The power of hands, hosted by Caroline Verdon, delves into the intricate world of hand transplants. Featuring an in-depth interview with Professor Simon Kay, a pioneer in the field who established the UK's Hand Transplant Unit at Leeds Teaching Hospitals NHS Trust in 2013, the episode explores his personal and professional journey. Prof. Kay shares insights from his electrocution injury at age 5 that spurred his interest in hand surgery, emphasizing both psychological and surgical care. The episode traces the evolution of hand transplants, comparing early challenges in Lyon with the success in Louisville, and details the establishment of a UK program, highlighting the hurdles overcome for NHS funding. It also underscores the profound significance of hands in functions such as communication, sensory feedback, and cultural identity, concluding with a look ahead to an inspiring story from Jamie Mines, a former footballer who lost his legs and hands in an accident.Produced by Under the Mast, this episode explores the significance of hands throughout all aspects of life

00:00 Introduction to Leeds Hand Transplant Team

00:52 Personal Story: Professor Simon Kay's Early Life

02:45 Lessons from Childhood Adversity

05:53 The Journey to Hand Surgery

08:21 Pioneering Hand Transplantation

10:59 The Journey to Hand Transplantation

12:06 Challenges and Breakthroughs

14:09 The Importance of Hands

14:59 The Complexity of Hand Functions

15:50 Hands in Human Culture and Communication

20:21 The Significance of Handshakes

22:11 Preview of the Next Episode

In safe hands, stories from Leeds pioneering hand transplant

team coming up in this episode.

Prof. Simon Kay: Ever since Friends, the sitcom series, there seems to have

been a sort of wave across the Western world of hugging, not shaking hands.

But the point about shaking hands is when you shake somebody's hands, you feel them

and you have to look them in the face.

My children will tell you.

That I like to shake hands with them rather than hug them because it's just a

telling way to say hello and how are you.

You get a lot of information very quickly.

Thank you for joining me for this podcast from the

UK's Hand Transplant Team based at Leeds Teaching Hospitals NHS Trust.

I'm Caroline Verdon and in this episode We meet Professor Simon Kay.

He's a world leading authority on hand transplants, and he set up

the unit here in the UK in 2013.

Prof. Simon Kay: So a large part of my work is working with

children with hand abnormalities.

And, um, That has been my goal in life since the age of about 12.

So when I was about 5, I had an electrocution injury to my hand.

I was at home with my mother, and we had an electric bar

fire, and I switched it on.

And of course, it doesn't go red immediately.

And so I grabbed it, thinking it wasn't energized as a child would.

And of course it was, and I was electrocuted, and it burnt my finger.

And I lived in Channel Islands then, so I was flown out to

Woodstock Plastic Surgery Unit.

in Salisbury, where I had, um, what I would now see as inappropriate and heroic

efforts to save me from losing a finger.

And I had to have skin grafts and so on.

So that was both instructive about parent child guilt, about parent child

separation, and about the complexities and interest of reconstructive

surgery, and in the end about Because, as I got older, I had a very, uh,

scarred and deformed part of my hand.

And the more activities I wanted to take part in, the more it was in the way.

And it was both unsightly, because the aesthetics of the hand are important.

It was both unsightly and inconvenient.

And so, I went back to my parents and said, you know, I think I'd

like to be rid of this digit.

And by then, they'd invested, as had doctors, a lot of

time and effort in saving it.

And so my father took me off to see some Harley Street bigwig who wanted

to do some clever, complicated thing.

And I didn't like the sound of it at all.

I was about 14 then, 15.

So I went to my GP when we got back to Channel Islands,

and he amputated it for me.

And it was the best thing I've ever done.

And it taught me that, that whole episode, which was a formative part of my life, had

lessons that have carried me through life.

One is about the enormous guilt my mother felt.

And how that guilt drove her, um, to find, you know, complex care for

me, how specialists always over egg it and don't do the simple things.

Um, partly because I suppose if you call yourself a specialist, you feel

you should do something special.

Well, I don't think that's necessary, I think that's, you should be

able to do something special, you shouldn't feel you have to do it.

Um, And it taught me that, uh, that what matters is what's between the

ears and not what's on the hand, so it was important for me to have this.

I was, as a child, young child, able to express my wishes, and

luckily I had a GP who would listen.

All of those are things that I think are really valuable lessons for any doctor.

So that's what's really sort of fueled

your, or driven your interest.

Prof. Simon Kay: In this, in my view, misguided endeavor to save a finger, um,

which involved several operations and very long periods of hugely unpleasant therapy.

Nobody really seemed to be thinking about whether it was worth it.

And there was an assumption that if we started, we have to finish,

and we can't change course.

I don't know, some of that might have been my parents being slightly

intimidated by the sort of great man surgeon thing, and the surgeon feeling,

just carry on down the same path.

It also had a profound effect on me in that I developed very bad stammer,

which I think, um, was quite a defining part of my childhood because it was

so bad that I was essentially mute, I didn't talk to anyone really at all,

and I, I dreaded conversation and so on.

Um, as you can see it's better now.

Yeah, you wouldn't know.

Well, sometimes, hear me on the phone or on the radio.

But, um, but That had a, a, a big effect on my life, and it all comes

from just picking up that barfire.

And so, I realized that these things that we see as, oh, it's just a

small burn, can have consequences that fan out throughout the life.

Some of them are good and bad, they're not, not everything bad

flows from an injury like that.

I mean, one of the good things was that I learned to, children who face adversity

in childhood, And come through it with the help of a strong structure, whether it's

religious or family or organization based, they often become very resilient and

also very empathetic and contemplative.

So they develop skills early that that other children don't, I'm

not advocating that you should put every child through, but it's

interesting that that's what happened.

And we see that time and again, there are many examples from.

public life and also in my clinics.

You see it all the time.

So it did have a strong influence on me and it made me think about

hands and made me think about hand surgery and hand surgery was

just in its infancy after the war.

Um, and the idea that you could mitigate injury and congenital

deformity and, and differences in the hand was utterly fascinating to me.

And so that's why I decided to to do medicine.

And that's why I decided to do reconstructive surgery.

And so for a large part of your career, it obviously

didn't involve the transplantation.

How did that come about?

Prof. Simon Kay: Well, first of all, I've had several things that

I wanted to contribute and think I have in children's hand surgery.

And amongst those are that The psychology and behavior of the child and the

family are far more important than the physical problem with the hand.

So, uh, straight away, I don't think surgery is the be all and end all.

I think behavior and the, and understanding, and, and, um, if you

don't have that, how can you advise?

And so that's why right from the get go when I was a consultant,

I had a psychologist with me in clinic all the time.

Um, And, as I say, it's what's between the ears that matters, not what's on the hand.

But then also, um, I trained part of my time with a chap called Graham

Lister in Louisville, Kentucky, who was an unusual personality and

a very good surgeon, good teacher.

And he started doing microsurgical transplants of toes to hands for

congenital absence of, say, thumbs.

And so, I was always a committed microsurgeon, just in the sort of

new wave of microsurgery in the 80s.

And so that's what we came to Leeds, a colleague of mine and I came to Leeds

to set up a microsurgery service here.

And he was a very good microsurgeon.

And he did a lot of the head and neck reconstruction microsurgery

and I did hand reconstruction.

So I was doing a lot of transplanting tissue to the hand.

Microsurgery refers to the idea that with the aid of an operating microscope you can

join together very small blood vessels.

And so you can take, say, a toe off a foot, transplant it to hand, and give

it blood flow and life immediately by joining up the very small blood vessels.

So I was doing children's reconstruction surgery with microsurgery, and I trained

in Kentucky, in the States, and that was a unit that was beginning to look at the

pros and cons of hand transplantation.

And I was there in sort of 85, 86, and they did their first transplant in 2000.

So 15 years later, but they're already beginning to talk about it.

And um, the team that did the transplant was the team I'd worked with.

So I knew them well.

And when they were first beginning to talk about

it and when that became a genuine conversation of possibility,

what were your thoughts on it?

Prof. Simon Kay: Oh, I thought it was a great idea.

But it's interesting the history of the first modern era transplants

is the first one was done in, in Lyon, in France, uh, by.

Guy called Max Dubinar and his team, but with an Australian

urological microsurgeon, um, and a patient from New Zealand.

And he said, why is that happening there?

And it was a very, in retrospect, I think everybody involved in that would agree

it was a poorly thought out procedure.

The patient was really unsuitable, he hadn't been assessed properly,

his requests weren't met, his conditions that he needed weren't met.

And he, in In fact, began to psychologically reject his hand.

Some people question whether such a thing exists, but it does.

He didn't like his hand.

So he stopped taking his immunosuppression, and then

immunologically rejected it, with the intent of losing it.

So, so three months later, Louisville did their hand transplant, and that's still

attached and alive and working well.

And the reason, there are two differences, one is that Louisville

spent 10 years working up towards it, analyzing it, researching, looking

at attitudes, understanding the psychosocial consequences and so on.

They screened their patients very carefully, um, they knew exactly

what the patient would tolerate and wouldn't tolerate, and so.

The chance of psychological rejection was much smaller and it's interesting

that the Leon transplant was three months before Louisville won and

one can't help wondering if there was a rush to be first there.

But so then Louisville did it in the year 2000, January I think it was 2000.

And so I went to our trust medical director and I said, uh, we've

got all the know how to do this.

There's a transplant service in Leeds for organs.

We've got the best microsurgery service in Britain.

Why don't we do this?

We need to start going on this and he said something to me, he's

a very nice chap, end up friends.

He said, he said, I think this is really interesting, but I think it

would be better to be in the vanguard, but not actually carry the flag.

And I thought that was a very nice way of putting it.

So get ready to be there early, but not the first, um, because there's a lot

of risk attached, both reputationally for me and for the hospital, but

also for the patient physically.

So then I kind of got busy with other stuff.

Um.

And, uh, it went on the back burner, and then a very nice chap called Raj Prasad

came along to me in about, probably about 2009, 10, and said, You should get

off your ass and do a hand transplant.

He's, he's a transplant surgeon.

Um, and it was 10 years later, and I thought, yeah, I haven't reactivated that.

So I started down that road, realized that it was actually a very difficult road

to get agreement to do, and that rather than just setting up a business, Plate

and saying anybody with no hand come on.

I'll give you one We had to get a lot of permissions cross a lot of boundaries

find a lot of funding put together a team And we finally did that and persuaded the

trust that they would do the first one financially at risk That is say they'd

go out and try and recoup the funding after it had happened because there was

no Basis in those days for negotiating that ahead So we did our first transplant

12 years ago And, uh, a month later they changed the commissioning rules.

So we, we couldn't do them without a centrally agreed contract.

And that took three years to negotiate and compete for and finally get, if I say that

in one sentence, but it was three years of learning how to, um, maneuver in NHS

culture and how to persuade people that if they've got a limited pot of money, this

is something they should buy instead of.

Something else, but we got there eventually, and so we became centrally

funded, and that's an enormous difference to other units around the

world, because other units like the American units, they have to rely on

either treating only very rich patients, because it's expensive business.

Treating people who are funded by a charity, looking for legal compensation

as part of treatment if they've lost it in an industrial accident.

And in fact, the most prolific hand transplant unit now is Philadelphia,

where my very good friend, Scott Levin, Runs the unit and his last

two patients have been from overseas, wealthy patients from overseas.

Um, so that's good that he's doing it, but it's kind of not

providing the local service.

But NHS England had both the competence and vision to see that this couldn't

be provided by local funding.

It would have to be a national structure and they stepped in and funded it.

So huge kudos to them.

And so let's have a look then at the importance of hands.

How significant are they to, you know, our existence?

Prof. Simon Kay: It seems that most people when they talk about hands and

loss of a hand or impairment of a hand, they talk about mechanical function.

You often hear the phrase pincer function or pincer grip or strength of

grip as if it's just simply a gripping shovel on the end of a hydraulic limb.

And of course, the truth is that it's far more complex.

The first thing to say is hands are paired and they're mirror images.

They work together and they work in front of you.

And so they complete a circle with your head and both arms, your head at the

centre directing things and your hands.

Out there doing all the things they do, and the things they do are

far more than simple mechanical.

In fact, there is no simple mechanical.

The mechanics of the hand are incredibly intricate and beautiful, um, in any case.

But, the mechanical function is the one people focus on.

Of course, there's a sensory function.

And when I say a sensory function, when you think about hands, the amount

of different sensory modalities they can detect, not just touch, light

touch, vibration, hot and cold, proprioception, by which may mean

they know the position they are at all times, so you can know what your

hand is doing when you're not looking.

These are remarkable qualities, so we've got the mechanical and the

sensory qualities, but then there's something that transcends that.

And I think it's a deeply sort of human cultural thing, which is

based in the fact that the hand, the face, and language are three things

that really do distinguish humans.

And of course the thing that distinguishes humans most is their

brain, and therefore their mind.

And we don't know whether animals have minds.

Uh, by which I mean the consciousness of others.

But I'm convinced that hands play a part in the development of

language, and so the development of the brain in reciprocal ways.

That sounds a bit airy fairy and complex, but let me give you an example.

One of the things that hands do is point.

And, uh, we're the only animal that points.

We point with what's called meant meaning, that is, it has meaning

and we intend it to have meaning.

It's not trained into us like a pointer dog.

And indeed, pointing is one of the distinguishes from neurodivergence.

It's a milestone you have to meet as a baby in order to

be meeting your milestones.

And you should be pointing within the first year.

And then, when we see pointing, The interesting thing about pointing,

it's done with the index finger, which is why it's called the index finger.

And, in order to point, um, you have to have somebody to point for.

So you're the pointer, and there's a consumer of the pointing, and

the thing you're pointing at.

And then if you want to tell somebody the name of something, you You indicate it

and you say stone or tree and then you suddenly have a language and once you

have a language, you can then communicate and you can communicate abstract things.

So back to the functions of the hand, I think there's something very

deeply embedded in humans that even though we don't think about it, we

recognize our hands are very important for how we got to where we are.

And so when people talk about hands and talk just about mechanical function,

sensory function, they forget all the higher functions hands have.

So in communication, in gesturing, in caring, you know, the caring touch of

a warm hand, the touch of human warmth is a very caring thing for a child or

for a partner or for an ill person.

We decorate them, we put rings on them, we tattoo them, we paint on hails.

And of course, the They're an important part of sex, almost

impossible to have enjoyable sex without using your hands in some way.

I don't mean just masturbating, but also in sex with a partner.

And then finally, one of the most brutal and effective punishments throughout the

ages, practiced throughout the world, is, is the amputation of the hands.

So for stealing, or for adultery, or just as a punitive thing, I think William

the Conqueror cut hands and feet off.

Some of his victims to encourage the others and it happens throughout the world

and we see it happening in Africa now And that's a brutal dehumanizing a thing

and that's why it's so brutal because it dehumanize you So I think for all these

reasons I hate it when people talk in my view ignorantly about the mechanical

function of the hand There's so much more Finally, as I say, they work as a, as

a ring, as in concert with each other.

They're mirror images, they fit together, and they do complementary tasks.

And we have one preferred hand.

I don't like the idea of dominant hand.

We have preferred hands for most activities.

And at the center of that is the human face.

Which incidentally, interestingly, has a lot of the same qualities.

It's unique, it's aesthetic, it has sensory, both the extraordinarily

sensitive proprioception of your lips and tongue, the sense of taste that is

the seat of vision and hearing, it also moves and gestures facial movement,

and it's an important part of sex.

So it's quite interesting that they share these things.

And they're the only two parts of the body that are always on view.

So it's, it's a lot more concerted and complex than most

people stop and think about.

And I suppose we also use them in every kind of

relationship that we have, whether it is a business relationship and

there's the expected handshake or kids high fiving or whatever it

Prof. Simon Kay: Well, now handshaking is really interesting for me because there's

all sorts of Cod philosophy and history around it and ever since friends this

year, the, you know, the sitcom series, um, There seems to have been a sort of

wave across the western world of hugging not shaking hands Particularly in the

anglo saxon world where shaking hands is sort of slightly austere and um thing

to do But the point about shaking hands is when you shake somebody's hands you

feel them So, you actually hold their hand, you feel its quality, is it warm,

is it cold, is it sweaty, is it soft, is it strong, is it weak, and in order to

shake somebody's hand, you have to look them in the face, you can't shake the

hand while you're looking away, if you hug somebody, you avoid face to face.

examination, and you don't get much sensory feedback because you put your

arms around them and sometimes give them that kind of phony pat on the back.

But that's very different from the handshake.

The French do it beautifully.

They shake hands and kiss.

Cheek, cheek, one, one, one, two, three.

Um, but shaking hands, I think is, I'd hate to see that go because it tells

you so much more immediately about the person you're, you're meeting.

That's really interesting.

And something I think it's easy to overlook and to just bypass this

whole gigantic part of society.

Prof. Simon Kay: And during COVID, when we were encouraged to sort of bump

elbows, if anything, then people were very slow to get back to shaking hands.

But I prefer shaking hands to any other form of greeting.

In fact, my children will tell you that I like to shake hands with them

rather than hug them because it's just, um, Uh, for me it's a telling

way to say hello and how are you.

You get a lot of information very quickly.

Coming up on our next episode, we meet Jamie Mines.

He was a semi professional footballer from Swindon who lost his legs and

hands in a building site accident.

Yeah, it was hard, honest to bear.

When I first woke up, I did ask why did they do it, why did they save me?

First, I said I would have Benny's hat.

And then they asked me if I would have different coloured skin or a lady's hat.

And then I thought about it.

I thought, because I'm quite a big tall lad, I actually said, oh no, I'd

like to have a guy's hat actually.

And similar like height, weight.

I got a bit choosy when it came to it.

I, I thought I was going to be upbeat for the rest of my life.

And you can hear more from Jamie Mines on our next episode,

which is out on the 30th of November.

This podcast is an under the mast studio production.