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Blood And Guts: A History Of Surgery -

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had a dead person's hand In 2006, David Savage attached to his arm. The day I woke up from surgery,

from a 32-year sleep. it was like waking up Totally amazing It was amazing. had the same operation, Forty-eight-year-old Clint Hallam but two and a half years later, having it removed. he was back on the table, It had begun to rot. realise it, but it's dead." My partner said "You don't had transformed one life, Transplant surgery to transform another. but it had failed with my new hand I'm almost more handicapped one and a half hands. than when I just had the success and the failure, These two men, one enduring obsession. are both part of and in this program My name's Michael Mosley history of the transplant dream I'm going to trace the twisted often at terrible cost. and the people who made it happen, transplants were dogged by delay, In the beginning, disaster and death. surgeons didn't understand That was because efficient killing system we know of, they were taking on the most complex, the immune system. than just biology. But it's about more I want to track down Clint and David, ended so very differently. and find out why their stories November the 29th, 2006. Louisville, Kentucky, USA. is David Savage. The man on the operating table More than 30 years ago, in an industrial accident. he lost his hand lasting 15 hours, But today in an operation of the world's leading surgeons, and employing the skills of 34 attached to his arm. David Savage will have a donor hand of extraordinary complexity. It is an operation First, orthopaedic surgeons in David's arm, join the ends of the tendons to the tendons of the donor hand. on the blood supply. Then vascular surgeons begin work arteries and veins They sew each of the donor's to the ends of David's own vessels. to perform the delicate task Next, the neuro specialists step in to David's stump. of rejoining the donor's nerves

is to close up the skin. And the final step will have a brand-new right hand. When he wakes up, David Savage We're on course, as we would hope that it would, everything is going exactly with really minimal problems. I'm really intrigued by David, an incredible surgical achievement. because to me this is more than just with a dead man's hand, The whole idea of living

but also disturbing. is one I find fascinating, I've talked to Many people by the idea of having are really freaked an arm transplant. something like of all the other bits that show, It's also true, frankly,

probably the freakiest of them all. like noses, eyes... and face is impacts on our sense of self No other form of surgery in quite the way transplants do.

about swapping body parts, There is something profoundly strange melding your flesh with another's. there seem to be no limits. And these days, strange but compelling dream began. I want to understand where this And that takes me to the 1760s of sweet-toothed aristocrats. and the festering mouths transplants was in the 18th century. The first serious attempt at human access to sugar Aristocrats had an increasing were developing rotten teeth. and as a result, with a brilliant idea: So someone came up from poor people why not take healthy teeth of the rich? and stick them in the mouths is a donor. So the first thing you need and find some poor pauper What you do is go out into the street with their teeth for a few pennies. who is prepared to part and you pull out one of these. You bring them in It's a pair of pliers one of the front teeth. which you'd clamp on and you'd just yank it out. You'd give it a good old shake would have been done All of this of any sort of anaesthetic. without benefit he got a bloody rag to chew on. If the pauper was lucky

and you simply ram it into place. You take the pauper's tooth cost 5 guineas, This whole procedure of a scullery maid. which was about the annual wage If you're extremely lucky, two months before falling out. it would stay in place for about If you were unlucky, gonorrhoea, syphilis you would pick up 18th-century disease, or some other delightful you had pulled out. from the poor soul whose teeth So, hardly a rip-roaring success.

transplanters' first big problem. They had come up against the would-be Before body parts could be swapped, how to reattach them. surgeons would have to work out A century later, here in Lyon, of a president... the sudden, brutal murder of a Frenchman and the nimble fingers more than just a fantastical dream. came together to make transplants This is Lyon University, the 20th century's greatest home to one of and most controversial surgeons. for Medicine, He won the Nobel Prize and his pioneering techniques and limbs of millions. have saved the lives But this is not him. or departments named after him. In fact there are no statues like transplant surgery itself, And that's because, had a very dark soul. the man who started it all His name was Alexis Carrel. imperious doctor, Carrel was an intense, thick glasses perched on his nose. immaculately dressed, with But if you took off those glasses piercing eyes, and gazed into his small, you'd notice a very unusual trait. was brown, The iris of one of Carrel's eyes while the other was blue. eyes, was a dangerous obsession. And burning behind those mismatched could reach perfection. Carrel believed the human race to a great breakthrough, It was an idea that was to lead him somewhere much darker. but it would also take him of the Nazi regime. Straight into the arms it was politics and murder Ironically enough, that led to Carrel's victory over transplant surgery's first great barrier. It's June 1894

and the French President Sadi Carnot has come here to Lyon. He's travelling in an open top cart like this one, when from amongst the cheering crowds emerges a young man clutching a rolled-up newspaper. The young man is actually an anarchist and hidden in the newspaper is a knife. He rushes up to the president and stabs him in the abdomen. The president began to bleed to death. They rushed him to hospital and the best surgeon in Lyon was summoned. But it was no use, one of his major blood vessels had been punctured and in 1894, no one could repair it. So all that they could do in that hospital, was stand by and watch the French president slowly bleed to death. This incident made a deep impression on Carrel, who wrote about it in his biography. "His life left him, with his blood. "I can still hear it flowing, "drop by drop, 50 years later." Carrel was appalled by the death of the president and the surgeon's failure to save him. He was convinced that he could find a way to repair broken blood vessels and against determined medical opposition

he set out to prove himself right. He went looking for Lyon's finest embroideress who lived at the top of the hill in the silk district. He needed her to teach him how to do minute, delicate stitches. This is not quite as strange as it might first appear. Carrel believed if he could master the tiny stitches used in embroidery,

then he could employ similar techniques to sew delicate blood vessels together. Carrel was a perfectionist and a very determined student.

Night after night he slaved away, bent over the intricate needlework. His stitches had to be so fine, they wouldn't damage the delicate walls of the blood vessels.

And so he practised on paper. It's said he became so accomplished, he could make 500 stitches in a piece of cigarette paper without tearing it. I've tracked down Lyon's finest embroideress, to see for myself the challenge Carrel faced. How many stitches can you put into something this size, do you think? I don't know. Only one centimetre? There is approximately 100 points. 100 stitches? In that small an area. Just here, yes.

You're doing better than Carrel. As in surgery, as in embroidery, it's very important to be calm and to be... to be quiet. Then I don't know if you say the same, but... Which is why I suspect I would have been a terrible surgeon. Ah!

You want to try it? Why not? Yes. Okay.

No... No? (Laughs and breathes deeply) Look here... It's not a body. Not flesh. Not flesh. You're not dying. No... No. Save me, Dr Mosley, save me! Right. Okay. So I go through here... trying to avoid going through my finger. You have to be very patient. I can imagine him at home,

just obsessively sewing this. And that's what's interesting about a lot of these... characters in surgery. It's not, in a funny way, that nobody else has tried it before. It's just, they do it better than anybody has ever done it before. Knots are the thing I was always not terribly good at, I have to say. Try and avoid the loop catching. Inverse. Inverse it. Yes. If you can.

What, I'm doing it wrong? I think your patient is dead.

Okay, never mind. Once Carrel had become a skilled embroiderer, he turned his attention to his real ambition, sewing blood vessels. And that is significantly more difficult than sewing a flat piece of paper. Blood vessels are rounded and they tend to collapse inwards. It's like trying to sew together two very soggy drinking straws.

Carrel solved this problem by inventing a technique that transformed surgery. It's one of those moments I absolutely love,

when a seemingly minute step changes everything. Carrel had invented vascular surgery. For the first time, surgeons could repair partially severed limbs or damaged arteries. Emboldened, Carrel's thoughts now turned to a very different surgical challenge: transplants. (Dogs whine) Carrel lived in an age of great experimenters. The Wright Brothers had launched human beings briefly into the skies. Thomas Edison had sold the world the delights of the phonogram and the light bulb, and Henry Ford created his Model T motor car. So there seemed no good reason why an arrogant young Frenchman should not transplant human organs. Having perfected his stitches, Carrel was now convinced that organ transplants were within his grasp. All he had to do was practise, which he did - on dogs. (Dog whines) Carrel's operating garb was, well, unusual. He dressed all in black to protect his sensitive eyes from glare. The effect was truly sinister. Carrel's experiments were a mixture of the scientific and the grotesque. He did kidney transplants between dogs, but he also took the kidney out of a puppy and put it in a cat.

And took the front legs off a white dog and attached them to a black dog. (Dog barks and whines) Carrel found that plumbing in the new organs was comparatively easy. But the problem was, within a short while they stopped working

and the animals died. It was perplexing. Something inexplicable was causing the animals' death. He eventually concluded that there was some mysterious biological force that made transplants impossible. In a letter he wrote: The biological side of the question, has to be investigated very much more. We must find out how to prevent the reaction of the organism against a new organ. Carrel's experiments were interrupted by the outbreak of the Second World War. Before then, he had publicly promoted the use of gas chambers to rid humanity of inferior stock. Carrel died in November 1944, while under house arrest as a Nazi collaborator. Carrel's descent from fame to obscurity was sudden and complete. This unremarkable street is the only place in Lyon that still carries his name, and even this has been changed. Carrel was a tragedy, a brilliant, flawed surgical genius. Carrel had proven it was possible to swap organs. But in doing so, he'd come up against the next great obstacle to doing transplants: rejection. The body's automatic reaction to any foreign invader. This is a sample of my blood. It contains some of the most remorseless and versatile killers known to man. In a sample this big, there would be at least 350 million white blood cells, all of them primed to deal with any foreign threat. I gave my precious blood to scientists at Imperial College. From it they extracted some of the white blood cells that are responsible for attacking invaders. These cells are called 'natural killer cells'. When they detect an invader, they move in, attack and destroy. My natural killer cells, here coloured red, can be seen vigorously attacking a cancer cell.

Unfortunately, a similar reaction occurs when you try to do a transplant. This microscopic army is part of the immune system, the hidden force that made Carrel's transplants all fail. And the battle to overcome it, was to define the next phase of the transplant dream. It was a battle that began as the Second World War ended. These were hopeful times. The fighting was over, and out of the carnage had come great surgical innovations. Advances in plastic surgery,

brain surgery and the beginnings of cardiac surgery.

But some body parts remained beyond repair. Dialysis offered temporary relief for failing kidneys, but there was no cure. The unglamorous kidney was about to reignite the transplant dream. In Boston, USA, surgeons began to wonder if transplants were the answer. The kidney is easy to remove and because we have two, it would be possible to use a living donor. But to succeed they would first have to outwit the immune system. This footage shows surgeons transplanting a kidney wrapped in a plastic bag. The idea was the bag would prevent the immune cells from attacking the surface of the kidney. It did not work, and the patient died. One of the early pioneers was Dr Joseph Murray. Today he's a Bostonian legend. Back then he was just plain old Joe Murray, a doctor who believed in transplants. Well I believed in it personally because it seemed to be reasonable.

These patients were dying, they were young. We had a team of good physicians and surgeons working, and if we weren't going to do it, who would? Joseph Murray got a chance to do it, when in 1954 he encountered a most unusual patient. In October, a 23-year-old man was admitted to this hospital. He was ranting and raving. His case notes say he was extremely uncooperative and he bit a nurse while she was changing his linen. The patient was Richard Herrick. His deranged behaviour was typical of massive, terminal kidney failure. Richard was, in some ways, doubly fortunate. He had come to the right place at the right time.

But he also had a very unusual biological quirk which none of the previous patients had shared. Richard was one of a set of twins and his brother Ronald was willing to donate him a kidney. Joe Murray believed that identical twins did not reject each other's tissue. We knew that in identical twins you could have successful grafting, but we never dreamed that we'd find an identical twin, one dying of kidney disease and another one willing to give a kidney. But you know, it's an example of happenstance favouring a prepared mind. They certainly looked alike, but were they really identical? Joe Murray began a series of tests to find out. If they weren't, Richard's body would reject Ronald's kidney. Murray performed 17 tests on the boys. He compared their eyes. He examined their skin. He even took them to the police station to see if their fingerprints matched. Finally, they took a sample of skin from Ronald's arm and they grafted it onto Richard's. If this failed, then the kidney would also fail. The skin graft took, Richard and Ronald were genetically identical. The transplant could go ahead. But Richard was worried about accepting his brother's gift. Even the night before the operation, the potential recipient told the donor "Get out of here. Don't come back." But the donor said "I'm here and I'm going to stay." So we went ahead and did it. Christmas 1954, an incredibly good moment for exchanging gifts. That morning, surgeons from this hospital removed a healthy kidney from Ronald. They then wrapped this precious present in a cold, wet towel and took it into the next operating theatre. At 9.53 precisely, Murray began to operate. We went ahead, deliberately, slowly. We were working under time constraints, we were well aware of it. It took about three hours before we got the blood vessels attached. By the time we released the clamps, the kidney began to pour out urine so copiously that we had to really suck it up and keep it out of our... site for our vision. The flow of urine was a fabulous sign. It meant the kidney was working. This was history! The next morning was a miracle. His eyes were sparkling, he was hungry for the first time in months. Richard Herrick, a man on the brink of death, married his nurse and lived for a further eight years. Transplant surgery had finally prolonged a life. But the operation had only worked because Richard had a twin. His treatment established a fundamental principle. Success depends on maximizing genetic closeness, of recipient and donor. Even today if you need a new kidney, your best chance is a member of your own family. I don't have an identical twin brother, but I do have two brothers and a sister and I've been running tests to see which would make the best match for me. The truth is, I won't know until I've had a look at the DNA. I persuaded each of my siblings and, for comparison, my wife to give me a tube of their blood. This contains their genetic code and should reveal how closely they are matched to me. Remarkably blue. Odd, isn't it, seeing your life force going in? I had my blood taken too, and dropped the whole lot off at the Anthony Nolan Trust where they run tissue-matching tests for real transplants. Here you go. Some blood, fresh and hot from my veins. Joyce at the Trust, ran our blood through this machine which reads DNA. She is looking at the genes on chromosome six that are markers for the immune system. I've invited my siblings round to my house where we will discover which of us really does have the most in common. Who do you think's your closest genetic match? Immediately to mine? David. Okay. David, who do you think? Probably John. Right. And I think John. What, for you two? You're the universal donor! I have some doubt about that. To reveal the results, I've invented a game called chromosome snap. There are six different cards, each representing a different immune system gene.

We're looking for matching pairs. The more matches, the more likely a kidney transplant would succeed. You're like the most generous. Six is really good. That's a perfect match - very, very unlikely. Nought is obviously very bad. The odds are not great. Really need a minimum of three... we're looking for. So there you go. What you do is turn them over one at a time. Okay? Claire. Marvellous. Ooh! Disappointing David. A card. Ooh good! Excellent. Okay. And da da! Oops! There we are. Excellent. One, two, three matches. Ooh, John! Marvellous. Doing well. I'm very pleased.

After the first card turn, all of my siblings match. But there are still five more cards to go. Hey! Wow! By the end of the game, there is a clear winner. My sister Susie and I are matched across all six genes. I wonder what the odds on that are. (laughter) If you have a brother or sister, you have a one-in-25 chance of making such a match. But unless you are identical twins, even the closest match will, eventually, lead to rejection. Unless the immune system is controlled. Joseph Murray decided the only way forward was to tackle the immune system head on. Murray wanted to treat all of his patients, not just those who happened to have an identical twin. To do that, he needed to disable, even destroy, the immune system. Joe Murray decided to go nuclear. In 1958, Murray met a 31-year-old woman called Gladys Lowman. She'd been born with only one kidney and that kidney had then been removed by a blundering surgeon who was trying to remove her appendix. Unless she had a transplant, she had only weeks to live. Hiroshima and Nagasaki had demonstrated the frightening power of nuclear radiation.

Ionising radiation attacks all fast-dividing cells, including the cells of the immune system. Murray knew that high doses of X-rays would produce similar results. It was clearly dangerous, but he thought it was worth a try. With Gladys sinking fast, Murray now transplanted a new kidney into her, and began irradiating. He knew he had suppressed the immune system, but doing this was like trying to open a front door with a bulldozer. There was a serious risk he'd knock the whole house down. We used total body radiation and the patient would lie under the X-ray machine and curl up in a foetal position so that all of the lymph nodes, spleen, bone marrow, would be irradiated. Gladys lay under the machine for three hours. She received the equivalent of 600,000 dental X-rays. With her immune system completely destroyed, Gladys now had to live in a sterile room. Murray infused her with bone marrow to replace her annihilated white cells. But even so, within four weeks, she succumbed to overwhelming infection.

In the years that followed, Murray irradiated 10 patients. Nine died soon after the treatment. But Murray still believed it could be done. It didn't work. But it was a necessary step along the way. And even in the most discouraging times, there were hints that something might be better. Maybe I'm just a pathological optimist. I've been called that. After five years of total failure, Murray met a young Cambridge doctor with a radically different set of ideas. From my point of view, I was very interested in trying to prove the critics wrong. I've always felt that way. If somebody says what you're doing is stupid and you shouldn't do it, it's a great pleasure to show that they're wrong. And when Mr Pathologically Optimistic met Mr Can't Be Wrong, something special was bound to happen. Roy Calne had been experimenting with another tool for defeating the immune system - drugs. He'd heard about a new drug called Azathioprine that destroyed immune cells in people with cancer. So he gave the drug to dogs with transplanted kidneys. It appeared to work. And this was enough to encourage Calne and Murray to try the drug in humans. With the door finally opened, lots of people now joined the party. In the 1960s, more and more surgeons started to experiment with transplants. Using Azathioprine to control the immune system, they dared to venture into new territory. They tried transplanting the liver and the lung. They attempted to put animal organs into people. And there was an absolute frenzy of media excitement when surgeons began transplanting human hearts.

TV PRESENTER: This is the team that yesterday performed Britain's first human heart transplant operation. The complete team whose skill, devotion and courage

has already made British medical history. We are going over to the National Heart Hospital now. Doctor, can you hear me? Yes, I can hear you very well. This is Raymond Baxter in a television studio. How is the patient? Well, he's doing extremely well at the present moment. But the optimism was short-lived.

Most transplant patients were still dying. The problem was, the new drug was incredibly difficult to administer. Too little led to rejection. But when they tried to increase the dose, Azathioprine could completely destroy a patient's immune system. The new drug was not the magic solution they had hoped for. There was a feeling that transplantation was not worth it. I mean, most prestigious medical institutions

didn't want to bother with transplantation. And then olive oil came to the rescue. It's one of those wonderfully unlikely but true medical stories. The tale of how olive oil came to rescue transplant surgery is lovely, beginning as it does with a Scandinavian holiday and a rather unusual souvenir. This belonged to an employee of the Swiss drugs firm Sandoz. The enthusiastic employee had returned from a trip to Norway with a suitcase full of soil. He was hoping to discover a new micro-organism. In the lab, the researcher carefully analysed the soil and was rewarded with a new species of fungus from which they extracted a brand-new drug. They called it Cyclosporine A. They must have jumped up and down in a quiet, scientific sort of way, because some of the most profitable drugs ever discovered, have come from fungi. Think of penicillin. Early tests on the fungus showed that it was actually useless at killing bacteria. But it did suppress the immune system. And that brought Cyclosporine A to the attention of Roy Calne and his team in Cambridge, who were still searching for better drugs. Roy contacted Sandoz and pleaded for a small sample of the magic mushroom. I've had some dealings with the Swiss drug firm myself and like Roy, I persuaded them to send some of the drug over to me. Thank you very much. Okay, gang! So I can show you what happened next. Inside here is some Cyclosporine A and it should be in the pure form that Roy Calne received it. Yes, it's a white powder, it looks harmless enough but I don't want any of this stuff inside me, so I'm going to take some necessary precautions.

This is what they wear in pharmaceutical laboratories when they are handling any dangerous drug. Although the risk to my health is small, I've been advised to make sure I'm gloved up and covered up. When they got Cyclosporine A back to the lab, Roy and his researchers had a nasty surprise. The problem was, before humans could ingest it they had to find a way to dissolve it. If it wouldn't dissolve, then there was no way it would work. The drug would be useless. Right. So I'm going to put the powder in there. That was 0.4. And I'm going to do the same in another one here. Yup, the same amount. Powder in the second one. And put the lid back on. They tried dissolving it first in water and I'll demonstrate to you what happens. And I need 40 ml. They tried dissolving it in water and as you can see, if you shake it up, it just doesn't dissolve. It floats there largely on the surface. They tried all sorts of other industrial solvents and none of them worked. Now it's in there, I can take this stuff off. Right. So they had a problem. But they were lucky. There was a Greek researcher who was working with Roy Calne and his mother was worried that her boy was going to be affected by the appalling British food. So she sent him a bottle of Greek olive oil. Now more in hope than expectation, he took that olive oil and he added it to the Cyclosporine. And I will show you just what happened. Give it a shake. As you can see, it's completely dissolved. The Greek student tried the olive oil formulation on his animals. He got spectacular results. So spectacular that I didn't believe him when he first told me. And I told him to repeat it, which he did and got the same results again. Cyclosporine was THE breakthrough that transplant surgery had been waiting for. Finally, the immune system could be controlled and transplant surgeons could start saving lives instead of ending them. In the 1980s and 90s,

kidney and heart transplants became widespread. The demand for organs soared and a national donor scheme was launched. NEWSREADER: 12 million of these new plastic cards are to be distributed. The new card is being issued because new techniques are increasing the range of organs which can be donated. This is a multi-donor card and people have the option of donating their kidneys, their eyes, their heart, their liver, their pancreas, or any one of those or all of them, or any other part of their body which they would like to donate. Transplants became something of an everyday miracle.

Two teams of doctors worked throughout the early hours of this morning to perform the world's first triple-organ transplant. This is BBC1. REPORTER: When Brook Matthews arrived from Australia in January, she had only months to live. Now following her four-and-a-half hour operation yesterday at Harefield Hospital, she's making good progress. It was her only chance of life, and few would blame her parents for taking that chance. A very special one-year-old had a birthday party today. She's Kaylee Davidson from Washington in Tyne and Wear and she's Britain's youngest-surviving heart-transplant patient.

We can't believe it, she was really poorly and she wouldn't do anything. She had no interest in anybody or anything. And now she's a typical little girl and into everything.

Surgeons once again began to dream of new frontiers. And in 1998, surgeons in France announced that they had pulled off a truly spectacular world first. On the 24th of September, in a blaze of publicity and surgical glory, Clint Hallam became the first person to receive a hand transplant. The operation pushed the boundaries of what surgeons had believed was possible. I was certainly impressed, but I also wondered if this was a genuine medical advance done to improve the life of the patient. Or was it being done simply because it could be done? I first crossed paths with Clint a year after the operation when I was making a medical series for the BBC. My first thoughts when I saw my hand was that it was a miracle. But it was a miracle that was starting to fade. No. No, no, no... One of the hard things to accept for me is that I'm almost more handicapped with my new hand than when I just had one-and-a-half hands. This is not exactly as the dream was, for eight, nine, ten years. This is not happening like it does in the movies. Clint was finding it hard to adapt psychologically to the new hand. A very dear friend who lives in London - I never understood why he used to grab my hand like this, in fact grab my wrist, simply because he didn't want to touch my hand. To him it was quite horrific. Clint had also started to feel ill, and he suspected that his anti-rejection drugs were intensifying his symptoms. The two most physical side effects that I notice is first I have diabetes. The second side effect is more physical in that my body has gone from chest to breast and that's a little bit difficult to deal with. As Clint cut back on his medication, his hand began to show signs of rejection. The fingertips had started to get red

and I lost all sensation. The redness in the fingertips, the fingernails falling off with new nails coming underneath them, are all indicators of a serious rejection problem. By 2001, Clint's immune system

had almost completely destroyed his new hand. Good evening. Clint Hallam was at the centre of a medical breakthrough two years ago, but now he wants out. Having had the hand of a dying man attached where his used to be, he's now begging for it to be removed. I certainly believe that there must come a stage,

with the number of rejections that I have experienced with my hand, that yes, my body has, or my mind has said enough is enough. The morning after this interview was recorded, Clint Hallam's dead hand was surgically removed. I am fascinated by Clint's story because in him I can see the terrible contradictions of cutting-edge surgery. There is the fame and glory, at least for the surgeon, of going first. However, there is the often appalling cost to the patients of being first. I'm on my way to meet Clint Hallam, who I haven't seen for many years. I want to find out how he is. ..last saw you, so I'm just intrigued by the new hand. Is it... does it move? It does. It clicks and goes in circles. But that's pretty much the range? That really is its limit. You can shake hands? Yes. But it's very limited. It's extremely limited. It really is cosmetic, as a prop. Ooh! Thank you very much. Marvellous. Clint is clearly not thrilled with his new plastic hand. But what I'm interested in is why he thinks the transplant failed. Were you never freaked by the idea that this was a hand from a corpse, this was a hand from a dead person. Did that not... worry you? No. Right. No. I was attached to it.

I was detached from everything about it. Right. In retrospect, in looking back. And, and... Were you ashamed of it? I was fucking angry with the doctors and I'm still angry with the doctors

that they didn't match it. Right. That was the big thing, was it? The matching. You saw it. I did, yes. Okay. It was huge. Yes. It seems Clint's mind rejected his new hand, before his body did. Despite his doctor's warnings, Clint stopped taking his medication, making physical rejection inevitable. Why did you stop taking the immunosuppressive drugs? Actually I didn't stop taking all of the drugs, all at the same time. I stopped taking some of the drugs in lesser quantities than I was supposed to. Why? Because I got sick. I was surprised, frankly, that you persisted with that hand as long as you did. It was putrefying. My partner of the time and now... Yes. ..said exactly the same thing. She said "you don't realise it, but it's dead."

What would your advice be to other people who are thinking about going first? About going first in anything? Yes.

I would tell them to walk slowly backwards. Go back down the line and keep thinking. Really? Think, and think very carefully. You regret being first? I regret being the first, I don't regret having the transplant. Soon after Clint had the transplanted hand removed,

he rang around asking for another hand transplant. Unsurprisingly the surgeons all said no. The truth is, no matter how good surgical techniques are, they will fail if the patient is not psychologically prepared. But was it simply that Clint was the wrong patient, or are hands just harder to do? I'm in Kentucky, USA

to meet the surgeon who performed the world's second hand transplant. Were you upset that you weren't the first? Yeah. I think every human being, you know, always wants to be a leader.

But I always told my team - and you can ask all of them - I emphasised this over and over again: it doesn't matter who does it first, it matters who does it best. Dr Breidenbach has performed three hand transplants and the latest is perhaps the most remarkable of all. In November 2006, he led a team of surgeons in replacing the right hand of 54-year-old David Savage. David had lost his hand 32 years earlier. I believe he is the longest time between amputee to transplant. So we ran into problems which are novel and new and the analogy that I make, it's kinda like closing your house down for 32 years and then you come back and decide you're going to take a shower. And you turn on the faucet and it splutters a little bit, sometimes it works and sometimes it doesn't. So we had some spluttering last night as his vessels were trying to get blood into the hand which we were transplanting. The operation was, in the end, a technical triumph.

But I wonder if David, unlike Clint, is truly comfortable with his new hand? When I meet him and his wife Karen, I'm instantly struck by how different his new hand is to the other one. Do you mind if I just compare your hands, just looking at them? Because one is quite spooky. Do you find it spooky? There are moments when I actually remember this hand came from somebody else. Right. Do you think that at all? All the time. I think about the family that donated it all the time. Yup. Really? You know... But, like I said the first day I woke up from the surgery, it's mine. Yes. It's now yours, isn't it? Yeah. Though they are quite different in a funny way. Yes. They're different...

Ever considered the possibility this could have come from a woman? I've thought about it, you know. Yes. I'm just curious. It wouldn't have bothered me. No. Because the only thing that's striking about this is obviously, you have very dark hair and this hand doesn't. If you look really closely you can see it's very fair, isn't it? Yeah, it's got blondish hair, but it's turning dark. Yeah. And it'll probably grow. And do the nails grow? Twice as fast as my other hand. Right. Mind if I have a look again? Yes.

It's curious because the fingernails on this one are rather longer and more elegant. And you look as though you've... No, never. They were all clipped at the same time. Really? How extraordinary! Of course, when you put them next to each other, they're different. Most people don't get the opportunity to compare like that. They'll see Dave from across the room and they don't really realise what the difference is. Absolutely. And do you think that's important? Yes, because we don't want people to focus on the difference. We want them to focus on the progress and the hope of what this transplant can mean to other people. David and Karen are full of optimism. And when I watch David's therapy sessions, I can see why.

He already has around 60% of the function of a normal hand and with more therapy, he may eventually get to 80%. Last September, my granddaughter... just going to her birthday party, just grabbing hold of her and picking her up,

you know, it was just a fantastic feeling. Dr Breidenbach believes that David's success is not just down to new drugs or better technique, but to David's personality. We say this all the time in hand surgery.

It does no good to have only a good surgeon. If you hook everything up properly but the patient goes home, doesn't use the hand, doesn't do physical therapy you get a lousy result. It's extremely important, the physical therapy and the cooperation and use and that's where, you know, he's been an excellent patient. Between 1998-99 and now, we now are 30% reduced, in theory, from the amount of immunosuppression you need. We're still a long way... that we can put a hand on or a face on, or transplant a kidney, then have people walk out the office and take one pill a month and that's it. Do you think that'll ever happen? Yes. Everything's going to eventually happen. Eventually we'll be able to grow spinal chord. There's gonna be no part of the body that's not gonna be interchangeable. There is no doubt that transplant surgery has come a long way, since Alexis Carrel's daring experiments. At least half a million transplants are done every year, and the main problem now is organ shortage. Millions have benefited from transplants' often blood-stained history, and I am sure that this branch of surgery will continue to push at the possible. But I am also sure that the price of progress will be paid by those bold enough to go first. Captions (c) SBS Australia 2009

This program is captioned live. The Prime Minister foreshadows another emergency injection to help protect the Australian economy from recession. Millions gather in Washington, ahead of the inauguration of Barack Obama as US president. Arab nations pledge billions to help rebuild homes in Gaza in the wake of Israel's incursion. And Lleyton Hewitt out of the Australian Open almost before it started, but not without a fight. Good evening - Ben Fajzullin with SBS World News Australia. The Australian economy is set to get another emergency injection with the Prime Minister confirming a second stimulus package that will focus on jobs. Kevin Rudd won't say exactly what he's planning. But business and unions are endorsing his call for cuts to working hours and wage claims in preference to sackings. Round one is done. Round two is coming to keep Australia afloat.

We remain resolved to take whatever action is necessary and we will do it in a calm, measured and methodical fashion. It'll be almost unprecedented the PM says, but won't say what or when. Retailer Gerry Harvey's criticising the first December $10 billion effort.

Harvey Norman's pre-Christmas figures were up almost 9% on last year. But Mr Harvey says the one-off stimulus didn't work because spending was one-off, falling in January. So, it's a one-month spike. So you think to yourself, "Gee, $10.5 billion. "We tried to do the right thing, but oh, oh." Perhaps there's a lesson to be learned - you don't do that again. I'm puzzled by that because when the package was announced, Mr Harvey said he saw it as a boost to confidence in the economy. It's certainly boosted the Opposition Leader's confidence. He says Mr Harvey's remarks... ..underline the importance of any additional round of stimulus being very carefully considered, very disciplined and very, very focused on jobs, jobs, jobs. You can sit to one side, sit on your hands and moan. Or you can get out there and have a go.