Linda Lu opens a bottle of water. She does the same thing every afternoon.
Yet, on this recent day, the seemingly ordinary act feels extraordinary. It speaks volumes about the determined college student’s grueling personal journey.
For the first time, Lu cracks open the plastic container using two hands — her right one, the one she was born with, and her new left hand, which wasn’t there until three months ago. The new, donated hand was recently attached to Lu’s skin, bones, nerves, tendons, arteries and veins during a risky and complex 19-hour-long operation at Atlanta’s Emory University hospital.
It’s an emotional moment for Lu, 21, who lost the left hand she was born with as a child due to illness.
“This has been, quite possibly, the most rewarding experience of my life,” Lu said. “It’s those little things. ... Before, I had to use my arm to stabilize the bottle, and now, I guess you could say I did it normally.”
On March 12, Lu became Georgia’s first hand-transplant recipient in a procedure that was one of only about a dozen performed successfully across the country.
Dr. Linda Cendales, the surgeon who led the team that performed the operation, hopes it is a harbinger of more such surgeries at Emory, perhaps restoring missing limbs for military veterans injured in Iraq and Afghanistan.
Shortly after the surgery, Lu, who lives in Oviedo, Fla., near Orlando, was thrust into the spotlight as news of the surgery generated headlines. Facing reporters and camera crews, she showed off her new donated hand, slightly swollen, cradled in a bulky brace and resting upward, not yet able to move.
Over the next few months, doctors and patient closely watched the new hand: The connections between Lu’s nerves and those inside the donated limb were regenerating. The swelling was gone. The fingers could move. Lu’s flesh accepted the new hand as its own. And the shy yet focused community college student was determined to make the most of this life-altering opportunity.
After the surgery, Lu settled into a routine of intensive therapy — as much as eight hours a day — designed to help her manipulate her new hand and give it new life.
Relaxing near a guest house on the Emory campus recently, Lu couldn’t help but marvel at her new hand, which looks like a mirror image of her other hand.
It’s the same shape, with feminine yet sturdy fingers.
It’s the same ivory shade, slightly pink.
It’s virtually the same size — only about two millimeters separate the diameters of the wrists, roughly equivalent to the thickness of a nickel.
The new hand is already growing fine, brunette hair, just like her right hand. Even the oval-shaped nails look identical. But those nails also shed light on the curious nature of matching limbs through donation: Lu had already had to cut the nails on her new hand since the surgery, and she was about trim them again.
“It grows faster on my left hand than my right,” Lu said with a big smile.
She’s most encouraged by what her new fingers can do: things like stirring brownie mix and watering plants. She still lacks sensation in the hand — she can’t feel hot or cold — but doctors expect that will come during the next year.
In the early weeks of her rehabilitation, Lu’s therapy was aimed simply at helping her hold her hand in the correct position. Then, multiple days were devoted to moving her fingers from curled-up ball to full five-finger extension.
In more recent weeks, her hand started doing what it was meant to do: take cups out of cabinets, pick up pennies, cook.
And, she said, make her life feel more complete.
Career motivation
As a 1-year-old, Lu lost her left hand from complications related to Kawasaki disease, a rare condition in children involving inflammation of the blood vessels.
She had long been accustomed to living with just one hand, she said. She stopped wearing a prosthesis when she was in elementary school. But as she approached her 21st birthday, she became determined to have two hands.
Functionality and appearance influenced her decision. She was also motivated by career choice: information technology, in which typing with both hands would be critical for her career aspirations.
Lu had been on Emory’s transplant waiting list since November. Around 10 p.m. one Thursday in March, she was on her way to the grocery store when she got the call telling her a match had been found.
She caught a flight to Atlanta at 6 a.m. the next day.
On March 12, Lu underwent the technically demanding and delicate surgery, a procedure involving multiple teams of surgeons, nurses and operating room staff.
Hand transplants are more complex than solid organ transplants because the intricate operation requires reconnecting multiple parts of the body. Surgeons begin by reconnecting the bones, then they use an operative microscope to connect nerves and vessels, followed by repairing tendons and skin.
Each step can take hours and requires absolute precision, with no guarantee the new hand will thrive.
Charla Nash, a Connecticut woman mauled by 200-pound chimpanzee gone berserk about two years ago, recently underwent a full face transplant as well as a double hand transplant. While the surgery giving Nash a new face is considered a success, the new hands were removed shortly after the surgery because of complications. Nash developed pneumonia and suffered a drop in blood pressure that compromised the blood flow to her hands.
Transplant hit or miss
Lu’s new hand was connected near the wrist, just below the palm. The donor’s family requested confidentiality, so doctors said only that it came from a young woman.
Cendales said Lu’s hand will never be a “normal hand,” but could go a long way in improving her quality of life.
Cendales, who spends hours with Lu every week, also provides patient care for combat veterans at the Atlanta Veterans Affairs Medical Center.
Emory’s program has received $3.6 million in grant funding from the Department of Defense, and doctors credited U.S. Sen. Saxby Chambliss, R-Ga., with helping to secure the funding. Grant money covered the costs of Lu’s procedure, which cost between $300,000 and $400,000, an Emory spokesman estimated. Since a hand transplant is considered experimental surgery, it is not covered by insurance.
Getting a new hand is also not a life-and-death matter like needing a heart or liver. Still, the desire to feel the human touch, to do everyday tasks with more ease, can drive people to take on the risks of a transplant.
In 2009, Jeff Kepner of Augusta received a double hand transplant at the University of Pittsburgh Medical Center. The now 59-year-old Air Force retiree had lost his hands a decade earlier because of a bacterial infection.
Besides getting two limbs at once, Kepner also had to have his new hands joined at the mid-forearm level, making the surgery and recovery more tricky.
Progress for Kepner has been excruciatingly slow. A year after the surgery, he could only wiggle his fingers. For a man who had become quite proficient with prosthetics, he said he must wait, perhaps years, to know whether he made the right decision in becoming the nation’s first double hand transplant recipient.
When asked how much he can now use his hands , two years since the surgery, he said, “I’d rather not talk about it.” But he also expressed concern about appearing too negative about the experience.
“I have always had mixed feelings about it,” said Kepner who still undergoes therapy on a regular basis. “But I am hopeful. ... I’m not sure yet whether it’s worth it or not.”
The perfect candidate
It takes a certain kind of person to be good fit for a hand transplant, a person willing to take anti-rejection medication every day, someone willing to stack blocks in rehab hundreds and hundreds of times. Requirements for a match include skin pigmentation, gender, size — it must be close but not exact — and blood type.
More than 40 men and women have expressed interest in Emory’s new hand transplant program. The in-depth screening process, which requires everything from medical exams to psychological evaluations, whittled the number of men and women on the waiting list to under 10. The list includes soldiers who have lost a hand in combat.
Once Lu made the list, it could have taken years to find a match. Luck was on her side.
Cendales said Lu was an ideal candidate for the transplant for several reasons, including the fact she passed a test assuring doctors her own nerves were still functioning and would regenerate once stitched with the nerves from the donated hand. Lu, who was in college and had held a part-time administrative job, was both a good student a good employee. Cendales also was impressed by how Lu carefully digested the information about hand transplants and asked good questions, making it clear she understood the complexity and ramifications of the surgery.
“I saw a young woman driven to continue improving her life, motivated by the possibilities, and committed to achieve her goals if given the opportunity,” said Cendales, who has built a reputation not only as a leader in her field, but also for her warmth and approachability, defying the surgeon stereotype.
For Lu, the surgery has been a gift. She sees improvements every day, she said, and that makes the hours of therapy and mind-numbing repetition worth it.
“When I first saw my [new] hand, it was a powerful image. It felt like mine from the moment I first saw it,” said Lu, resting a porch spring. “But now, I am seeing what it can do. ... I am happy and optimistic.”
Lu got the OK this month to return to Florida, about a week earlier than scheduled, to allow her to enroll in two college classes this summer.
She’s taken up drawing while at Emory. Her left hand can keep the paper in place, allowing her right hand to sketch scenes from a new beginning.
For now, she calls her drawings “just scribbles.” But she will continue to open sketch pads to nurture her new hobby, and her life with two hands.
How we got the story
AJC reporter Helena Oliviero first interviewed Linda Lu at a March press conference shortly after Lu received her hand transplant. Oliviero interviewed Dr. Linda Cendales several times for this story, including an initial interview that took place months before the March surgery. Oliviero and AJC photographer Vino Wong spent time with Lu at Emory in early June, accompanying Lu to her therapy and interviewing her at the guest house where she was staying, before she returned home. The AJC was the only newspaper and one of only two media outlets granted permission by Lu for a follow up interview.
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