4 Jan 2013

UK’s first hand transplant: the psychological impact

As a 51-year-old man receives the first UK hand transplant, Channel 4 News looks at the possible psychological effects of this kind of surgery.

Mark Cahill, who lost the use of his right hand through gout, underwent the eight-hour operation to have the hand removed and replaced with the donor hand on 27 December.

Doctors at Leeds General Infirmary said a new technique was used which allowed very accurate restoration of nerve structures.

Consultant plastic surgeon Professor Simon Kay, who led the surgical team, said: “This operation is the culmination of a great deal of planning and preparation over the last two years by a team including plastic surgery, transplant medicine and surgery, immunology, psychology, rehabilitation medicine, pharmacy and many other disciplines.”

Mr Cahill said: “Hopefully I will be able to get back to work for a start, that’s a major difference. For a start I might be able to cut my food up, button my shirts, fasten a pair of shoelaces, and mainly I’ll be able to hold my grandson’s hand.”

One of the next steps for him will be the psychological adjustment to his new hand, so what are the psychological issues recipients of organ donation can face?

Psychological impact

The impact of the transplant of major external organs, as in hand or face transplants, is to some extent a relatively unexplored area because the type of surgery rarely takes place. However, it is something that is carefully measured in all transplant patients.

Some people are able to absorb it into their psychologies easily but others have to view it as an advanced prosthesis – Professor Martin Birchall

Professor Martin Birchall, of University College London, who was part of the team that carried out the world’s second voicebox transplant in 2012, said transplants that alter appearance are not suitable for everyone.

“If you have something that alters appearance then you have to have a very careful psychological work-up in advance,” he said.

“It is not something that everyone can accept and the responses can be unpredictable.” He said that the fact that the first hand transplant, in 1988 on Clint Hallam, was later removed for psychological reasons is an example of that.

Dr Joseph Chilcot, a lecturer in health psychology at the Institute of Psychiatry said: “It (the hand transplant) is a fantastic step forward, but we need to make sure we continue to evaluate patietns pre and post-operation to ensure that psychological care is at an optimum.”

He said one of the main psychological issues for transplant patients is adherence to the medicines needed to ensure the organ functions with the body, and such non-adherence can be an issue in between 30 to 50 per cent of transplant patients.

The reasons for non-adherence can be concerns over the side effects of medicines, or a lack of understanding about what they are doing.

Transplantation milestones

Alexis Carrel demonstrates method of joining blood vessels to make organ transplants feasible.
First reported cornea transplant takes place in Moravia (now the Czech Republic)
First successful kidney transplant operation performed in Boston, USA
First heart transplant operation performed by Dr Christiaan Barnard in South Africa.
: Kidney donor card introduced in the UK
First ever hand transplant, in France, given to Clint Hallam.
First UK living donor liver transplant
First partial face transplant takes place in France.
First full face transplant carried out in Spain.

Professor Anthony Warrens, vice-president of the British Transplantation Society, said the effect of receiving a transplant for an external organ, such as a hand or face transplant, can be more severe than for internal organ transplants.

“It is a part of your body that you are aware of all the time in a way that you aren’t with a kidney or liver transplant,” he told Channel 4 News.

“Being aware that it come from someone else is quite strategically challenging. It is not a common problem (with internal organ transplant). It can be a problem with hearts which are, by their very nature, more emotive organs.”

Professor Birchall also said that there can be a sense of detachment from the hand. “Some people are able to absorb it into their psychologies easily but others have to view it as an advanced prosthesis,” he said.

“They almost have to view it as a robotic device in order to not see it as an independent part of somebody else.” He also emphasised the need for psychological follow-up and support.


Leeds Teaching Hospitals announced in late 2011 that it was looking for potential candidates for arm or hand transplants. Mr Cahill was one of two potential candidates for treatment after a search across the country.

He was picked for the hand transplant surgery because he was the best tissue match. The Leeds team worked with colleagues in Lyon, France, where hand transplants were pioneered in 1988.