In episode four, host Caroline Verdon delves into the intricate psychological aspects of hand transplants with expert insights from Dr. Maggie Bellew and Dr. Rachel Mandela. The episode highlights the critical role of psychological assessments in hand transplant procedures, illustrating the balance needed between physical and mental readiness. The discussion covers patient expectations, the selection process, and the ongoing psychological support crucial to the success of hand transplants. The episode explores the unique challenges of hand transplants, including psychological rejection and the importance of donor limb acceptance.

Produced by Under the Mast, this episode provides a moving insight into resilience, medical innovation, and the human spirit. The podcast is presented by Caroline Verdon

You can find out more about hand and upper limb transplants at LEEDS TEACHING HOSPITALS NHS TRUST here

00:00 Introduction to Leeds' Hand Transplant Team

00:31 The Role of Clinical Psychologists

01:24 Initial Patient Assessment

02:40 Managing Expectations and Risks

04:19 The Importance of Psychological Preparation

05:37 Patient Experiences and Success Stories

20:34 Post-Transplant Care and Support

26:39 Dealing with Rejection and Psychological Impact

28:25 The Donor Aspect and Ethical Considerations

31:34 Preview of the Next Episode

In safe hands, stories from Leeds'

pioneering hand transplant team

coming up in this episode.

Dr Maggie Bellew: We don't progress everybody to hand

transplant because we know that it's not successful for everybody.

The very first hand transplant that was ever done was a physical and surgical

success, but was a psychological failure.

And we've always had it in our mind from day one, we do not want

that to happen to our patients.

Thank you for joining us.

This is episode four.

I'm Caroline Verdon.

And this week, I'm speaking with consultant clinical psychologist, Dr.

Maggie Bellew and principal clinical psychologist, Dr.

Rachel Mandela.

Now, they play a huge part in the hand transplant team, and are there right

from the very beginning from the initial meeting with a potential patient.

All the way through, in fact, for the rest of a patient's life.

Dr Maggie Bellew: It's a very detailed assessment because this is

not something to risk getting wrong.

The risk of psychological rejection is as strong as.

or stronger than immunological rejection and far more behaviorally damaging

and likely to threaten successful outcome from the hand transplant.

So it's really important to get the psychological assessment right and patient

selection right, uh, with a conformity as much as possible to the ideal patient,

both physically and psychologically.

So

what happens with your meeting with a patient then if somebody comes forward

and says, look, I've heard about this, I think I might like to have it done.

What happens with, with your involvement?

Dr Maggie Bellew: The first meeting is with the multidisciplinary team in a

big clinic where everybody's present.

So Rachel and I are both there, um, but there were also all the physios,

the OTs, various surgeons, because there's a big surgical team, nurses.

our medics from transplant and we all meet the patient initially at that forum.

Um, so that's the first opportunity to get some information noted down on the

patient, what their backstory is and pick up a few cues and clues about what

might be going on for this patient.

If it looks like they are going to be physically Suitable with no tests

being done at that stage, but just from the clinical examination by the

surgeons, then the next step is a clinical psychology assessment, but

they will also be going off for having bloods and various other medical tests.

So the first meeting with them is actually at the MDT, not the appointment

with the clinical psychologist alone.

That is on another day, and that is a long appointment.

It's either one very long face to face appointment or several

shorter video appointments.

Dr Rachel Mandela: One

of

the big things that we're looking, we're all looking for but Maggie's really

looking at in detail But we're all looking at in every clinic is are this person's

expectations, realistic, you know, do their wants and desires for how this

thing is going to change their life.

Does it fit with what the surgeon thinks?

Does it fit with what we think as a team can be achieved or is it not realistic?

Because what we know about lots of different types of surgery is that the

more the patient's, um, expectations are aligned with the surgeon's expectations

and the more likely the patient is going to be to be happy with the outcome.

Dr Maggie Bellew: So it hopes that

the assessment reduces the risk of psychological rejection and complications

and by extending that process over a year concurrent with the necessary

immunological assessment which also takes place over 12 months and that's aimed

at preventing immunological rejection.

But they're always warned about this year of waiting and it's this cautious approach

that underpins our approach to avoid rejection psychological and immunological.

So, we're looking at the patient's fitness to proceed from a psychological

point of view and it's a complex assessment and the length of time

taken ensures that the final decision is a stable and enduring one.

I suppose, you know, you could rush an assessment through

and, and do it a number of weeks, but then if you were to do that, the patient

would never have had the time to never properly sit with the the thoughts.

Yeah.

And sit with the processes.

'cause it must raise a lot of questions for them.

And perhaps when they come and see you, would it be accurate to say that

they might say one thing and then a few weeks later having thought things

through have changed their minds?

Absolutely.

Dr Maggie Bellew: Absolutely.

Um.

The assessment always raises things they hadn't thought of, and that's,

and it should do, that's what it's for.

Um, there are always areas that they've just not thought about.

Maybe issues about the donor, or issues about the reality of using a donor

hand to do day to day activities, but also very intimate activities of self

care, holding someone else's hand.

Um, Quite often they haven't thought about these things.

And sometimes people come along not wanting to think

about the risky side of it.

They just want to be positive, but actually part of my job is,

is to enable them to, to, to look at the risks and the benefits.

You can't just look at the benefits.

It's got to be an informed decision making process.

And a lot of time is spent on helping them understand the risks

and process of hand transplant.

Yes, the benefits, but all the risks, immunosuppressive medication.

Because there are risks with that and they need to understand that and how it

all works and all the ins and outs of it.

And it's, it's quite complicated material.

So we take as long as it takes for the person to fully understand it and be able

to remember it and retain it and continue to consider it so that they are really

making an informed decision and not a snap decision or trying to be a positive

decision, but a truly informed decision.

I was speaking to, um, a patient who was talking

about how when they first, uh, in the early days of coming to see you,

they were saying, I'll take any hand.

I don't mind the color of the skin.

I don't mind tattoos.

I don't mind male, female.

I'll take any hand and they were absolutely adamant that they just

wanted a hand and that was it.

Um, and then they were saying slowly, the more they talk to you and the more

questions that you ask them, the more they really started thinking about it.

And they came to the conclusion that as a tall man, they wouldn't

want actually a petite hand.

Feminine hand, they would feel as uncomfortable with

that as they do currently.

And since they've had the hand transplant, that has absolutely

solidified and they know they've made the right choice in being so picky.

But it's that part and that time and those questions that are so important.

Sounds to me like that really hinges on the success or failure of the transplant.

Dr Maggie Bellew: That is a really good example of an issue that

can change over time and needs to be returned to several times.

Because yes, sometimes they do come, they want to be really positive and

they don't want to reduce their chances of getting a transplant so they think

they ought to be as open as possible.

But actually a lot of the success of it can be on, on matching

because you've, you've got to be able to accept the resulting limb.

No one cares what your kidney transplant looks like because no one sees it, but

everybody sees your hand transplant.

It's permanently on view to yourself and others.

And if you're not happy with how it looks, you're at huge risk of psychological

rejection and all the things that follow on from that, like not complying with.

Physio, not taking medication and ultimately potentially losing the limb.

So it's important we get this bit right.

There's no right or wrong answers.

Some people are more exacting in their requirements than others.

Some people will be very open to accepting a hand that's quite different to their

original hand or hands, but some people are going to be more exacting and there's

no value judgment applied to that.

We just need to know what it is for that person.

And that can change over time.

I have to say the matches that we have got, because we.

go into in such detail beforehand.

Um, the matches that our patients so far have received have been extremely good.

And so they, they've been very happy with the outcome and, and that helps

them accept these hands as being their own and not a donor limb, but their own

hands, um, very quickly in our experience, quicker than we thought it would be.

That's something I found very interesting because I've asked some

patients do they think much about the the donor and the donor hand and whilst

they have said yes they do in terms of they're forever grateful and that you

know that will cross their mind multiple times it's their hand it feels like

it's their hand it doesn't feel like they're borrowing you Somebody else's.

Yeah.

And that's what

Dr Maggie Bellew: we really need.

Because if they do feel like it's somebody else's hand, not their

own, a dead donor hand, that can be a source of potential rejection.

They need to be able to feel it's, it's theirs.

And they felt like that almost immediate, but they've all been quite immediate.

Haven't they, Rachel?

We thought it would take a while for them to assimilate and to feel like they're

theirs and not the donors or something the surgeon would give them, but they

seem to have accepted them as their own.

Much quicker than we anticipated.

Dr Rachel Mandela: I could speak to the experience of meeting people

in hospital, usually the day after transplant, and so the hand will be

in dressings, in splints, but there'll be fingers sticking out at the end.

And what surprised all of us, I think, and it still surprises me

when I see it, is that straight away from the beginning, people are using

that hand to brush away hair from the forehead, even though there's

no movement in the hand, but they're using their shoulder and their elbow.

They're using it already to gesture.

Um, they're using it to brush hair away from their face, you know,

and they're using it as if it belongs to them, and that happens.

instantaneously, um, which I think is partly a testament to Maggie's very

thorough preparation, but also What's fascinating to me is the idea that

actually what makes a hand feel like your hand is the map in your brain, not the

piece of tissue on the end of your arm.

So, of course it still feels like theirs because the brain map

is the same brain map, and it's almost as if it gets accepted.

into the body plan in the brain almost overnight it feels, doesn't it Maggie?

It's been incredible how quickly,

Dr Maggie Bellew: but it's interesting if you contrast that with having a

prosthetic limb, because that's not the experience of having a prosthetic limb,

and it's an important part of our protocol that patients do try alternatives,

doing nothing, um, having a prosthesis.

The importance of having hands and the use of hands

psychologically, it's something I hadn't considered until we started.

doing the podcast, I would have just instantly have thought foot

transplant, hand transplant, surely they're the same, you know, and it's

only when you then sit and sit with that thought, you realize, wow, it's,

it's really, really very different.

And it, society is sort of based on our hands.

Dr Maggie Bellew: We don't appreciate them until we lose them, really.

They affect us physically and psychologically to a degree,

which is disproportionate to their size, integral to our self image.

They're always on view.

We're judged by how they look, what they do and what they reveal about us.

They're used in communication, written communication, gesturing, signs and

signals, pointing, very human thing, pointing, their contact between

individuals, formal, informal, kind.

Secrets, signs, salutes, friendly, unfriendly, sexual activity, they

provide information through touch.

They're the eyes of the blind.

They're used in our work, our leisure, our self care, and our independence.

So if the condition, function, or appearance of hands is compromised

in any way, the implications are massive psychologically, socially, and

vocationally, but we don't, we take it for granted until we lose them.

Dr Rachel Mandela: Something that I've heard over and over again from patients

is this feeling of completeness.

Yes.

When the dressings come down and you see along your arm and it ends

in a hand instead of ends in a stump, that there's a feeling of,

ah, I'm complete and it does, yeah.

And going back to the, the brain map, which I've mentioned before,

when we actually look at how.

Parts of the body are represented in the brain.

They're not proportionate to the size that they actually physically are.

So, the amount of brain map that your hands take up is huge.

You know, you think about how sensitive your hands are compared

to other parts of your body.

You know, you can tell which part of your hand is being touched.

You can rummage in a bag and feel the difference between keys and paper and

lipstick and, you know, So there's a huge amount of kind of sensory

information in your hands, which is represented in it taking up this

large proportion of the brain map.

They're not equivalent to other body parts.

It's

Dr Maggie Bellew: quite a thing to think about using the hand from somebody

else to self care, uh, intimate self care, holding the hands of loved ones.

and in sexual activity hands are a sexual organ and if you're going to find that

too weird to cope with again that would be a reason for not going ahead and they

also need to talk to their partners about it because if you if your partner is

not going to want to be touched by this hand and is going to be so disturbed

by it that it has an impact on the relationship again that's something we

need to know beforehand not afterwards.

Um, so I'll, I'll, I think we've realized more and more how much I need to involve

families in the pre op assessment stage.

So certainly partners, children, you know, we don't want to do

something that's going to make the family situation more difficult.

So again, we address all of that pre operatively.

How people talk about when they lose a limb,

still having sensation in the limb that is no longer there.

You mean the phantom

Dr Maggie Bellew: sensations?

Phantom sensations, yeah.

Um, how does that tie in with when, when they then receive a limb?

Dr Rachel Mandela: It's interesting, isn't it?

Because we, we have actually had somebody who experienced a lot of

pain in his hands before they were amputated for the hand transplant.

Were he to have had an amputation without a transplant, you might have expected

him to experience a lot of phantom pain.

But the first thing he said when he woke up after the surgery was pain's gone.

So I guess part of what we look at as well is are there any barriers, and

that could be cognitive barriers, to the person understanding the process.

So part of our role might be to do some cognitive testing and to

understand how's the person's memory?

Are they able to take on board and retain this information

enough to make a decision?

And it's not about saying no to people.

It's about thinking about whether we need to adjust our processes because

some of our patients have had illnesses, which may have affected brain function.

Some of our patients have had accidents, which may mean they've had brain injuries.

So that's part of the key part of the role of psychology here as well

as assessing cognitive function.

In addition to that.

Obviously our patients are a cross section of human beings, so they

come with potentially mental health problems which may be related or not

related to the reason why they're coming to for hand transplant.

Often it is, and as you can imagine, people coming with trauma symptoms,

having lost, lost their limbs, either through sepsis or, or, or through a

traumatic incident, quite often there's a piece of work for us to do there.

And usually what we do so we can, we can keep things clear is that Maggie will

assess and then she'll give bits of that work to me or to other psychologists

in the team who might then treat the patient for post traumatic stress and

the assessment process is paused and then they come back into the service again.

I found this quite

interesting that that seems to be very much the ethos that this

isn't a person and you're dealing with one little part of them and that's it.

This is a whole person and every single clinician who sees this person sees, you

know, you know, sees the whole of that person and everything that they are rather

than whatever their speciality may be.

Dr Maggie Bellew: Whether they've had, whether they've lost their

limb through a disease process or an accident, they can all be traumatic.

Experiences being extremely unwell is very traumatic, having a physical

accident can be very traumatic.

Not everybody has PTSD, but we certainly need to be mindful of that.

And would it be fair to say then that in terms of this

year's assessment, each assessment is catered to the individual as opposed to

there being a, if you have this, it's a no, if you have this, it's a yes.

Um, It sounds like it's very person centered.

Dr Maggie Bellew: Yeah, I mean, I have a, I have a protocol that I follow, that

I make sure I've done every section on it and fill it in, but it's necessarily

fluid and every patient is different.

There's, there's no two assessments that ever feel the same and it

stops and starts as appropriate.

Dr Rachel Mandela: I think, key point, key thing here is that when somebody

has a transplant we're asking, we're putting them through a lot of stress.

So they're going to have a really long surgery and then a really difficult

recovery process that probably will involve them feeling physically unwell,

psychologically stressed, having to stop their normal activities, having an

experience of being re disabled quite often because they might have been very

good at using their stumps and now they've got these weights on the end of their

arms that don't do anything at first.

So we need to help people get into the right place to be able to cope with that.

And so sending people in with untreated post traumatic stress

or depression that isn't managed, isn't, it's not a good idea.

We need to do that work before they get onto the list.

What if they don't

Dr Maggie Bellew: appreciate?

Dr Rachel Mandela: That's

Dr Maggie Bellew: what it's going to be like.

That was a brilliant description of what the post op period is like.

And if they don't appreciate that, because they only want to think

positively, and they don't want to think about the risks, and if they've

got really unrealistic expectations, then that would be, come as a huge,

perhaps unmanageable shock afterwards.

But clearly we don't, we don't want that.

Progress everybody to hand transplant because we know that it's not successful

for everybody and I'm sure Prost already told you the very first hand

transplant that was ever done was a physical and surgical success, but

was a psychological failure and we've always had it in our mind from day one.

We do not want that to happen to our patients.

Um, so a lot of people don't progress, they go through the

process and sometimes they.

take themselves out of the process because they decide it's not for them.

When they hear about the risk, they say, I'm, I'm all right as I,

I am, I decided, and I don't want to take that level of risk on.

And for other people they're undecided for a while, or they not

really engaging in decision making.

But by the end of it, they may have changed beyond all recognition from the

person that first walked through our doors and are in a position to make a decision.

And so the ones that they want to go ahead and we're happy for

them to go ahead, they're the ones that go ahead with surgery.

And I guess all outcomes within that.

are a success.

You know, if, if somebody has gone into it saying they want to have a transplant,

but then actually you've helped them look deeper and they've come to the conclusion

that, no, this isn't going to be for me.

That's the best outcome because it would have been awful had

they just pushed on through.

Dr Maggie Bellew: You can withdraw at any point and no one's going to mind really,

no one's going to mind because all that matters is the right decision for you.

And you can pull out at any point.

Dr Rachel Mandela: And quite often, we could be in the position of allying

ourselves with the patient and getting alongside them with perhaps a part of them

that's thinking, I don't want to do it.

You know, an example would be patients who perhaps have an amputation,

which has left them quite functional.

And that they would have to lose aspects of that function in

order to have a hand transplant and they may feel some pressure.

I ought to want it, you know, my hands would look more normal, for example.

Um, but actually deep down, they don't want to do it and they can

do what they need to do with what their amputation has left them with.

They can boil kettles and, and write and do things that, you know, they

really value and they wouldn't want to take the risk of the transplant

failing and then being left worse off.

So.

Our job is definitely not only to support people down the path of

transplant, it's to support people to find the path that's right for them.

Dr Maggie Bellew: Yeah,

Dr Rachel Mandela: we're not on commission.

Dr Maggie Bellew: We're not trying to get more help.

It's about, it's only ever about getting the right answer.

So let's go then to the patients having had a

surgery and where you step in then.

Dr Rachel Mandela: At first we would be popping in every day to see how

somebody is when they're in patients and that might be quite brief at first

because as you can imagine people might be recovering from general anaesthetic

on lots of pain relief, very tired.

So.

We're kind of touching base more than sitting down and having a long involved

psychology session like Maggie might do.

But I guess I'm mindful of a couple of factors when I'm going

in to have those check ins.

So we're looking out for signs of psychological rejection

or distress about the hands.

And as Maggie's said, we haven't seen any of that in the 10

patients we've transplanted so far.

But that doesn't mean we should stop looking for it because We've

got a very small sample here.

We've got 10 people.

So, you know, we are going to see that at some point and we need to be picking it

up early and supporting it, not letting it run unnoticed, if people are having

those kinds of thoughts and feelings.

Related to that, I often think of our patients as having this experience

of being a bit like a racehorse, you know, that this, this, this special

patient who gets all this attention.

It's this very cutting edge technique.

It's, it's all new and exciting.

And the media are interested.

And, and I always think how easy is it for you to say in the

context of having all this resource poured into you, I feel awful.

You know, I feel really terrible.

I feel ill.

I feel anxious.

So for me, a really key role of the psychological input in the early

stages is to normalise and support how difficult it might feel psychologically

to go through that surgery, to go through all the revision surgeries and

dressing changes and how exhausting it is, and being in hospital and

away from your life and all of that.

It's really important that patients have a space to verbalize that and to feel

that it's normal, that it's expected, they don't have to hide it and put on a brave

face and pretend that everything's fine.

And I suppose that it's okay to feel

grateful and thrilled and just a little bit crappy at the same time.

These two things don't, don't aren't, aren't separate, they can go hand in hand.

Dr Maggie Bellew: And we're, they're pre warned of all of this, so it shouldn't

come as a huge shock, but there's nothing like actual experience in reality

over the theory that I've given them.

Yeah, yeah.

And we also warn them that there's likely to be episodes of rejection

during that first year, and that's again normal, it's normalized.

And we, we used to panic first.

patient, we panicked at the first signs of rejection.

Again, you don't see it in kidneys.

It's probably happening all the time with kidneys as well.

These little flurries of rejection, physical rejection

that is, immunological rejection.

Um, we now know we can manage it and we make adjustments and

it's, it's, it's controllable.

But again, we have to warn that because that could be really frightening

if they're thinking this is really unexpected and threatening, but

actually it's, it's, it's normalized.

It's normalized now.

Dr Rachel Mandela: Yeah, so I kind of see my role as being a bit of a pressure

valve, you know, somewhere where you can dump all that stuff and, and, you know,

really get it out of your system and not have to put a brave face on things.

And I think reflecting on that, I think that's been really important

for many patients because that first period can be very rocky.

You know, as the body gets used to the medication, people find themselves

exhausted or ill all the time, or they're going into hospital with, you know,

complications of the medication, so on.

Yeah.

It's tough.

It's, it's a bit of an uphill struggle.

And so having someone to complain about it too, and to get it off your

chest and to say, who can say this is normal, it will pass, you know, um, and

be a listening ear and supportive ear.

So that's it.

That's a key role.

So yeah, at first I'm going in every day or every other day.

And then once the patient gets discharged, I'll be checking in with them once a

week for the first months and just seeing how they're settling in, how they manage

their first outing to a coffee shop.

You know, how are they managing people's questions?

How are they managing people looking at them?

How's it, how is it juggling all these different appointments?

So I'm, I'm, I'm, Figuring out whether there's anything that I need

to support with and I'm filtering information to other team members that

they may need to know about as well.

And that, that kind of intensity of input gradually falls off, assuming

that the person is, is feeling okay.

It'll go down to kind of once a month, then once every three months and, and

finally it'll be, But, but there's always the capacity for it to spike

again and to go back to being more regular, if for any reason the person's

struggling with something in particular.

And I guess it certainly has happened that in the postoperative period, people

find themselves more able to reflect on the experience of the limb loss

in the first place, almost as if they had the lid on that so tightly that

when they come out, come out of the initial, um, acute stage of recovering

from the surgery, they're able to look back and say, Do you know what?

I'm really starting to process some of the stuff around when I lost my limbs.

And at that point, I wouldn't do direct therapeutic work with people at that

time because I'm expecting to have a lifelong relationship with them.

I'm in a position to be able to, you know, really monitor how someone is

in terms of their mental health and to make onward referrals if needed.

And I guess, just like physio and occupational therapy are there to

ensure that the patient gets the best out of their mental health.

transplant, so is psychology.

So there could be psychological barriers to people feeling that

they can go out and use their hands.

They might have appearance related concerns about their scars.

For example, they might be worried about attention from other people.

They might be worried about field, fielding questions.

So all of that is, is kind of grist for the mill.

And I guess success is a long French loaf, isn't it?

You know, we can have a successful outcome, but there still be

barriers that we can support person to unblock, which would.

Be even better for them.

So it's about optimizing, I guess, rather than just a binary of

whether it's successful or not.

And then I guess the other thing that's really important to mention in terms

of psychology follow up is, is helping people cope with rejection episodes.

And we, we may be now as a team.

confident about it.

And I know Prath and Richard Baker, the transplant

physician, are pretty confident.

They know what to do.

They don't panic when someone shows signs of immunological rejection.

But that's not how it feels sometimes with a patient.

It can be really, really scary.

Um, and they will wonder, am I going to lose my hands?

And, you know, the anxiety that can go along with that.

However much reassurance people get.

Sometimes that needs a bit of extra psychological support to help the

person cope in that situation.

And then, finally, I guess we have happily, so far, never had an experience

of someone having a rejection that can't be dealt with medically and

needing to have their hands amputated.

That hasn't happened in the UK.

Sadly, and none of us like to think about this, it is going to happen one day and

when it does happen, it's going to have a psychological impact and our job is

to support the person to manage that.

And that is

Dr Maggie Bellew: also something I discussed with them at the pre

op assessment, is how they would manage, how they anticipate they'd

feel if the ultimate downside happened and they lost the limb.

We need to understand how they would likely approach that,

how do they think they would.

react to that situation.

Um, and some think, well, at least I've tried.

Some say, well, I'll go again, try again.

Others say, well, I'll just carry on as it was before the hand transplant.

But, you know, they need to have at least given some thought to it beforehand.

It can't all be done after the event.

Preparing the mind to have thought through scenarios, whatever that may be.

Possible eventuality has to be considered preoperatively.

Can we, um, touch upon the, the donor aspect?

I think, as a person who researches, I would really struggle to not try

and Facebook and find the donor and try, and I can completely see why all

of these actions would be unhealthy.

But how do you get into the right mindset so that you're comfortable

so that you don't feel the need to perhaps ask a million questions?

Dr Maggie Bellew: They, they know that it's an anonymous donation and

that they're not going to be provided with the details of who it is.

Um, it'd be quite hard for them to find out.

If they wanted to write a letter thanking the donor, that can be facilitated,

but again, it's all anonymous.

So unless the donor family went public themselves and made it obvious that they

donated, the recipient wouldn't know.

And obviously, because there has been media coverage of our earlier

transplants, the donor family are likely to know who's been the recipient.

But we're at the stage now where it's not quite so clear.

headline newsworthy.

I guess what I'm getting at really is, what

about the thought processes of who the donor might have been?

So, what if the donor was a criminal?

What if the hand had been used for negative purposes?

Dr Maggie Bellew: You cannot specify, I do not want the hand

of a criminal, or I don't want the hand of a this, that and the other.

You know, that would be an absolute contraindication to proceeding,

you cannot put those parameters on it, it is an anonymous donation.

Dr Rachel Mandela: I guess the other thing to say about that is that if the

recipient decides to write to the family who've donated the limb, the transplant

nurse will then contact the family and say, there's been a letter come.

from the recipient, would you like to receive it?

And that's the same process the other way around.

If the transplant nurses then say to the recipient, we have a letter from the

family, would you like to receive it?

That's part of the thinking for the person, because they might find things

out that they wouldn't want to find.

When somebody receives a It may have a wedding ring indentation.

You know, patients have commented to me before, Oh, I know that the previous

owner of these hands did physical work.

I can see with the nails and the, you know, how the fingertips are rough.

So, there is this real, Bond, I think, but certainly in my experience, and

I think, again, this is testament to Maggie's really thorough preparation.

It's, it's kind of a nice thing for the, for the recipient, you know, it touches

them, they look at it and they're, they're connecting imaginatively with the

previous owner and appreciating the gift.

It's always had a, a kind of really grateful flavor, I think,

when people talk about this stuff.

Dr Maggie Bellew: I think appreciating the gift is a really good, succinct.

We're putting that actually that is exactly what it is.

They appreciate the gift that this person's given them

coming up on our next Episode we meet Kim Smith now She lost

all her limbs to sepsis and is currently on the waiting list for a hand transplant

Oh gosh my life before sepsis.

I was a busy working woman very independent I had two businesses.

I worked seven days a week I was constantly on the go then I decided that

I wanted to take it a little bit easier.

We bought a villa in Spain and we were out there on holiday

when I then developed sepsis.

So I ended up losing the businesses because I couldn't work.

Yeah, now I sit on my backside doing nothing all day.

I mean, I can't cut

hair if I haven't got hands.

And you can hear more from Kim in our next episode, which is out on Friday.

This podcast is an under the mast studio production.