My New Hand

SIRENS WAIL

Arriving in this emergency ambulance

is a donor limb for Britain's first-ever hand transplant.

Will prep, thanks.

We have a limb. It's on the way.

After a nationwide search lasting more than a year,

over 30 people came forward,

eager to have the pioneering surgery.

In this film,

we'll meet four potential patients,

all of whom are desperate to make it through the tough selection process.

How would you feel about a white hand like mine?

We have to be clear about that, cos once you've got it, you've got it.

For one of them, this transplant will transform their life.

The difference it will make to us is beyond words, really.

I'll be able to do things like normal again.

When you tell people, they think, "Someone else's hand?!"

You wouldn't say that if you had somebody's heart, kidney or liver.

I want to just live again. Just live again.

But will they all be suitable?

We've now had the faxed reports through from the lab,

telling us the match of the recipient.

And which candidate will ultimately be the one

to receive this new hand and make British medical history?

Right, we're in business.

Let's go.

It's the early hours of the morning at Leeds General Infirmary

and Professor Simon Kay

briefs his team ahead of a landmark operation.

The patient will be anaesthetised

when the retrieval starts. Dan is calling me.

OK?

Grainne will lead the limb team.

And I'll lead the recipient team,

but I'll interchange between them,

so that I have the overall picture. Is that all right?

This operation has been two years in the planning.

But it's still a daunting prospect,

even for a microsurgeon with Professor Kay's years of experience.

Like a pilot doing a solo

on final approach...

..it's fine being up there but now you have to land it.

It is quite nerve-racking.

I think the obstacles now

are all technical, and it's

possible for any microsurgical process to fail.

You should never say it, but I think we have the basics covered.

We'll see. We haven't done it before.

There have been around 80 successful transplants

carried out around the world.

Now it's down to Professor Kay

and the team to prove it can be done in the UK.

With the surgeons on standby,

a call comes in from the donor retrieval team.

Will prep, thanks.

Cheers, Dan, bye. We have a limb. It's on the way.

Establishing a hand transplant programme

has been a long-term aim for Professor Kay.

The people who talk against hand transplant

almost always don't know what life's like without a hand.

It's a pretty poor life -

how do you button your shirt like that?

Or put your socks on? You just can't do it.

You have to be a very hard-hearted Jeremiah to say

it's not worth the cost of a kidney transplant to do that.

You have to really not have much humanity about you, I think.

A hand is what makes humans special.

I'm a lot older now,

and it's the last major thing I want to see working in Britain

before I throw in the towel and live in a tent.

Stand by, camera two to start off with.

13 months earlier...

Stand by, everyone.

..and Professor Kay's search for candidates begins

with a nationwide media campaign.

Tonight, pioneering surgery.

Plastic surgeons across the country have been asked to identify

'possible patients for what is an extremely complex operation.'

We were over in Belfast,

and your mum and dad was with us.

Yeah, my mum and dad said, "Have you ever heard about the LGI?

"It's wanting to do Britain's first hand transplant."

I just went, "Dean, I know this is for you."

Nightclub DJ Dean Smahon

lost both legs, his right hand

and three fingers on his left

after contracting septicaemia two years ago. He was lucky to survive.

I was in such pain.

Pain that I'd never experienced before.

His blood pressure was incompatible with life.

All his organs failed and he had black hands, black feet.

They tried their best to save them

but it was just too severe.

This left hand...the right hand was particularly bad.

You can see all the scars along here.

Right along here.

Without functioning hands, day-to-day

life for Dean is extremely difficult.

This is where it gets really awkward, because

sometimes I'll have a good day and sometimes it'll be a bad day.

You can just imagine me trying to tie this up.

It's a non-starter, you just can't.

I've been told to not do this and I keep doing it all the time.

I just grab it with my mouth and...

..do it like that.

That's when things get frustrating.

When you do all this, you start heating up in this before you go out,

so I'm usually a ball of sweat.

Dean puts a brave face on - for me, himself and everybody else.

But I think that element of feeling trapped

is psychologically

such an awful, awful feeling to have.

You want to do something so simple and you can't do it.

I could never have imagined the emotions

and feelings I experience by just not having a hand.

Of waking up in the morning and looking down at that.

No matter how strong I am or portray to be,

there's always a sadness in there.

That eats away at you, no matter what.

He won't be able to pick me up.

He won't be able to hold my hand

or dance with me

or walk on the beach properly or give me a massage.

It's always an element of sadness.

You can't get that back, can you?

Today is Dean and Kirsty's first meeting with Professor Kay

and the transplant team.

The thought of having the hand, actually,

is very exciting.

I think it's mixed emotions. I'm quite nervous

about such dramatic surgery. Dean's been through so much already.

But obviously I'm quite excited

of how life-changing it could be, as well.

Let's have a look at this. Wiggle a thumb for me.

You have a useful hand on the left side,

but it's not enough to live your life with,

to do the things you need to do.

So I think you would be somebody we would consider,

purely from a physical point of view, for a transplant.

There's a lot of other stuff we have to go through

to decide whether you're suitable...

from our point of view, and a lot of stuff you have to go through

to decide if we're suitable from your point of view.

One thing not in Dean's favour

is the amount of blood transfusions he had

following his illness.

The more transfusions, the more sensitive the body,

increasing the chances it could reject a donor hand.

And Dean's had a lot of transfusions.

We need to make sure that he doesn't have any antibodies

to the donor limb we'd be seeking out for him.

Every candidate will face similar blood tests.

The higher the levels of antibodies,

the lower the percentage of the population that will be

suitable donors.

Bloods will go off to the lab. They will keep a profile

of him, and when we identify a donor,

those two samples will be merged

and if there's any kind of overlap where one doesn't match the other,

it would invalidate the transplant for him and he wouldn't be offered that one.

He has taken quite a lot of blood transfusions in the past

and his response to that will be important.

It would be disappointing if it came to that.

If everything else is ticking the right boxes

and then we've been told. "You're not, unfortunately, suitable

"because of your transfusions,"

then it would be very disappointing.

But hopefully, it will not come to that.

Fingers crossed.

As well as being a good tissue match for potential donors

and physically suitable,

anyone hoping to make it onto the transplant shortlist

must also be psychologically prepared to cope with such

dramatic surgery.

Hands are very unusual. They are very, very visible.

They're as visible as the face, really.

The importance of the hand far outweighs

the physical size of them.

They effect us emotionally, physically, socially.

They're used in communication,

they're used in touch, they're used in relationships.

They're used in caring roles.

They also have very intimate functions and in self-care,

so it's a lot to consider...

..to weigh that up and decide whether you'll be able to

cope with such a life-changing event

as having a donor transplant.

The youngest person hoping for a transplant

is 23-year-old hairdresser Sarah Hayward.

She lost her hand in a car crash eight months ago,

while working in the Middle East.

On the night of the accident, we'd been working.

We got a lift home with one of my friends,

and he literally, split-second, looked at his phone.

He was going quite fast.

He just hit the roundabout and the car flipped.

I landed on my hands.

They tried to save my hand.

I had six or seven operations, it was.

After that, he said, "I'm really sorry,

"but we've done everything we can

"to try and save your hand, but

"I'll have to amputate your hand."

Once a professional stylist,

losing her dominant right hand means Sarah can't work

and now only styles hair as a favour for friends.

As soon as I heard you could have a hand transplant,

I just thought, "I'll be able to go back to work again."

Just thought I'd be able to do all this again,

be able to do all the colouring, extensions, cutting,

be able to just have my job back that I was doing.

You obviously don't think anything like this would ever happen to you,

so I'd just be able to have my life back.

Since the accident,

Sarah's been adjusting to life without her right hand.

I call it "the paw".

When I had the accident,

I always have my hand like that

and my mum always said I look like the lucky cat.

Obviously it's not that lucky, but I look like the lucky cat -

the Chinese that stand with their paw like that, so

ever since then it's been called "the paw."

And it does actually look like a paw a bit.

So that's what it is!

That's pretty.

Would you feel confident wearing that?

Well, I don't know if that's really me.

For a once outgoing, image-conscious young woman,

Sarah's disability has had a dramatic effect on her confidence.

I always feel people are looking at my hands.

I always tend to go for floaty sleeves,

like things to cover, like this.

Now...that's the style of clothes I would wear normally now...

..to cover everything.

Which is not something I would have picked a year ago.

I'll be able to do everything I was able to do beforehand,

cos it's a real hand.

It wouldn't move exactly the same as this hand

and it wouldn't be exactly the same,

but as long as they got quite a good match to the hand that I have,

I'll be able to do things like normal again.

Sarah Hayward and Dean Smahon

weren't the only candidates hoping to receive the transplant.

Mark Cahill, a former pub landlord from West Yorkshire

and Edna Kerr, a retired carer from Dumfries, also came forward.

But, only one eventually made it into the operating theatre

to receive a new hand.

After a selection process that's taken more than a year,

the successful patient is ready for surgery.

The donor hand is then taken from its protective icebox

and transferred into theatre by Professor Kay.

Right, can we have some prep?

The new hand will be attached to the patient's arm using

-metal plates secured on the bones...

-Right. We're in business.

..before veins, arteries, tendons and nerves are stitched together,

using precision microsurgery.

I tell you what I'm just going to do is check it's the right limb.

It is the right-hand limb, that, isn't it? Yes.

That would be quite important.

The two teams of surgeons will work side-by-side during

the first few hours of the operation,

one team working on the donor limb, while the

second prepares the patient's arm to receive the new hand.

Let's have a new blade, please.

But, less than an hour into the operation,

there's a problem with the patient's arm.

I'm a bit slower than you here, I've got a lot of scar to deal with.

The median nerve is very badly scarred and abnormal,

so we'll have to do that reasonably approximately,

and I don't think we'll get motor repair.

It's very, very scarred.

The nerves in the arm are badly damaged

and it's a major worry at such an early stage.

I'm just slightly concerned about the extent of scarring

internally, but that's unpredictable

and there's no scan or imaging or anything you can do to predict that.

So, we knew there would be some.

It can affect whether we leave here with two hands or not.

That's the worry.

OK, I'm going to come and join you in a moment.

We'll do the anastomosis.

-Hi, Pete, can I have two pints, please, mate.

-Two Carling.

Thing about it is, Pete, if I do get another hand,

I might be able to work behind the bar again,

I could relief manager for you.

Fantastic. I might get a week off.

What I could do!

Like all the potential candidates, Mark had led a normal life

until losing the use of his right hand.

Before I got ill, I was a landlord of a pub.

Eight and a half years. The pub just down the road, actually.

And my hand swelled up with gout,

so I thought I better go to hospital

and they kept me in for two months.

Five operations on my hand

and my hand ended up paralysed,

so that was the basic start of it.

Losing function in a hand can mean undertaking the most basic

human tasks - washing, eating, even going to the toilet -

require assistance from someone else.

To start with, it was absolutely everything.

I used to have to basically bed bath him.

He couldn't use both hands at one point,

so everything was not just cut up and...

cooked and cut up for him, it was

actually feeding him,

physically feeding him, which he didn't like.

He hated that bit.

I did love... One of my things was cooking.

Now, I'm down to basically something on toast,

and I can't even really do that, now.

At this point, I start to struggle,

because I don't have total control

over the pans or the handles.

Oops.

And this is where it gets messy.

51-year-old Mark still has both hands, but his right is

completely paralysed, making it virtually useless.

I end up buttering my fingers.

Everything's cold.

I thought I'd be great with the ready meals but...

..I can't get the cellophane off them without burning myself.

You try and tip them out and it's even worse.

It doesn't make you feel good

when you're having to rely on people all the time,

when you've been so independent all your life,

when you've been able to do anything you want to do, you can do yourself.

I must admit, it's something I do miss, cooking.

I used to be a dab hand at cooking. Pretty good at...

Ravioli on toast doesn't really come up to that mark.

A new hand could be life-changing for the candidates,

but one of the biggest hurdles they must overcome is

the concept of having a stranger's hand attached to their body.

Would they accept it,

or will it permanently feel like someone else's hand?

'When people's bodies change in any physical way,'

it takes a while for their body image...

their mental image of themself to catch up,

so we'd assume it would take a while before they can fully

integrate the new hand to feel like part of them.

You'd be lying if you said it's just easy.

I think there will be an element of getting used to it

and getting accustomed to somebody else's hand attached

to your body, but I just think, through time,

it's become one of those things that you don't notice,

because I don't notice the amputations now.

I don't see it when I see Dean.

So I think, over time, you just get used to that.

They could face disappointment, they may find it difficult to

adjust to the reality of the donor hand and, I suppose,

the worst-case scenario would be psychological rejection of it

and then wanting to have the hand removed.

To get his head around the idea, Mark turned to the internet,

to find out how patients in America have fared following their

hand transplants.

-MAN ON INTERNET:

-'Oh, yeah, they feel like my hands...

'..in every way. She loves them.'

'These are his hands, to me.'

-MARK:

-People's reactions, they say to me, "How will your hand feel?

"Will it feel like your own hand or not feel like your own hand?"

And I don't suppose, until I get it, that I'll know,

but from the videos I have seen of American people that have had it,

and actually think it's their own hand,

I think it's a good opportunity to go forward

and get some life back, basically.

MAN LAUGHS

At the Leeds General Infirmary, it's now two hours

since the transplant operation began.

Rob, how are you doing this end?

Professor Kay's early concerns have subsided, as the surgeons working on

the patient's arm have found intact nerves amongst the damaged tissue.

On the other side of the operating table,

the donor hand team has reached a crucial stage.

Miss Bourke's very beautifully dissected out the donor hand

and shortly we'll be dividing the donor hand from the forearm

and putting a plate onto both of the forearm bones,

in preparation for transferring over

to the other side and restoring

the skeleton's integrity,

before we start restoring the other structures.

It's vital that the hand is separated from the donor

forearm at exactly the right point.

A ruler.

Look there, at the end. If we can see...

An inaccurate measurement means that

when the hand is attached to the patient,

it could be a different length

to their existing, healthy limb.

It's at this stage that complex surgery becomes precision DIY.

-OK, locking.

-Yes.

-All good?

-Yes.

Drill.

DRILL WHIRRS

The metal plates are then screwed onto the bones of the donor hand.

Even at this early stage,

the team are racing against the clock.

Three hours, it's been off.

I think we'll go for four hours

and we'll cool it again in a minute.

'We're going to keep it as cool as we can, just'

because warm muscle that doesn't have blood supply dies very quickly.

The rest of it, there's the bone and the skin,

will live a long time without blood supply

but, for the muscle it's crucial.

In another couple of hours we'll be beginning to get a bit antsy.

-It's sitting on ice, OK?

-All right, thank you.

In the previous 12 months, more than 30 hopeful patients from

across the UK contacted Professor Kay

to find out about the hand transplant.

Sit down. OK. You go and sit with granny.

One of them was Edna Kerr, who's 65.

I've got a watch to tell the time. Look what time it is!

Whoa!

THEY LAUGH

-You've not done that before, have you?

-No!

A life-threatening viral infection led to keen traveller Edna

losing her limbs just over a year ago.

I looked at my hands

and they were all bandaged up.

And I just could feel just part of my legs had been...

..chopped off, if you like. Yes.

I thought, "Well, I'll have to get on with it."

Having already had her first consultation with

Professor Kay, Edna's now eager

to make it onto the transplant shortlist.

Fantastic news and I hope I go through with it.

Life's on hold just now

and getting up and getting out

and just doing things without...

..having to rely on anybody.

-Independence.

-Independence.

In any transplant surgery,

patients must continually take a cocktail of immunosuppressant

drugs, to prevent their body rejecting the alien donor organ.

But the drugs also lower the body's natural defences,

making it susceptible to possible serious infection and illness.

-WOMAN:

-When she's pouring herself...

For some, any benefits gained from having a hand transplant

might be outweighed by potential health problems.

No, it's Charlotte's birthday...

'This chance, this hand transplant, would be a great chance,

'but it's just, you know, a big thing to think about.'

'I didn't think, "Oh, medication, side effects."

'I just thought, "Oh, my God, I'll have a hand."'

The anti-rejection medication increases the chance

of skin cancers.

There's a higher risk of diabetes

and life expectancy could be reduced,

as the immune system becomes less able

to fight off infection in old age.

Now, because I'm sort of thinking,

I don't know what to do about the whole hand transplant.

At first, I was thinking, "I'm just going to go through with it.

"I definitely want to do it. I think it's amazing, blah, blah, blah."

Now, because I've heard all the side effects and stuff like that,

it knocks me back down again to think,

"Oh, no, I'm going to be like this now. What am I going to do?"

Everyday tasks like learning to write with your weaker hand,

are a struggle, but a transplant might not prove to be a miracle fix.

'For some people, the downside is just too great.

'The requirement to take the medication,'

which can open them up to serious side effects,

maybe life-threatening side effects, is a step too far.

After three hours of intense surgery, Professor Kay and his

transplant team are ready to attach

the new hand to the patient's arm.

Now, will we get that on?

That's a good question, because that plate is slightly angled, isn't it?

I think there's room, though.

The professor's now joining the bones together,

the two main bones of the forearm,

the radius and the ulna.

The radius has a locking plate on it which he has just performed,

and he is now putting on an ulna plate.

Once the hand is then stable,

he will then join together the nerves, a couple of the muscles,

then rejoin the arteries and let the blood flow back through the limb.

Actually, I don't need a guide.

I just need a drill. Thank you.

Plate holding forceps, please.

It takes around 40 minutes to attach the bones in the new hand to

the patient's forearm.

I'll have a sore wrist after all this.

Once the plates are connected securely,

the surgeons can begin to join the tendons,

which are fibrous tissue

that connect bone to muscle, and provide movement in the hand.

So that's ring, so that should be middle.

One, two, three, four. OK?

There are 11 tendons in the wrist,

there are eight that bend the fingers,

one that bends the thumb,

and two that bend the wrist, as well, and of course, on the other side,

there are ones that straighten out the wrist and the tendons, as well.

So, there's lots to do.

Scissors.

OK, let's fish that one out of here.

Keep going. No pressure.

In Dumfries, Edna is managing to get by as she waits to hear

if she will be added to the transplant list.

Everything is an effort to me.

I would just get myself showered, get my breakfast,

do my housework, it just takes longer to do everything.

It just takes a morning to get out.

For Edna, a new hand would mean getting back her old life.

I want to just live again, just live again. It's just...

I'm old before my time.

And I just want to live.

Just a normal life.

And...just go out with the grandchildren...

In Leeds, Dean has received the results of crucial blood tests.

These will reveal how many donors would be a suitable

biological match for him.

They found out that my blood,

my parameters were actually better than anticipated.

It works out that my suitability of the population of Leeds should

fall in about three quarters of the population.

-Potential.

-Yes, potential.

That, of course,

just makes it more probable that you will find a suitable donor...

And hopefully will speed the process up, theoretically.

However, a genetic match isn't the only thing to be taken into consideration.

So, if I get you with that arm out to the side...

Who will receive the transplant

will also be based on how particular the candidates are about

size, gender and skin colour of the donor hand.

We've got colour photographs for you which

we are going to use for the match, but obviously that shows us

what you are, it doesn't show you what your limits are.

So, how would you feel about a white hand like mine?

A really white one.

-Yes, I don't see a big problem.

-No?

We've got to be absolutely clear about that,

because once you have got it, you have got it.

I always said from the beginning that it was other points that

were more important to me - the functionability,

the colouring was actually further down, the question of

whether it was a male or female hand, it wouldn't bother me.

Dean, I'm going to write you today, then, confirm the offer.

I'd think there is no reason we wouldn't be live from next week.

Two years in the planning, and now Dean is the first person to

make Professor Kay's transplant shortlist.

Hairdresser Sarah has also made a decision.

Well, I have had a long think about what I want to do,

and I don't think I really want to go ahead with the hand transplant, now.

I didn't think there were going to be all these side effects,

I literally didn't think, I was so excited, I just thought, "Oh, I'm

"going to have a new hand," I didn't think it would come with all this.

I don't think it's wise to put myself through it at my age.

I'm not unfit, and I'm not ill, and I know I've lost my hand,

but it's not the end of the world, and I've learned to deal without

having it now, so, I definitely think I'm making the right decision.

Can we have that ice pack?

Four hours in, and the operation has reached the most critical stage.

OK. Let's...

..start thinking about the veins.

Using microscopes, Professor Kay and surgeon, Grainne Bourke,

are now joining the veins and arteries that will allow

blood to flow into the hand and restore life.

Wait, wait, wait.

The next step is to reperfuse the limb,

so, get the blood back into the limb,

because that is the time-critical component of the operation.

Professor is joining first some veins together on the back of the arm,

and then he'll turn it over to the front and join up two arteries,

the radial artery and the ulnar artery, and then, as the clamps come

off, blood will flow back into the hand and it will become pink again.

This is the bit that takes the most concentration, I think.

Working down the microscope is quite tiring, as well,

it is quite tiring on your eyes,

especially after you have been going so many hours, as he has already.

With every stitch,

the hand gets nearer to becoming a part of the patient's own body.

Between the two metal clamps you will see a little tube that

has been joined together with the very small stitches that he

is tying a knot with now, and the tube is a vein

which will allow blood to flow outwards of the hand.

It is almost joined back together now, so that is what

we call a completed anastomosis, so, in a moment, he will take

the two metal clamps off

and blood will start flowing between the join.

With blood flow restored, the arteries and veins fill up,

turning the lifeless limb from yellow to a healthy pink.

After more than three and a half hours of intense microsurgery,

the pinking up of the hand is a big relief.

I think just do the extensions,

and then if you can do the ulnar plexus that would be great.

I will go and have a break.

Perfect.

And then when that is done, we will do the nerves together.

OK, that sounds the best way.

-BOY:

-I have to make it better soon.

You have to make my hand better soon?

-I'm going to get my hand better soon, aren't I?

-Yes, you are.

-Will it be better when granddad has a nice hand?

-Yes.

With Dean now on the transplant waiting list,

Mark is also hoping he will make it through the selection process.

Oh!

It's not going to work, is it? No.

We're going to go over everything that we have been through about prosthetics

Advances in prosthetic and bionic limbs might mean these are more

suitable for patients than a real donor hand.

Mark is at the LGI to find out which would be the better

option for him.

This is Sylvia, my wife.

When I first met you, where we started from was,

I thought you might be a good candidate,

you would get more function from an artificial hand than you have now.

And then I thought, "Why don't we think about a transplant first?"

The good thing about a transplant is it is warm, it feels sensation,

and it is on all the time.

The other thing is it mends itself, just as your ordinary hand does,

so if you cut your hand, or break it, it fixes itself.

Whereas, if you have an artificial one, you have to put it on,

it doesn't have feeling, it is cold, it whirrs when it moves.

I don't know if I would use a bionic hand as much

as I would use normal hand.

With an artificial hand always a fallback option

if a donor transplant fails, Mark now joins Dean on the waiting list.

I've spoken to Mark, and I will speak to Dean and say, "You may be

"called into hospital and then it will be judged on the blood tests."

Whoever has the best chance of a good match will be

the recipient on the day.

It is two days before Christmas.

Dean and Kirsty have been put on standby for the transplant.

A donor might have been found.

Of all the candidates,

his blood type is the only one that looks likely to give a match.

It could be good news for Dean,

but they know it means sadness for someone else.

Now we find ourselves waiting to find out

if the family are willing for such an unusual transplant,

and sort of waiting for that, and I think it is...

it's a bittersweet moment for us, because obviously we know that

somebody in a family has got some sadness at this time of year.

We're just waiting to see about how they feel about one

of their relatives being used in a hand transplant.

Every year, 1,100 people in the UK donate their organs after death.

Never before have limbs been given for transplant.

The delicate task of approaching bereaved families is undertaken

by specialist nurses from the NHS blood and transplant service.

From the time that a donor becomes available, I had imagined

they would just go through a list of heart, lung, whatever.

But, actually, what they do is they approach the donor

family in a very sensitive way and they sense what the right family

is to ask, and what they can ask for, and how they would manage that.

One of the things I like about hand transplantation

is that it is very visible.

It will be very visibly beneficial.

And, of course that can cut both ways,

but it does tell potential donors - here's a really tangible benefit.

Get on the organ donor register, get a donor card

and discuss it with your family, so that they know your wishes.

TELEPHONE RINGS

Three hours after being put on alert,

Dean receives a call from the hospital.

Hello!

'Dean, hello, this is Simon Kay.'

Hi, Simon.

'I'm very sorry to say that the family have said no.'

Oh, right, OK. Fair enough.

'I'm really sorry about that, Dean.'

OK.

'So, we're back to the wait.

'They spent a long time with the transplant coordinator,

-'and they have said no.'

-Right.

-'So, there is nothing we can do about that.'

-OK.

'We got the cross-match and everything going,

'it's a great disappointment to you, I know.

'But, we now know the system works.'

Yes, cool, that's the good side, yes, definitely.

-'OK.'

-All right, Simon, thanks a lot. Have a nice Christmas.

-'You, too.'

-OK, bye.

I think in a situation like this, for me, it's the family, definitely.

It's their decision.

They're the ones that have lost so much.

And, as much as I would gain anything,

the thought of them being unhappy

or unsettled about being in that situation, where they know

their loved one is donating like that... I think it's a big call.

I think that's good, Grainne.

It's been eight hours

since Professor Simon Kay and a 20-strong team

at the Leeds General Infirmary

started the hand transplant operation.

I'm getting a bit antsy about the time.

And while progress has been relatively smooth,

Professor Kay is conscious that he must keep up the pace.

I'm an absolute believer in eight hours is...

You enter the dead zone then.

You want things to progress at a good pace,

because you don't want to have unduly long anaesthetic,

for example, and when you join up the arteries

and let the blood flow again, tissues start to swell.

And it can you make it technically more demanding

to join the nerves together precisely as they start to swell,

and things like that. So there becomes a degree of time pressure.

Edna is on her way to the LGI

to find out if she's suitable to receive a life changing transplant.

-Hello.

-Hello, there.

Nice to see you, come and have a seat.

-How are you?

-All right.

OK.

Um, the news that's not very good for you

is that all the tests on your immune system

show that you would only be compatible with 3% of the population.

So that's a very small percentage.

That in itself doesn't exclude you from receiving a transplant.

But it does make it much less likely.

Mm-hmm.

The blood transfusions that Edna had to save her life

left her body highly sensitised...

Bye. Bye.

..meaning her immune system would instantly reject

the majority of donor hands.

I keep hoping some day,

some day the telephone will ring or...

I'll get a letter.

I'll...I'll keep hoping, and I'll keep praying...

some day.

But I just have to keep moseying on

and...getting better at things that I do. Uh-huh.

And...

keep asking for help.

There's lots of things I can't do,

but I just have to put it to the side and that's it.

It's done, it's dusted.

After assessing more than 30 hopeful candidates,

Professor Kay's shortlist is down to just two.

Bye, buddy. Merry Christmas. See you later.

And on Boxing Day night

both Dean and Mark have been called into the LGI.

Tonight, one of their lives will be changed for ever.

DAN WILKS: 'We now know we've got a donor.

'And that donor's family

'has consented to the donation of the limb.'

-MARK:

-'Everybody's on tenterhooks now, waiting to see what goes on.

'I may be going home in an hour or I might be staying for a while.'

-DEAN:

-'I'm not worried about it. I'm not anxious about it.

'I'm just excited to know. Is this it? Is this it?'

Because on a physical level,

the donor limb will match both of our recipients well.

In terms of long-term function, we know the best function

will come from the one who has the best immunological match.

And that's how we'll choose who will get which arm.

After three hours, the results are finally in.

Yeah, I've got one. I think there's something else coming through now.

So it's coming up for nearly 3am,

we've now had the faxed reports through from the lab.

Telling us the match, um, of the recipient.

So I now go and pass these results on.

-Hi.

-Hi.

So I have the lab results...

Um, you're a match.

I'm pleased to say it's good news. You match entirely.

-But unfortunately, the other person has matched closer than you have.

-OK.

-I'm terribly sorry...

-That's OK.

-That's all right.

..to be the barer of that bad news.

It's so close. You know it's so close, but yet, it's so far.

So...the transplant's good to go.

Let's get it on then.

As Mark prepares for surgery, Dean must now head home.

His hopes of receiving the new hand tonight are over.

After nine hours, the operation to make Mark Cahill

the first person in Britain

to get a hand transplant is almost finished.

Stapler.

-DAN:

-The professor's closing the skin over all the repairs.

Part of the skill here is to make sure that it's not closed too tight.

Because any compression on any of those small repairs underneath

could impair the blood flow down the small vessels

so you'll notice it's left quite loose

and that's deliberate.

Any small amounts of bleeding can make its own way out,

rather than staying inside

and pressing on the vessels or the nerves.

-Is it still pink?

-Yes.

The last staples are inserted into Mark's arm

and the pioneering surgery is complete.

Can I have a Savlon swab please, two warm Savlon swabs.

This is the most valuable hand in England at the moment.

Let's get a picture.

All right.

Let's go with the dressing gauze. Thank you, everybody.

He's off the table, seven blood vessels in all joined together.

Every single one of them working at the end.

The really marvellous thing about this

is not that you join up arteries and blood vessels

and nerves and tendons,

and suddenly, you've got a pink hand that looks like hand.

Because we've done that before

for people who've cut through the wrist or whatever.

But the marvellous thing is that it's not his hand.

And yet, he hasn't already rejected it.

Mark's off the table now for 24 hours and he's fabulous.

-Hello. You all right?

-Yup. Give us a kiss.

He's healthy, cheerful.

-How are you?

-Fine.

Yeah, and everybody's very happy with how it's gone on.

I didn't expect it to move.

What I really like is that he immediately wanted to see his hand

and immediately feels that he owns it.

That's absolutely incredible.

I can't believe how much them fingernails look like your old ones.

It's a very good match, isn't it?

We've still got a long way to go,

just from the normal healing point of view,

he has to get his bone healed, his tendons healed, his skin healed.

So that will all take time.

-You saw Fiona this morning?

-Yes.

-Good.

What do you think so far?

I think it's absolutely brilliant so far.

Like you said, it feels like it's yours already. Well, it IS yours.

As you look at them, I can move the fingers, you see.

-I know I'm doing that.

-Yes.

Now if I bend them down, can you push them out? Yes. Very good.

That's enough. That's enough.

It's now 10 days after the operation.

And just one last time, so nice and straight for me,

go on, go on, go on, go on.

Mark is in rehab learning how to use his new hand.

And then bring them down.

The other thing that's really important, is Mark watches

what he does all the time.

So it's important that he sees himself opening his hand

and then bending his fingers as well.

So they start to build up this movement pattern in his brain

about his hand moving again.

So the big muscles of the hand work at the moment

because they're all connected up here.

But then he got really, really small muscles around his thumb,

small muscles within the hand,

that at the moment he doesn't have a nerve supply to.

So that's what takes many months,

and that's why it's really going to take us...a few years.

You've been very good so far.

After three weeks recovering in hospital,

Mark's allowed to go home.

-You all ready?

-We're all set.

-OK, Mark.

-Thank you very much.

I look forward to seeing you.

We're actually going to see you...daily, aren't we this week?

So I'll probably see you tomorrow. Yes. But you'll be glad to escape.

And don't just spend the next three hours in the pub.

Well, I'm pleased that he's well enough to go home,

but nervous to let go of him.

Right. Thank you very much. See you later.

He'll be out of the woods when either I die or he dies, really.

That'll be when I stop worrying about him.

But, you know, the world experience now, I think, three flaps,

three graphs have been lost from rejection out of 80.

So he's got a really good chance.

Edna now plans to keep in touch with the Leeds transplant team

in the hope that one day they might find a donor match for her.

Sarah has gone back to the Middle East to teach hairdressing

and she started wearing a prosthetic hand.

Dean and Kirsty plan to marry this summer.

And he's hoping to be the next patient

if the medical team do a second hand transplant.

As for Mark, his block building is definitely getting better.

Mine's bigger than yours now.

'I absolutely love my new hand.

'It's fantastic. Couldn't wish for anything better.

'I'm so pleased that they made this donation of the hand.'

And, um, I can't thank them enough.

Me and my wife, both the same,

we so much appreciate what they did at such a difficult time.

And...I will make them proud of it.

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