:51the physical size of them.
0:09:51 > 0:09:55They effect us emotionally, physically, socially.
0:09:55 > 0:09:58They're used in communication,
0:09:58 > 0:10:01they're used in touch, they're used in relationships.
0:10:01 > 0:10:02They're used in caring roles.
0:10:02 > 0:10:06They also have very intimate functions and in self-care,
0:10:06 > 0:10:09so it's a lot to consider...
0:10:10 > 0:10:14..to weigh that up and decide whether you'll be able to
0:10:14 > 0:10:16cope with such a life-changing event
0:10:16 > 0:10:19as having a donor transplant.
0:10:27 > 0:10:30The youngest person hoping for a transplant
0:10:30 > 0:10:34is 23-year-old hairdresser Sarah Hayward.
0:10:34 > 0:10:36She lost her hand in a car crash eight months ago,
0:10:36 > 0:10:38while working in the Middle East.
0:10:38 > 0:10:41On the night of the accident, we'd been working.
0:10:41 > 0:10:44We got a lift home with one of my friends,
0:10:44 > 0:10:48and he literally, split-second, looked at his phone.
0:10:48 > 0:10:50He was going quite fast.
0:10:50 > 0:10:53He just hit the roundabout and the car flipped.
0:10:53 > 0:10:56I landed on my hands.
0:10:56 > 0:10:57They tried to save my hand.
0:10:57 > 0:11:00I had six or seven operations, it was.
0:11:00 > 0:11:03After that, he said, "I'm really sorry,
0:11:03 > 0:11:06"but we've done everything we can
0:11:06 > 0:11:09"to try and save your hand, but
0:11:09 > 0:11:11"I'll have to amputate your hand."
0:11:11 > 0:11:13Once a professional stylist,
0:11:13 > 0:11:17losing her dominant right hand means Sarah can't work
0:11:17 > 0:11:21and now only styles hair as a favour for friends.
0:11:21 > 0:11:25As soon as I heard you could have a hand transplant,
0:11:25 > 0:11:28I just thought, "I'll be able to go back to work again."
0:11:28 > 0:11:32Just thought I'd be able to do all this again,
0:11:32 > 0:11:36be able to do all the colouring, extensions, cutting,
0:11:36 > 0:11:41be able to just have my job back that I was doing.
0:11:41 > 0:11:44You obviously don't think anything like this would ever happen to you,
0:11:44 > 0:11:46so I'd just be able to have my life back.
0:11:46 > 0:11:49Since the accident,
0:11:49 > 0:11:51Sarah's been adjusting to life without her right hand.
0:11:53 > 0:11:55I call it "the paw".
0:11:57 > 0:11:59When I had the accident,
0:11:59 > 0:12:01I always have my hand like that
0:12:01 > 0:12:04and my mum always said I look like the lucky cat.
0:12:04 > 0:12:06Obviously it's not that lucky, but I look like the lucky cat -
0:12:06 > 0:12:09the Chinese that stand with their paw like that, so
0:12:09 > 0:12:12ever since then it's been called "the paw."
0:12:12 > 0:12:15And it does actually look like a paw a bit.
0:12:15 > 0:12:18So that's what it is!
0:12:18 > 0:12:21That's pretty.
0:12:21 > 0:12:24Would you feel confident wearing that?
0:12:24 > 0:12:27Well, I don't know if that's really me.
0:12:27 > 0:12:29For a once outgoing, image-conscious young woman,
0:12:29 > 0:12:33Sarah's disability has had a dramatic effect on her confidence.
0:12:35 > 0:12:39I always feel people are looking at my hands.
0:12:43 > 0:12:45I always tend to go for floaty sleeves,
0:12:45 > 0:12:48like things to cover, like this.
0:12:48 > 0:12:52Now...that's the style of clothes I would wear normally now...
0:12:52 > 0:12:55..to cover everything.
0:12:55 > 0:13:00Which is not something I would have picked a year ago.
0:13:02 > 0:13:06I'll be able to do everything I was able to do beforehand,
0:13:06 > 0:13:09cos it's a real hand.
0:13:09 > 0:13:11It wouldn't move exactly the same as this hand
0:13:11 > 0:13:13and it wouldn't be exactly the same,
0:13:13 > 0:13:18but as long as they got quite a good match to the hand that I have,
0:13:18 > 0:13:22I'll be able to do things like normal again.
0:13:22 > 0:13:25Sarah Hayward and Dean Smahon
0:13:25 > 0:13:30weren't the only candidates hoping to receive the transplant.
0:13:30 > 0:13:33Mark Cahill, a former pub landlord from West Yorkshire
0:13:33 > 0:13:38and Edna Kerr, a retired carer from Dumfries, also came forward.
0:13:39 > 0:13:42But, only one eventually made it into the operating theatre
0:13:42 > 0:13:45to receive a new hand.
0:13:51 > 0:13:55After a selection process that's taken more than a year,
0:13:55 > 0:13:57the successful patient is ready for surgery.
0:14:01 > 0:14:05The donor hand is then taken from its protective icebox
0:14:05 > 0:14:07and transferred into theatre by Professor Kay.
0:14:13 > 0:14:14Right, can we have some prep?
0:14:16 > 0:14:19The new hand will be attached to the patient's arm using
0:14:19 > 0:14:22- metal plates secured on the bones... - Right. We're in business.
0:14:22 > 0:14:27..before veins, arteries, tendons and nerves are stitched together,
0:14:27 > 0:14:30using precision microsurgery.
0:14:30 > 0:14:34I tell you what I'm just going to do is check it's the right limb.
0:14:34 > 0:14:37It is the right-hand limb, that, isn't it? Yes.
0:14:37 > 0:14:39That would be quite important.
0:14:41 > 0:14:45The two teams of surgeons will work side-by-side during
0:14:45 > 0:14:49the first few hours of the operation,
0:14:49 > 0:14:52one team working on the donor limb, while the
0:14:52 > 0:14:55second prepares the patient's arm to receive the new hand.
0:14:58 > 0:15:02Let's have a new blade, please.
0:15:02 > 0:15:05But, less than an hour into the operation,
0:15:05 > 0:15:08there's a problem with the patient's arm.
0:15:08 > 0:15:12I'm a bit slower than you here, I've got a lot of scar to deal with.
0:15:12 > 0:15:14The median nerve is very badly scarred and abnormal,
0:15:14 > 0:15:17so we'll have to do that reasonably approximately,
0:15:17 > 0:15:20and I don't think we'll get motor repair.
0:15:20 > 0:15:21It's very, very scarred.
0:15:21 > 0:15:24The nerves in the arm are badly damaged
0:15:24 > 0:15:27and it's a major worry at such an early stage.
0:15:27 > 0:15:30I'm just slightly concerned about the extent of scarring
0:15:30 > 0:15:31internally, but that's unpredictable
0:15:31 > 0:15:36and there's no scan or imaging or anything you can do to predict that.
0:15:36 > 0:15:38So, we knew there would be some.
0:15:38 > 0:15:42It can affect whether we leave here with two hands or not.
0:15:42 > 0:15:44That's the worry.
0:15:46 > 0:15:49OK, I'm going to come and join you in a moment.
0:15:49 > 0:15:51We'll do the anastomosis.
0:15:54 > 0:15:58- Hi, Pete, can I have two pints, please, mate.- Two Carling.
0:15:58 > 0:16:01Thing about it is, Pete, if I do get another hand,
0:16:01 > 0:16:03I might be able to work behind the bar again,
0:16:03 > 0:16:05I could relief manager for you.
0:16:05 > 0:16:06Fantastic. I might get a week off.
0:16:06 > 0:16:09What I could do!
0:16:09 > 0:16:13Like all the potential candidates, Mark had led a normal life
0:16:13 > 0:16:16until losing the use of his right hand.
0:16:16 > 0:16:19Before I got ill, I was a landlord of a pub.
0:16:19 > 0:16:23Eight and a half years. The pub just down the road, actually.
0:16:23 > 0:16:25And my hand swelled up with gout,
0:16:25 > 0:16:28so I thought I better go to hospital
0:16:28 > 0:16:31and they kept me in for two months.
0:16:31 > 0:16:34Five operations on my hand
0:16:34 > 0:16:35and my hand ended up paralysed,
0:16:35 > 0:16:39so that was the basic start of it.
0:16:39 > 0:16:42Losing function in a hand can mean undertaking the most basic
0:16:42 > 0:16:46human tasks - washing, eating, even going to the toilet -
0:16:46 > 0:16:49require assistance from someone else.
0:16:49 > 0:16:52To start with, it was absolutely everything.
0:16:52 > 0:16:55I used to have to basically bed bath him.
0:16:57 > 0:17:00He couldn't use both hands at one point,
0:17:00 > 0:17:02so everything was not just cut up and...
0:17:02 > 0:17:05cooked and cut up for him, it was
0:17:05 > 0:17:07actually feeding him,
0:17:07 > 0:17:10physically feeding him, which he didn't like.
0:17:10 > 0:17:11He hated that bit.
0:17:11 > 0:17:14I did love... One of my things was cooking.
0:17:14 > 0:17:17Now, I'm down to basically something on toast,
0:17:17 > 0:17:19and I can't even really do that, now.
0:17:19 > 0:17:21At this point, I start to struggle,
0:17:21 > 0:17:25because I don't have total control
0:17:25 > 0:17:27over the pans or the handles.
0:17:27 > 0:17:29Oops.
0:17:30 > 0:17:32And this is where it gets messy.
0:17:32 > 0:17:3651-year-old Mark still has both hands, but his right is
0:17:36 > 0:17:39completely paralysed, making it virtually useless.
0:17:39 > 0:17:43I end up buttering my fingers.
0:17:44 > 0:17:45Everything's cold.
0:17:47 > 0:17:51I thought I'd be great with the ready meals but...
0:17:54 > 0:17:57..I can't get the cellophane off them without burning myself.
0:17:57 > 0:18:00You try and tip them out and it's even worse.
0:18:02 > 0:18:03It doesn't make you feel good
0:18:03 > 0:18:05when you're having to rely on people all the time,
0:18:05 > 0:18:07when you've been so independent all your life,
0:18:07 > 0:18:10when you've been able to do anything you want to do, you can do yourself.
0:18:10 > 0:18:13I must admit, it's something I do miss, cooking.
0:18:13 > 0:18:16I used to be a dab hand at cooking. Pretty good at...
0:18:18 > 0:18:22Ravioli on toast doesn't really come up to that mark.
0:18:24 > 0:18:28A new hand could be life-changing for the candidates,
0:18:28 > 0:18:31but one of the biggest hurdles they must overcome is
0:18:31 > 0:18:34the concept of having a stranger's hand attached to their body.
0:18:34 > 0:18:36Would they accept it,
0:18:36 > 0:18:39or will it permanently feel like someone else's hand?
0:18:40 > 0:18:44'When people's bodies change in any physical way,'
0:18:44 > 0:18:46it takes a while for their body image...
0:18:46 > 0:18:48their mental image of themself to catch up,
0:18:48 > 0:18:50so we'd assume it would take a while before they can fully
0:18:50 > 0:18:54integrate the new hand to feel like part of them.
0:18:54 > 0:18:57You'd be lying if you said it's just easy.
0:18:57 > 0:19:00I think there will be an element of getting used to it
0:19:00 > 0:19:02and getting accustomed to somebody else's hand attached
0:19:02 > 0:19:05to your body, but I just think, through time,
0:19:05 > 0:19:07it's become one of those things that you don't notice,
0:19:07 > 0:19:10because I don't notice the amputations now.
0:19:10 > 0:19:12I don't see it when I see Dean.
0:19:12 > 0:19:14So I think, over time, you just get used to that.
0:19:14 > 0:19:18They could face disappointment, they may find it difficult to
0:19:18 > 0:19:23adjust to the reality of the donor hand and, I suppose,
0:19:23 > 0:19:26the worst-case scenario would be psychological rejection of it
0:19:26 > 0:19:29and then wanting to have the hand removed.
0:19:29 > 0:19:32To get his head around the idea, Mark turned to the internet,
0:19:32 > 0:19:35to find out how patients in America have fared following their
0:19:35 > 0:19:37hand transplants.
0:19:38 > 0:19:42- MAN ON INTERNET:- 'Oh, yeah, they feel like my hands...
0:19:42 > 0:19:45'..in every way. She loves them.'
0:19:45 > 0:19:47'These are his hands, to me.'
0:19:47 > 0:19:50- MARK:- People's reactions, they say to me, "How will your hand feel?
0:19:50 > 0:19:53"Will it feel like your own hand or not feel like your own hand?"
0:19:53 > 0:19:56And I don't suppose, until I get it, that I'll know,
0:19:56 > 0:19:59but from the videos I have seen of American people that have had it,
0:19:59 > 0:20:02and actually think it's their own hand,
0:20:02 > 0:20:05I think it's a good opportunity to go forward
0:20:05 > 0:20:08and get some life back, basically.
0:20:10 > 0:20:13MAN LAUGHS
0:20:19 > 0:20:22At the Leeds General Infirmary, it's now two hours
0:20:22 > 0:20:25since the transplant operation began.
0:20:25 > 0:20:27Rob, how are you doing this end?
0:20:27 > 0:20:31Professor Kay's early concerns have subsided, as the surgeons working on
0:20:31 > 0:20:36the patient's arm have found intact nerves amongst the damaged tissue.
0:20:36 > 0:20:38On the other side of the operating table,
0:20:38 > 0:20:42the donor hand team has reached a crucial stage.
0:20:42 > 0:20:46Miss Bourke's very beautifully dissected out the donor hand
0:20:46 > 0:20:52and shortly we'll be dividing the donor hand from the forearm
0:20:52 > 0:20:55and putting a plate onto both of the forearm bones,
0:20:55 > 0:20:57in preparation for transferring over
0:20:57 > 0:21:00to the other side and restoring
0:21:00 > 0:21:01the skeleton's integrity,
0:21:01 > 0:21:04before we start restoring the other structures.
0:21:05 > 0:21:08It's vital that the hand is separated from the donor
0:21:08 > 0:21:11forearm at exactly the right point.
0:21:11 > 0:21:12A ruler.
0:21:15 > 0:21:19Look there, at the end. If we can see...
0:21:21 > 0:21:24An inaccurate measurement means that
0:21:24 > 0:21:26when the hand is attached to the patient,
0:21:26 > 0:21:27it could be a different length
0:21:27 > 0:21:29to their existing, healthy limb.
0:21:29 > 0:21:35It's at this stage that complex surgery becomes precision DIY.
0:21:35 > 0:21:37- OK, locking.- Yes.
0:21:39 > 0:21:41- All good?- Yes.
0:21:44 > 0:21:46Drill.
0:21:50 > 0:21:53DRILL WHIRRS
0:21:58 > 0:22:03The metal plates are then screwed onto the bones of the donor hand.
0:22:06 > 0:22:08Even at this early stage,
0:22:08 > 0:22:10the team are racing against the clock.
0:22:10 > 0:22:12Three hours, it's been off.
0:22:12 > 0:22:14I think we'll go for four hours
0:22:14 > 0:22:16and we'll cool it again in a minute.
0:22:16 > 0:22:19'We're going to keep it as cool as we can, just'
0:22:19 > 0:22:23because warm muscle that doesn't have blood supply dies very quickly.
0:22:23 > 0:22:26The rest of it, there's the bone and the skin,
0:22:26 > 0:22:28will live a long time without blood supply
0:22:28 > 0:22:30but, for the muscle it's crucial.
0:22:31 > 0:22:35In another couple of hours we'll be beginning to get a bit antsy.
0:22:35 > 0:22:37- It's sitting on ice, OK? - All right, thank you.
0:22:45 > 0:22:49In the previous 12 months, more than 30 hopeful patients from
0:22:49 > 0:22:51across the UK contacted Professor Kay
0:22:51 > 0:22:55to find out about the hand transplant.
0:22:56 > 0:22:59Sit down. OK. You go and sit with granny.
0:22:59 > 0:23:02One of them was Edna Kerr, who's 65.
0:23:02 > 0:23:06I've got a watch to tell the time. Look what time it is!
0:23:09 > 0:23:11Whoa!
0:23:11 > 0:23:13THEY LAUGH
0:23:13 > 0:23:16- You've not done that before, have you?- No!
0:23:16 > 0:23:21A life-threatening viral infection led to keen traveller Edna
0:23:21 > 0:23:24losing her limbs just over a year ago.
0:23:24 > 0:23:26I looked at my hands
0:23:26 > 0:23:28and they were all bandaged up.
0:23:29 > 0:23:34And I just could feel just part of my legs had been...
0:23:36 > 0:23:39..chopped off, if you like. Yes.
0:23:39 > 0:23:43I thought, "Well, I'll have to get on with it."
0:23:43 > 0:23:46Having already had her first consultation with
0:23:46 > 0:23:48Professor Kay, Edna's now eager
0:23:48 > 0:23:51to make it onto the transplant shortlist.
0:23:51 > 0:23:55Fantastic news and I hope I go through with it.
0:23:55 > 0:23:59Life's on hold just now
0:23:59 > 0:24:02and getting up and getting out
0:24:02 > 0:24:05and just doing things without...
0:24:06 > 0:24:09..having to rely on anybody.
0:24:09 > 0:24:13- Independence.- Independence.
0:24:13 > 0:24:15In any transplant surgery,
0:24:15 > 0:24:19patients must continually take a cocktail of immunosuppressant
0:24:19 > 0:24:24drugs, to prevent their body rejecting the alien donor organ.
0:24:24 > 0:24:27But the drugs also lower the body's natural defences,
0:24:27 > 0:24:31making it susceptible to possible serious infection and illness.
0:24:31 > 0:24:34- WOMAN:- When she's pouring herself...
0:24:34 > 0:24:38For some, any benefits gained from having a hand transplant
0:24:38 > 0:24:42might be outweighed by potential health problems.
0:24:42 > 0:24:44No, it's Charlotte's birthday...
0:24:44 > 0:24:48'This chance, this hand transplant, would be a great chance,
0:24:48 > 0:24:52'but it's just, you know, a big thing to think about.'
0:24:54 > 0:24:57'I didn't think, "Oh, medication, side effects."
0:24:57 > 0:25:00'I just thought, "Oh, my God, I'll have a hand."'
0:25:02 > 0:25:06The anti-rejection medication increases the chance
0:25:06 > 0:25:07of skin cancers.
0:25:07 > 0:25:09There's a higher risk of diabetes
0:25:09 > 0:25:12and life expectancy could be reduced,
0:25:12 > 0:25:14as the immune system becomes less able
0:25:14 > 0:25:16to fight off infection in old age.
0:25:18 > 0:25:19Now, because I'm sort of thinking,
0:25:19 > 0:25:22I don't know what to do about the whole hand transplant.
0:25:22 > 0:25:24At first, I was thinking, "I'm just going to go through with it.
0:25:24 > 0:25:28"I definitely want to do it. I think it's amazing, blah, blah, blah."
0:25:28 > 0:25:31Now, because I've heard all the side effects and stuff like that,
0:25:31 > 0:25:33it knocks me back down again to think,
0:25:33 > 0:25:37"Oh, no, I'm going to be like this now. What am I going to do?"
0:25:37 > 0:25:40Everyday tasks like learning to write with your weaker hand,
0:25:40 > 0:25:46are a struggle, but a transplant might not prove to be a miracle fix.
0:25:46 > 0:25:49'For some people, the downside is just too great.
0:25:49 > 0:25:52'The requirement to take the medication,'
0:25:52 > 0:25:55which can open them up to serious side effects,
0:25:55 > 0:26:00maybe life-threatening side effects, is a step too far.
0:26:08 > 0:26:12After three hours of intense surgery, Professor Kay and his
0:26:12 > 0:26:14transplant team are ready to attach
0:26:14 > 0:26:16the new hand to the patient's arm.
0:26:16 > 0:26:19Now, will we get that on?
0:26:21 > 0:26:24That's a good question, because that plate is slightly angled, isn't it?
0:26:24 > 0:26:26I think there's room, though.
0:26:29 > 0:26:31The professor's now joining the bones together,
0:26:31 > 0:26:33the two main bones of the forearm,
0:26:33 > 0:26:34the radius and the ulna.
0:26:34 > 0:26:37The radius has a locking plate on it which he has just performed,
0:26:37 > 0:26:40and he is now putting on an ulna plate.
0:26:40 > 0:26:41Once the hand is then stable,
0:26:41 > 0:26:46he will then join together the nerves, a couple of the muscles,
0:26:46 > 0:26:51then rejoin the arteries and let the blood flow back through the limb.
0:26:51 > 0:26:53Actually, I don't need a guide.
0:26:53 > 0:26:55I just need a drill. Thank you.
0:26:59 > 0:27:01Plate holding forceps, please.
0:27:01 > 0:27:05It takes around 40 minutes to attach the bones in the new hand to
0:27:05 > 0:27:07the patient's forearm.
0:27:08 > 0:27:11I'll have a sore wrist after all this.
0:27:13 > 0:27:16Once the plates are connected securely,
0:27:16 > 0:27:19the surgeons can begin to join the tendons,
0:27:19 > 0:27:21which are fibrous tissue
0:27:21 > 0:27:24that connect bone to muscle, and provide movement in the hand.
0:27:25 > 0:27:30So that's ring, so that should be middle.
0:27:30 > 0:27:33One, two, three, four. OK?
0:27:33 > 0:27:35There are 11 tendons in the wrist,
0:27:35 > 0:27:36there are eight that bend the fingers,
0:27:36 > 0:27:38one that bends the thumb,
0:27:38 > 0:27:41and two that bend the wrist, as well, and of course, on the other side,
0:27:41 > 0:27:44there are ones that straighten out the wrist and the tendons, as well.
0:27:44 > 0:27:47So, there's lots to do.
0:27:48 > 0:27:50Scissors.
0:27:53 > 0:27:54OK, let's fish that one out of here.
0:27:54 > 0:27:57Keep going. No pressure.
0:28:03 > 0:28:07In Dumfries, Edna is managing to get by as she waits to hear
0:28:07 > 0:28:10if she will be added to the transplant list.
0:28:13 > 0:28:18Everything is an effort to me.
0:28:21 > 0:28:25I would just get myself showered, get my breakfast,
0:28:25 > 0:28:30do my housework, it just takes longer to do everything.
0:28:32 > 0:28:34It just takes a morning to get out.
0:28:36 > 0:28:40For Edna, a new hand would mean getting back her old life.
0:28:41 > 0:28:46I want to just live again, just live again. It's just...
0:28:48 > 0:28:52I'm old before my time.
0:28:52 > 0:28:55And I just want to live.
0:28:55 > 0:28:56Just a normal life.
0:29:00 > 0:29:05And...just go out with the grandchildren...
0:29:17 > 0:29:21In Leeds, Dean has received the results of crucial blood tests.
0:29:22 > 0:29:25These will reveal how many donors would be a suitable
0:29:25 > 0:29:27biological match for him.
0:29:29 > 0:29:31They found out that my blood,
0:29:31 > 0:29:34my parameters were actually better than anticipated.
0:29:35 > 0:29:39It works out that my suitability of the population of Leeds should
0:29:39 > 0:29:44fall in about three quarters of the population.
0:29:44 > 0:29:46- Potential.- Yes, potential.
0:29:46 > 0:29:48That, of course,
0:29:48 > 0:29:53just makes it more probable that you will find a suitable donor...
0:29:53 > 0:29:56And hopefully will speed the process up, theoretically.
0:29:57 > 0:30:02However, a genetic match isn't the only thing to be taken into consideration.
0:30:05 > 0:30:09So, if I get you with that arm out to the side...
0:30:09 > 0:30:11Who will receive the transplant
0:30:11 > 0:30:14will also be based on how particular the candidates are about
0:30:14 > 0:30:18size, gender and skin colour of the donor hand.
0:30:19 > 0:30:22We've got colour photographs for you which
0:30:22 > 0:30:25we are going to use for the match, but obviously that shows us
0:30:25 > 0:30:27what you are, it doesn't show you what your limits are.
0:30:29 > 0:30:31So, how would you feel about a white hand like mine?
0:30:31 > 0:30:32A really white one.
0:30:33 > 0:30:36- Yes, I don't see a big problem.- No?
0:30:36 > 0:30:39We've got to be absolutely clear about that,
0:30:39 > 0:30:41because once you have got it, you have got it.
0:30:43 > 0:30:50I always said from the beginning that it was other points that
0:30:50 > 0:30:52were more important to me - the functionability,
0:30:52 > 0:30:55the colouring was actually further down, the question of
0:30:55 > 0:30:59whether it was a male or female hand, it wouldn't bother me.
0:30:59 > 0:31:03Dean, I'm going to write you today, then, confirm the offer.
0:31:03 > 0:31:09I'd think there is no reason we wouldn't be live from next week.
0:31:09 > 0:31:12Two years in the planning, and now Dean is the first person to
0:31:12 > 0:31:15make Professor Kay's transplant shortlist.
0:31:20 > 0:31:24Hairdresser Sarah has also made a decision.
0:31:26 > 0:31:29Well, I have had a long think about what I want to do,
0:31:29 > 0:31:34and I don't think I really want to go ahead with the hand transplant, now.
0:31:34 > 0:31:36I didn't think there were going to be all these side effects,
0:31:36 > 0:31:40I literally didn't think, I was so excited, I just thought, "Oh, I'm
0:31:40 > 0:31:43"going to have a new hand," I didn't think it would come with all this.
0:31:45 > 0:31:49I don't think it's wise to put myself through it at my age.
0:31:49 > 0:31:53I'm not unfit, and I'm not ill, and I know I've lost my hand,
0:31:53 > 0:31:57but it's not the end of the world, and I've learned to deal without
0:31:57 > 0:32:01having it now, so, I definitely think I'm making the right decision.
0:32:11 > 0:32:13Can we have that ice pack?
0:32:15 > 0:32:20Four hours in, and the operation has reached the most critical stage.
0:32:20 > 0:32:21OK. Let's...
0:32:24 > 0:32:25..start thinking about the veins.
0:32:27 > 0:32:31Using microscopes, Professor Kay and surgeon, Grainne Bourke,
0:32:31 > 0:32:33are now joining the veins and arteries that will allow
0:32:33 > 0:32:36blood to flow into the hand and restore life.
0:32:39 > 0:32:40Wait, wait, wait.
0:32:46 > 0:32:49The next step is to reperfuse the limb,
0:32:49 > 0:32:51so, get the blood back into the limb,
0:32:51 > 0:32:54because that is the time-critical component of the operation.
0:32:56 > 0:33:00Professor is joining first some veins together on the back of the arm,
0:33:00 > 0:33:03and then he'll turn it over to the front and join up two arteries,
0:33:03 > 0:33:07the radial artery and the ulnar artery, and then, as the clamps come
0:33:07 > 0:33:10off, blood will flow back into the hand and it will become pink again.
0:33:24 > 0:33:27This is the bit that takes the most concentration, I think.
0:33:27 > 0:33:30Working down the microscope is quite tiring, as well,
0:33:30 > 0:33:31it is quite tiring on your eyes,
0:33:31 > 0:33:35especially after you have been going so many hours, as he has already.
0:33:35 > 0:33:37With every stitch,
0:33:37 > 0:33:41the hand gets nearer to becoming a part of the patient's own body.
0:33:42 > 0:33:45Between the two metal clamps you will see a little tube that
0:33:45 > 0:33:49has been joined together with the very small stitches that he
0:33:49 > 0:33:52is tying a knot with now, and the tube is a vein
0:33:52 > 0:33:54which will allow blood to flow outwards of the hand.
0:33:56 > 0:33:59It is almost joined back together now, so that is what
0:33:59 > 0:34:02we call a completed anastomosis, so, in a moment, he will take
0:34:02 > 0:34:04the two metal clamps off
0:34:04 > 0:34:08and blood will start flowing between the join.
0:34:08 > 0:34:12With blood flow restored, the arteries and veins fill up,
0:34:12 > 0:34:15turning the lifeless limb from yellow to a healthy pink.
0:34:21 > 0:34:24After more than three and a half hours of intense microsurgery,
0:34:24 > 0:34:27the pinking up of the hand is a big relief.
0:34:27 > 0:34:29I think just do the extensions,
0:34:29 > 0:34:32and then if you can do the ulnar plexus that would be great.
0:34:32 > 0:34:34I will go and have a break.
0:34:37 > 0:34:40Perfect.
0:34:40 > 0:34:43And then when that is done, we will do the nerves together.
0:34:43 > 0:34:45OK, that sounds the best way.
0:34:51 > 0:34:53- BOY:- I have to make it better soon.
0:34:53 > 0:34:56You have to make my hand better soon?
0:34:56 > 0:35:00- I'm going to get my hand better soon, aren't I?- Yes, you are.
0:35:00 > 0:35:04- Will it be better when granddad has a nice hand?- Yes.
0:35:04 > 0:35:06With Dean now on the transplant waiting list,
0:35:06 > 0:35:12Mark is also hoping he will make it through the selection process.
0:35:12 > 0:35:13Oh!
0:35:13 > 0:35:16It's not going to work, is it? No.
0:35:17 > 0:35:21We're going to go over everything that we have been through about prosthetics
0:35:21 > 0:35:24Advances in prosthetic and bionic limbs might mean these are more
0:35:24 > 0:35:27suitable for patients than a real donor hand.
0:35:31 > 0:35:34Mark is at the LGI to find out which would be the better
0:35:34 > 0:35:35option for him.
0:35:38 > 0:35:40This is Sylvia, my wife.
0:35:43 > 0:35:45When I first met you, where we started from was,
0:35:45 > 0:35:47I thought you might be a good candidate,
0:35:47 > 0:35:51you would get more function from an artificial hand than you have now.
0:35:51 > 0:35:56And then I thought, "Why don't we think about a transplant first?"
0:35:56 > 0:36:01The good thing about a transplant is it is warm, it feels sensation,
0:36:01 > 0:36:02and it is on all the time.
0:36:02 > 0:36:05The other thing is it mends itself, just as your ordinary hand does,
0:36:05 > 0:36:09so if you cut your hand, or break it, it fixes itself.
0:36:09 > 0:36:11Whereas, if you have an artificial one, you have to put it on,
0:36:11 > 0:36:15it doesn't have feeling, it is cold, it whirrs when it moves.
0:36:15 > 0:36:17I don't know if I would use a bionic hand as much
0:36:17 > 0:36:20as I would use normal hand.
0:36:21 > 0:36:24With an artificial hand always a fallback option
0:36:24 > 0:36:30if a donor transplant fails, Mark now joins Dean on the waiting list.
0:36:30 > 0:36:33I've spoken to Mark, and I will speak to Dean and say, "You may be
0:36:33 > 0:36:37"called into hospital and then it will be judged on the blood tests."
0:36:37 > 0:36:40Whoever has the best chance of a good match will be
0:36:40 > 0:36:42the recipient on the day.
0:36:47 > 0:36:49It is two days before Christmas.
0:36:49 > 0:36:53Dean and Kirsty have been put on standby for the transplant.
0:36:53 > 0:36:55A donor might have been found.
0:36:55 > 0:36:57Of all the candidates,
0:36:57 > 0:37:00his blood type is the only one that looks likely to give a match.
0:37:02 > 0:37:04It could be good news for Dean,
0:37:04 > 0:37:07but they know it means sadness for someone else.
0:37:07 > 0:37:10Now we find ourselves waiting to find out
0:37:10 > 0:37:14if the family are willing for such an unusual transplant,
0:37:14 > 0:37:18and sort of waiting for that, and I think it is...
0:37:18 > 0:37:22it's a bittersweet moment for us, because obviously we know that
0:37:22 > 0:37:25somebody in a family has got some sadness at this time of year.
0:37:25 > 0:37:28We're just waiting to see about how they feel about one
0:37:28 > 0:37:31of their relatives being used in a hand transplant.
0:37:34 > 0:37:40Every year, 1,100 people in the UK donate their organs after death.
0:37:40 > 0:37:44Never before have limbs been given for transplant.
0:37:44 > 0:37:47The delicate task of approaching bereaved families is undertaken
0:37:47 > 0:37:53by specialist nurses from the NHS blood and transplant service.
0:37:53 > 0:37:57From the time that a donor becomes available, I had imagined
0:37:57 > 0:38:01they would just go through a list of heart, lung, whatever.
0:38:01 > 0:38:04But, actually, what they do is they approach the donor
0:38:04 > 0:38:09family in a very sensitive way and they sense what the right family
0:38:09 > 0:38:14is to ask, and what they can ask for, and how they would manage that.
0:38:14 > 0:38:17One of the things I like about hand transplantation
0:38:17 > 0:38:19is that it is very visible.
0:38:19 > 0:38:21It will be very visibly beneficial.
0:38:21 > 0:38:23And, of course that can cut both ways,
0:38:23 > 0:38:28but it does tell potential donors - here's a really tangible benefit.
0:38:28 > 0:38:30Get on the organ donor register, get a donor card
0:38:30 > 0:38:35and discuss it with your family, so that they know your wishes.
0:38:41 > 0:38:44TELEPHONE RINGS
0:38:44 > 0:38:47Three hours after being put on alert,
0:38:47 > 0:38:50Dean receives a call from the hospital.
0:38:50 > 0:38:52Hello!
0:38:52 > 0:38:54'Dean, hello, this is Simon Kay.'
0:38:54 > 0:38:56Hi, Simon.
0:38:56 > 0:38:58'I'm very sorry to say that the family have said no.'
0:38:58 > 0:39:01Oh, right, OK. Fair enough.
0:39:01 > 0:39:03'I'm really sorry about that, Dean.'
0:39:03 > 0:39:04OK.
0:39:04 > 0:39:07'So, we're back to the wait.
0:39:07 > 0:39:11'They spent a long time with the transplant coordinator,
0:39:11 > 0:39:15- 'and they have said no.'- Right.
0:39:15 > 0:39:18- 'So, there is nothing we can do about that.'- OK.
0:39:18 > 0:39:21'We got the cross-match and everything going,
0:39:21 > 0:39:23'it's a great disappointment to you, I know.
0:39:23 > 0:39:25'But, we now know the system works.'
0:39:25 > 0:39:30Yes, cool, that's the good side, yes, definitely.
0:39:30 > 0:39:35- 'OK.'- All right, Simon, thanks a lot. Have a nice Christmas.
0:39:35 > 0:39:37- 'You, too.'- OK, bye.
0:39:39 > 0:39:45I think in a situation like this, for me, it's the family, definitely.
0:39:45 > 0:39:46It's their decision.
0:39:46 > 0:39:48They're the ones that have lost so much.
0:39:48 > 0:39:52And, as much as I would gain anything,
0:39:52 > 0:39:55the thought of them being unhappy
0:39:55 > 0:39:58or unsettled about being in that situation, where they know
0:39:58 > 0:40:02their loved one is donating like that... I think it's a big call.
0:40:09 > 0:40:11I think that's good, Grainne.
0:40:11 > 0:40:13It's been eight hours
0:40:13 > 0:40:16since Professor Simon Kay and a 20-strong team
0:40:16 > 0:40:18at the Leeds General Infirmary
0:40:18 > 0:40:21started the hand transplant operation.
0:40:21 > 0:40:23I'm getting a bit antsy about the time.
0:40:23 > 0:40:26And while progress has been relatively smooth,
0:40:26 > 0:40:30Professor Kay is conscious that he must keep up the pace.
0:40:30 > 0:40:33I'm an absolute believer in eight hours is...
0:40:33 > 0:40:35You enter the dead zone then.
0:40:35 > 0:40:39You want things to progress at a good pace,
0:40:39 > 0:40:42because you don't want to have unduly long anaesthetic,
0:40:42 > 0:40:45for example, and when you join up the arteries
0:40:45 > 0:40:48and let the blood flow again, tissues start to swell.
0:40:48 > 0:40:50And it can you make it technically more demanding
0:40:50 > 0:40:54to join the nerves together precisely as they start to swell,
0:40:54 > 0:40:58and things like that. So there becomes a degree of time pressure.
0:41:08 > 0:41:10Edna is on her way to the LGI
0:41:10 > 0:41:14to find out if she's suitable to receive a life changing transplant.
0:41:18 > 0:41:20- Hello.- Hello, there.
0:41:20 > 0:41:22Nice to see you, come and have a seat.
0:41:22 > 0:41:24- How are you?- All right.
0:41:24 > 0:41:25OK.
0:41:25 > 0:41:30Um, the news that's not very good for you
0:41:30 > 0:41:37is that all the tests on your immune system
0:41:37 > 0:41:43show that you would only be compatible with 3% of the population.
0:41:43 > 0:41:46So that's a very small percentage.
0:41:46 > 0:41:52That in itself doesn't exclude you from receiving a transplant.
0:41:52 > 0:41:55But it does make it much less likely.
0:41:55 > 0:41:56Mm-hmm.
0:42:00 > 0:42:03The blood transfusions that Edna had to save her life
0:42:03 > 0:42:05left her body highly sensitised...
0:42:05 > 0:42:07Bye. Bye.
0:42:07 > 0:42:10..meaning her immune system would instantly reject
0:42:10 > 0:42:12the majority of donor hands.
0:42:16 > 0:42:18I keep hoping some day,
0:42:18 > 0:42:22some day the telephone will ring or...
0:42:22 > 0:42:25I'll get a letter.
0:42:25 > 0:42:28I'll...I'll keep hoping, and I'll keep praying...
0:42:28 > 0:42:30some day.
0:42:31 > 0:42:34But I just have to keep moseying on
0:42:34 > 0:42:39and...getting better at things that I do. Uh-huh.
0:42:39 > 0:42:41And...
0:42:41 > 0:42:43keep asking for help.
0:42:45 > 0:42:47There's lots of things I can't do,
0:42:47 > 0:42:51but I just have to put it to the side and that's it.
0:42:51 > 0:42:52It's done, it's dusted.
0:42:56 > 0:42:59After assessing more than 30 hopeful candidates,
0:42:59 > 0:43:02Professor Kay's shortlist is down to just two.
0:43:07 > 0:43:10Bye, buddy. Merry Christmas. See you later.
0:43:10 > 0:43:13And on Boxing Day night
0:43:13 > 0:43:18both Dean and Mark have been called into the LGI.
0:43:20 > 0:43:24Tonight, one of their lives will be changed for ever.
0:43:26 > 0:43:28DAN WILKS: 'We now know we've got a donor.
0:43:28 > 0:43:30'And that donor's family
0:43:30 > 0:43:32'has consented to the donation of the limb.'
0:43:37 > 0:43:42- MARK:- 'Everybody's on tenterhooks now, waiting to see what goes on.
0:43:42 > 0:43:44'I may be going home in an hour or I might be staying for a while.'
0:43:50 > 0:43:53- DEAN:- 'I'm not worried about it. I'm not anxious about it.
0:43:53 > 0:43:56'I'm just excited to know. Is this it? Is this it?'
0:44:06 > 0:44:08Because on a physical level,
0:44:08 > 0:44:11the donor limb will match both of our recipients well.
0:44:14 > 0:44:18In terms of long-term function, we know the best function
0:44:18 > 0:44:21will come from the one who has the best immunological match.
0:44:21 > 0:44:23And that's how we'll choose who will get which arm.
0:44:30 > 0:44:33After three hours, the results are finally in.
0:44:35 > 0:44:39Yeah, I've got one. I think there's something else coming through now.
0:44:41 > 0:44:43So it's coming up for nearly 3am,
0:44:43 > 0:44:46we've now had the faxed reports through from the lab.
0:44:46 > 0:44:50Telling us the match, um, of the recipient.
0:44:56 > 0:44:58So I now go and pass these results on.
0:45:04 > 0:45:05- Hi.- Hi.
0:45:05 > 0:45:08So I have the lab results...
0:45:09 > 0:45:12Um, you're a match.
0:45:12 > 0:45:17I'm pleased to say it's good news. You match entirely.
0:45:17 > 0:45:22- But unfortunately, the other person has matched closer than you have.- OK.
0:45:22 > 0:45:24- I'm terribly sorry... - That's OK.- That's all right.
0:45:24 > 0:45:25..to be the barer of that bad news.
0:45:25 > 0:45:30It's so close. You know it's so close, but yet, it's so far.
0:45:32 > 0:45:36So...the transplant's good to go.
0:45:37 > 0:45:38Let's get it on then.
0:45:40 > 0:45:44As Mark prepares for surgery, Dean must now head home.
0:45:45 > 0:45:48His hopes of receiving the new hand tonight are over.
0:45:57 > 0:46:00After nine hours, the operation to make Mark Cahill
0:46:00 > 0:46:02the first person in Britain
0:46:02 > 0:46:05to get a hand transplant is almost finished.
0:46:05 > 0:46:06Stapler.
0:46:06 > 0:46:11- DAN:- The professor's closing the skin over all the repairs.
0:46:13 > 0:46:16Part of the skill here is to make sure that it's not closed too tight.
0:46:18 > 0:46:23Because any compression on any of those small repairs underneath
0:46:23 > 0:46:26could impair the blood flow down the small vessels
0:46:26 > 0:46:28so you'll notice it's left quite loose
0:46:28 > 0:46:29and that's deliberate.
0:46:29 > 0:46:32Any small amounts of bleeding can make its own way out,
0:46:32 > 0:46:33rather than staying inside
0:46:33 > 0:46:36and pressing on the vessels or the nerves.
0:46:45 > 0:46:47- Is it still pink?- Yes.
0:46:49 > 0:46:52The last staples are inserted into Mark's arm
0:46:52 > 0:46:56and the pioneering surgery is complete.
0:46:56 > 0:46:59Can I have a Savlon swab please, two warm Savlon swabs.
0:46:59 > 0:47:02This is the most valuable hand in England at the moment.
0:47:06 > 0:47:08Let's get a picture.
0:47:10 > 0:47:12All right.
0:47:12 > 0:47:15Let's go with the dressing gauze. Thank you, everybody.
0:47:21 > 0:47:26He's off the table, seven blood vessels in all joined together.
0:47:26 > 0:47:28Every single one of them working at the end.
0:47:31 > 0:47:33The really marvellous thing about this
0:47:33 > 0:47:35is not that you join up arteries and blood vessels
0:47:35 > 0:47:36and nerves and tendons,
0:47:36 > 0:47:39and suddenly, you've got a pink hand that looks like hand.
0:47:39 > 0:47:41Because we've done that before
0:47:41 > 0:47:43for people who've cut through the wrist or whatever.
0:47:43 > 0:47:47But the marvellous thing is that it's not his hand.
0:47:47 > 0:47:50And yet, he hasn't already rejected it.
0:48:04 > 0:48:08Mark's off the table now for 24 hours and he's fabulous.
0:48:09 > 0:48:13- Hello. You all right? - Yup. Give us a kiss.
0:48:14 > 0:48:16He's healthy, cheerful.
0:48:16 > 0:48:18- How are you?- Fine.
0:48:18 > 0:48:22Yeah, and everybody's very happy with how it's gone on.
0:48:22 > 0:48:24I didn't expect it to move.
0:48:24 > 0:48:28What I really like is that he immediately wanted to see his hand
0:48:28 > 0:48:31and immediately feels that he owns it.
0:48:33 > 0:48:34That's absolutely incredible.
0:48:34 > 0:48:38I can't believe how much them fingernails look like your old ones.
0:48:38 > 0:48:40It's a very good match, isn't it?
0:48:40 > 0:48:42We've still got a long way to go,
0:48:42 > 0:48:44just from the normal healing point of view,
0:48:44 > 0:48:48he has to get his bone healed, his tendons healed, his skin healed.
0:48:48 > 0:48:49So that will all take time.
0:48:49 > 0:48:52- You saw Fiona this morning? - Yes.- Good.
0:48:54 > 0:48:55What do you think so far?
0:48:55 > 0:48:57I think it's absolutely brilliant so far.
0:48:57 > 0:49:02Like you said, it feels like it's yours already. Well, it IS yours.
0:49:02 > 0:49:05As you look at them, I can move the fingers, you see.
0:49:05 > 0:49:07- I know I'm doing that.- Yes.
0:49:07 > 0:49:10Now if I bend them down, can you push them out? Yes. Very good.
0:49:10 > 0:49:12That's enough. That's enough.
0:49:18 > 0:49:20It's now 10 days after the operation.
0:49:20 > 0:49:23And just one last time, so nice and straight for me,
0:49:23 > 0:49:25go on, go on, go on, go on.
0:49:25 > 0:49:27Mark is in rehab learning how to use his new hand.
0:49:27 > 0:49:29And then bring them down.
0:49:29 > 0:49:32The other thing that's really important, is Mark watches
0:49:32 > 0:49:34what he does all the time.
0:49:34 > 0:49:36So it's important that he sees himself opening his hand
0:49:36 > 0:49:38and then bending his fingers as well.
0:49:38 > 0:49:41So they start to build up this movement pattern in his brain
0:49:41 > 0:49:42about his hand moving again.
0:49:43 > 0:49:45So the big muscles of the hand work at the moment
0:49:45 > 0:49:47because they're all connected up here.
0:49:47 > 0:49:50But then he got really, really small muscles around his thumb,
0:49:50 > 0:49:52small muscles within the hand,
0:49:52 > 0:49:55that at the moment he doesn't have a nerve supply to.
0:49:55 > 0:49:56So that's what takes many months,
0:49:56 > 0:50:00and that's why it's really going to take us...a few years.
0:50:01 > 0:50:03You've been very good so far.
0:50:09 > 0:50:12After three weeks recovering in hospital,
0:50:12 > 0:50:13Mark's allowed to go home.
0:50:17 > 0:50:21- You all ready?- We're all set. - OK, Mark.- Thank you very much.
0:50:21 > 0:50:23I look forward to seeing you.
0:50:23 > 0:50:26We're actually going to see you...daily, aren't we this week?
0:50:26 > 0:50:30So I'll probably see you tomorrow. Yes. But you'll be glad to escape.
0:50:30 > 0:50:34And don't just spend the next three hours in the pub.
0:50:34 > 0:50:37Well, I'm pleased that he's well enough to go home,
0:50:37 > 0:50:39but nervous to let go of him.
0:50:39 > 0:50:42Right. Thank you very much. See you later.
0:50:42 > 0:50:46He'll be out of the woods when either I die or he dies, really.
0:50:46 > 0:50:49That'll be when I stop worrying about him.
0:50:49 > 0:50:54But, you know, the world experience now, I think, three flaps,
0:50:54 > 0:50:57three graphs have been lost from rejection out of 80.
0:50:57 > 0:50:59So he's got a really good chance.
0:51:11 > 0:51:14Edna now plans to keep in touch with the Leeds transplant team
0:51:14 > 0:51:17in the hope that one day they might find a donor match for her.
0:51:23 > 0:51:27Sarah has gone back to the Middle East to teach hairdressing
0:51:27 > 0:51:30and she started wearing a prosthetic hand.
0:51:37 > 0:51:39Dean and Kirsty plan to marry this summer.
0:51:39 > 0:51:42And he's hoping to be the next patient
0:51:42 > 0:51:45if the medical team do a second hand transplant.
0:51:48 > 0:51:52As for Mark, his block building is definitely getting better.
0:51:52 > 0:51:55Mine's bigger than yours now.
0:51:55 > 0:51:57'I absolutely love my new hand.
0:51:57 > 0:52:00'It's fantastic. Couldn't wish for anything better.
0:52:00 > 0:52:05'I'm so pleased that they made this donation of the hand.'
0:52:05 > 0:52:09And, um, I can't thank them enough.
0:52:09 > 0:52:11Me and my wife, both the same,
0:52:11 > 0:52:16we so much appreciate what they did at such a difficult time.
0:52:16 > 0:52:19And...I will make them proud of it.
0:52:28 > 0:52:31Subtitles by Red Bee Media Ltd