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Living with a transplanted hand

Six years later, how is the new hand's sense of touch?

From the very beginning, it was a long shot. But, today, 44-year old Matthew Scott is as attached to his transplanted left hand as ever.

When “Dateline” first met Scott in 1998, he had a lot to be thankful for: his wife, Dawn, his young sons Jeremy and Ian, and a busy career as a health care administrator and as a teacher.

But it’s what he didn’t have and what he couldn’t do that he so often thought about. That’s why he was so willing to put himself at risk, to undo what had happened to him 13 years earlier.

Around the holiday season of 1985, on December 23, Scott was partying with two friends. He was smoking cigarettes and playing with an M80 firecracker, the equivalent of an eighth of a stick of dynamite, with a very quick fuse.

Matthew Scott: So, as I was playing games with it, lit it to touch the end of my cigarette, that fuse was burning down. And it exploded.

Scott was rushed to the emergency room. But what remained of his hand could not be saved. Doctors amputated the rest. It was his left hand that was blown off.  And Scott is left-handed. A short time later, he was fitted with an artificial hand.

But as advanced as his prosthesis was, and as proficient as he became using it, Scott struggled with little things most people take for granted. He had trouble turning door knobs, tying his shoes, knotting a tie. And then there were the important things.

Scott: My son is now at an age where he’s starting to play sports and he wants to go out there and learn to play baseball because he knows how much dad loves playing baseball, and to show him how to swing a bat and how to catch a pop fly, those are the things I worry about now.

Scott’s uneasiness with his artificial hand was never only about physical limitations.

Scott: When that hand went away, a huge part of my self-image and my body image went away with it.Stone Phillips, "Dateline" anchor: You were self-conscious about it.Scott: Incredibly. And I still am today.  I’m just not comfortable in public putting that out for people to see. In my mind, always been something I had to settle for because nothing better was available.

But, in the summer of 1998, while Matt and Dawn were vacationing in London, this article appeared in the newspaper. It was about a team of doctors in Kentucky announcing plans to perform what they hoped would be the world’s first successful hand transplant.

Scott: I read that article as quickly as I possibly could, read it again on the plane on the way home. Wasn’t too terribly long after that, I was calling Kentucky. I just wanted to get my name on somebody’s list somewhere.

That list belonged to doctors at Jewish hospital, University of Louisville hospital and Kleinert and Kutz Hand Care Center. After years of meticulous research, they had a transplant team in place, ready to proceed. 

Doctors had been reattaching severed hands for 30 years. As delicate as the procedure is, connecting all those tiny blood vessels, tendons, muscles and nerves, it’s actually become almost routine.

But when the hand being attached comes from a donor, doctors were entering the unknown.

Dr. Warren Briedenbach, team chief hand surgeon: The part where I’ll be nervous is the part that I have no control over. And the part that I have no control over is “What is this patient going to do when his immune system starts responding to this foreign body?” and I can’t control that.

And that’s where the danger came in, not with the surgery, but with the anti-rejection drugs the patient must take for the rest of his life— drugs that can severely compromise the immune system.

Phillips: And the risk involved?Briedenbach: Well, the risk involved is death.Dr. Jon Jones, in charge of administering the anti-rejection drugs:  When we talk about death, to a large degree, it’s going to be from lymphomas or some type of infection that’s unrecognized until it’s too late or we’re unable to control. Phillips: That’s when you get to the crux of the criticism.Jones: That’s true.

In January 1999, the phone call Scott had been waiting for finally came— he flew to Louisville. Led by Breidenbach and Jones, more than 50 doctors, nurses and researchers teamed up. About 15 hours later, Matthew Scott had a new left hand.

Scott: My left hand is a little smaller than my right hand.

When we talked to Scott in 2000, a year after the surgery, it was remarkable to see and touch his new hand. 

Phillips: What’s the best thing so far about having this new hand?Scott: There isn’t a single best thing, it’s a composite of everything. I just feel balanced now.  I didn’t have a sense of that before with the prosthesis.  

His progress was testament not only to the skill of the doctors, but to Matt’s determination.  He spent long, strenuous hours with therapists in Louisville.

At home in New Jersey, he went to therapy 3 times a week, working to improve his strength, range of motion, and flexibility.  It wasn’t easy.

Scott: I suppose in my mind, I had this idea that it would just be attach the hand, some therapy, and everything would be back to the way it was before.  And it’s certainly not that way.  It has been much harder than I think I anticipated.

But less than three months after the operation, Scott had a coming out party, invited to toss out the ceremonial first pitch at a major league baseball game, the home opener for his beloved Philadelphia Phillies.

Wearing number 13, he hugged his son Ian for good luck, then took the ball in his new left hand. That slow toss was just the beginning: Before long, he was able to do things, that for years, he’d been unable to do with his artificial hand.

Scott: I can open a door with my left hand. I can carry both my sons at the same time. I can carry my briefcase in one hand and talk on my cell phone on the other. I can drive with two hands on the wheel now you know, feeling safer than I ever had before. I can tie my shoes! I haven’t been able to tie my shoes for 13 years. Getting dressed in the morning, pulling my pants up, as silly as it sounds, it’s now this way as opposed to that versus that and that. So many of those little things that I thought I had forgotten.

The thumb and index finger are free moving but the other fingers only move together, so his new left hand will never be quite as good as his right.

Phillips: And strength? How’s your grip?Scott: My right hand is obviously much, much stronger.Phillips: But that’s surprisingly strong. I would not have expected you to have that kind of strength in your grip.Scott: At last test it was 7 and a half lbs. of grip. When I first started, it was zero.

But a big question was whether Scott would be able to feel anything with his new hand. At first, he said, all he could feel was pressure. But, within months after the operation, as nerves developed, a breakthrough.

Scott:  The first sensation I guess I really felt was cold. And one morning getting the boys’ breakfast ready, reaching into the, into the freezer, took out a box of waffles and I looked at my wife Dawn and said “I feel that. That’s cold.”

But along the way, there were set-backs as well. Three times in that first year, Matt’s body seemed to be rejecting the transplanted hand. But Dr. Jones adjusted the medication and that seemed to take care of the problem. Matt also experienced phantom pain in his new hand—much like the pain he felt after his original injury. Special medication eventually took care of that, too, and the phantom pain didn’t come back.

Today, six years after the surgery, another kind of pain that has disappeared is the pain of embarrassment about that old prosthesis.

Scott: There were clouds in my eyes. There were issues that I had with, you know, the loss of the hand and the prosthesis. And, and those issues have gone away.

Scott has become an old hand at using his new hand. Although he did have some minor rejection symptoms back in march, they subsided on their own and his health has been good. He’s taking less medicine, now, and goes in for therapeutic evaluation about three times a year.

Matt’s right hand will always be dominant, but his left hand is twice as strong as it was when we saw him five years ago. He’s better at signing his name left-handed though he’s still more comfortable using his right. And there is progress in other areas, as well.

Scott: I can go to a tollbooth and get the change this way instead of reaching across my body. I can clap my hands now when my sons do wonderful things in baseball and karate. I can go to the store and put change in my hand and work through it and find the pennies, nickels, dimes to give to the cashier. Whereas, before, I couldn’t do that.

There’s also been improvement in Matt’s sense of touch.

Scott: Now I can distinguish smooth and rough. I can distinguish hard and soft. I cannot distinguish wood from plastic from rubber. Those types of fine sensations are not there.

A couple of years ago, Matt got a special father’s day gift: a drum pad and sticks. It was a reminder of his younger years as a rock band drummer, before the accident, and a symbol of just how far he has come.

Scott: Now to be able to go back and do something that I was able to do years before my injury was a feeling inside that— it’s just like this affirmation to me that, “Yeah, this was worth it. This is good. This is something that you know I could never do before.” And, as insignificant in life as it may seem that is, inside, a world of difference to me to be able to go back and do that.

It's a medical marvel and an extraordinary comeback story with chapters still being written, all about priceless moments like this.

There have about two-dozen hand transplants performed in the world to date. Matt Scott has lived with his new hand longer than anyone else.