He’s the expert surgeon who carried out the UK’s first hand transplant. Rod McPhee looks at the remarkable work of Professor Simon Kay.
YOU’D be forgiven for feeling a little nervous when you shake the hand of your surgeon and discover said hand has a digit missing – particularly if it was your own hand he was about to operate on.
But in the case of Professor Simon Kay the absent finger should serve as reassurance.
After accidentally burning the pinkie of his left hand on an electric fire at the age of five, he later had it removed in his teens. But in the intervening years young Simon endured, in vain, numerous painful procedures to restore its function and, as a result of having to learn to use his right hand, developed what many people develop in those circumstances: a serious stammer.
But from the age of 12 his experiences also led to him develop a lifelong obsession with being a top hand surgeon. Almost half a century later, he is simply world class.
“There’s no overstating it,” says Prof Kay. “My childhood explains why I do what I do.
“And the older I get the more I understand one thing: adversity in childhood isn’t always an entirely bad thing. That whole episode of my life that taught me all kinds of skills about how you make decisions, how to communicate and consider parental concerns.”
Those nine years of discomfort also taught him two lessons as a surgeon. Firstly, that the consequences of almost every physical imperfection invariably dwarfs the nature of the imperfection itself. Secondly, that he should do exactly what is necessary to improve the quality of a patient’s life. Do nothing more than is required, but certainly do nothing less.
That is why, from a specialist clinic at Leeds General Infirmary and the Spire Hospital in Roundhay, Leeds, he’s spent the last three years spearheading steps to carry out the UK’s first hand transplant.
And just six weeks ago it finally happened.
Heading a specialist team at the LGI on Boxing Day, he attached a donor hand to Yorkshire landlord Mark Cahill, whose own had become useless due to years of untreated gout. Now Prof Kay is lining up the next recipient who, if the right donor becomes available, could be rushed into theatre tomorrow.
Although he has been building up to this point for years, it was only when the professor embarked on the final stages that the full ramifications of what he was doing started to sink in.
Mr Cahill was actually having a hand removed, unlike other potential candidates who had already lost theirs. But Prof Kay has no regrets.
“When he came to me, Mark had already been to two other surgeons, neither of whom could help him,” he says.
“I told him that, with a phlegmatic personality like his, he’d probably be better off with a prosthesis. But attaching one of those would require amputating part of the existing forearm anyway, so why not consider a hand transplant?
“And, as I said this to him, I thought: ‘Hmmm, Simon, I think you’re getting yourself into something here’.”
Why the nervousness? Because to the lay observer seeing a man having an apparently functional hand removed and replaced by a donor hand might have looked unnecessary and the indulgence of a surgeon keen to get himself in the record books.
The reality was that Mr Cahill’s hand had very little function left, save for minimal feeling. But that didn’t stop the online chattering classes piping up.
Prof Kay says: “There have been some uninformed and irritating remarks on the internet about how his gout was probably self-inflicted -–which is not true any more than diabetes is self- inflicted. Some even said he should just live with it.
“But why? His quality of life would be completely upgraded if it was successful. And if it failed then we would probably just attach a prosthesis anyway, which was always an alternative.
“The trouble is that the only truly perfect candidate for this operation is very rare. It would be someone who has had a liver transplant, and is therefore already taking the anti-rejection medication required, is partially sighted and has lost both hands, meaning they’re severely disabled.
“That way there would be no downside to the situation – even Lord Winston wouldn’t be able to pontificate about that.”
It’s at this stage that the professor introduces the W word into the conversation ahead of being prompted on the subject.
Shortly after Prof Kay carried out the procedure (with a team of specialists who worked for nothing because the project had yet to receive full funding) one of Britain’s most high-profile medics, Lord Robert Winston, gave his verdict.
He said that Mr Cahill could just end up with: “A dead hand at the end of an arm,” and that “These transplanted hands were very limited and most often caused huge inconvenience.”
Lord Winston did tap into some of the concerns which surround hand transplantation. The first ever recipient was Clint Hallam in 1998, who eventually asked for his new hand to be removed three years later claiming it felt like exactly what it was: the hand of a dead man.
There are other ethical issues to consider too, like the fact that donor’s families, friends and partners could see the hand of their dead loved one on someone else’s body. But Prof Kay has hardly rushed into this field of work, he has invested time and much consideration into the vision of his Leeds hand clinic.
So his response to Lord Winston is unequivocal: “He does serve a useful purpose because I wouldn’t expect something that involves such complex decision-making and so much ethical and moral debate to pass without remark or opposition.
“It’s very useful to have a critic to bounce ideas off and promote a sensible debate. But I might have chosen a better informed critic than Lord Winston. My understanding of Lord Winston is that his particular field of expertise is IVF and communication. What more need I say?”
In fact the professor agrees with the lord, he agrees that the solution to the problem of severe limb disfunction, or the absence of a limb, is prosthetics. It’s just that the professor believes prosthetics need only be part of the solution.
As proof that transplants work, he points towards the fact that, out of around 70 validated cases of hand transplants, mostly across Europe and the US, there have only been a few failures. And among the success stories have been individuals who have had no problems over the last 14 years.
As for the inference that this may be some kind of ego trip for the professor: “I never viewed this project as a means to monomaniacally find a patient for a transplant.” he says “I started it simply because I was interested in transplantation as a result of my microsurgery heritage.”
And no one could question his heritage. Over the last 25 years through his microsurgery work at Spire, LGI and St James’s Hospital in Leeds, he has risen to become one of only a handful of British experts working at his level. He’s even been named among the top 50 doctors in the country.
The ascent began when he pioneered the removal of toes to replace fingers detached as a result of deformities and accidents.
His first case was in the late 80s when he operated on a little girl whose hand had been badly burned when, just after being born, a hospital placed her inside a makeshift “incubator” made up of a cardboard box and an unfortunately positioned hairdryer which caused the horrific injuries.
This toe-to-hand procedure was repeated on multiple occasions by the professor. Over the years he has operated on 300 toes and has never lost one.
He went on to focus on repairing damaged nerves (previous patients have included victims of the Cumbria shootings by gunman Derrick Bird) and during the filming of Yorkshire Television documentary, Jimmy’s, the focus moved onto the professor, particularly in 1989 when he reattached the arm of schoolboy Jamie McGrath, who had a terrible accident involving a tumble drier.
The same principles of microsurgery which have seen him detach and reattach body parts over the last quarter of a century are those which he transferred to his work with hand transplantation.
But he is keen to stress, often in deliberately self-deprecating terms, that the innovations in this field aren’t solely down to him.
“I work closely with psychologists, for example,” he says. “The interesting thing about surgery isn’t joining up small blood vessels, because any goon can do that, it’s choosing the right patients and understanding what you can do to help them.
“It’s never a one-man show. You can’t even talk about a team anymore, because it’s more of a network made up of agencies, experts and institutions around the world. I have never wanted people to say it’s all about me.”
But the biggest concern of Prof Kay is the continued “Frankenstein nonsense” talked about with regards to some aspects of surgery. He fears it may put off potential organ donors.
He is heartened by the fact that, over in the US, the rise in transplantation has actually led to an increase in donors, not least because he knows his transplantation work would be impossible without them.
Prof Kay says: “On the night we carried out the hand transplant, the donor in question donated not just his hand but his liver, his kidneys, his heart and all sorts of other organs which require you to use your imagination to realise what else they’ve done for the recipients.
“One positive aspect with the hand transplant in particular is that people can actually see the outcome.
“And we should take real pride in families like that who, at the moment of enormous grief and loss, make that generous decision. They are the story. They are the people who have no spotlight shone upon them. But it’s something that we can all do – become a hero at the time of our deaths.”
The CV of a super surgeon
Born: Jan 14, 1952, Channel Islands.
Lives: Thorner, Leeds.
Family: Wife, Rowan. Two sons: Cyrus, 22, Jacob, 19.
Education: Elizabeth College, Guernsey, Royal Shrewsbury School, Christ Church, Oxford, Oxford University Medical School.
Qualifications: 1973, BA (Oxon) Animal Physiology; 1976, B.M. B.Ch; 1981, Fellow of the Royal College of Surgeons; 2003, awarded a professorship.
Motorcyclist has hand rebuilt using his toes as fingers
A motorcycle racer who had three fingers ripped off in a high-speed crash last year became one of the latest patients to benefit from Professor Simon Kay’s elite skills.
Father-of-three Jonas Barber, of Blake Crescent, Guiseley, Leeds, is getting his life back on track after having two of his toes removed and reattached to his hand.
He underwent the 12-hour operation at the Spire Hospital in Roundhay, Leeds, and he’ll soon undergo another operation to remove unsightly scar tissue.
But despite his ordeal, keen rider Jonas, 31, saw the restoration of his grip as an opportunity to return to his lifelong passion.
“I was willing to do anything to get back on a bike,” he says. “But it has also meant I can do all kinds of day-to-day things like hold a laptop or grab a pint.
“They aren’t the prettiest of things, but I don’t really care. All that matters is that I have some function back.”
The married auto-electrics expert, who runs his own business in Guiseley called Auto Teknik, was injured during a race in Lincolnshire in July, 2011. The operation took place in March.
Prof Kay used the toes immediately next to Jonas’s big toes. This provided him with large enough digit substitutes, but didn’t adversely affect the function of his feet.
Jonas certainly seems to be taking the presence of his unusual digits in his stride – as does his family.
“When I first had the accident we initially told my youngest daughter my fingers would grow back,” he said “And since I’ve had the toes sewn on to my hand she thinks that’s exactly what’s happened – and we aren’t about to tell her any different.”
The technique used to transfer toes onto hands to replace damaged or detached digits is nothing new, but over the last 25 years the professor has usually carried out the procedure on babies and very young children. Compared to the numbers of infants he’s operated on, adult patients are rare.
“People think that if you’re operating on youngsters it’s more tricky because they’re small,” says Prof Kay
“But it’s not, if anything it’s more difficult working with the size of an adult’s body. Kids also tend to be more resilient than adults in these situations.
“But in the case of Jonas he was a great patient because he has the right personality – he doesn’t want to be dramatic or make a big fuss he just wants to sort himself out and get on with life, which makes him just the right person to deal with this type of operation.
“It wasn’t really complicated surgery, I mean ‘don’t try it at home!’ but I have done over 300 operations like this and that’s more than anyone else in the West. So, for me and my amazing team, it is relatively straightforward.
“Even poor fingers with a hand provide some function. The operation gives you some feeling, some movement, some power. A patient goes from having a thumb you can push to a pincer with another finger, to a tripod which allows you to grip.
“We aren’t trying to create something beautiful, we’re trying to create something functional.”