Dr. Kodi Azari has traveled the U.S. as a lead surgeon in five hand transplants. Hand transplant recipients have usually lost their hands before surgery, but Azari laid the groundwork for a new kind of procedure:
The doctor had some hypotheses he wanted to test, provided he could find a patient with the ideal requirements: excellent health, enormous self-discipline, a positive attitude, and—rarest of all—a limb that needed to be replaced but had not yet been amputated.
Azari knew he was hoping for a long shot. Most hand transplant candidates have been injured in accidents or in battle, when a catastrophic event forces an emergency amputation. These procedures are aimed at minimizing suffering and are usually carried out to facilitate future prosthetic use. Generally that means the arm is severed closer to the elbow than the wrist, and the nerves and tendons are trimmed back and tucked inward to lessen discomfort. That creates challenges, however, if a transplant is attempted later. All those tucked-in nerves and tendons tend to merge over time into a jumble of tissues that is difficult to connect to a new hand with precision.
Wouldn’t it be great, Azari thought, if a transplant recipient’s arm could be amputated in a way that prepped it specifically to receive a new limb? How much more quickly would a patient recover if each tendon, nerve, artery, and vein were left in place and marked—labeled, like so many colored speaker wires, to be hooked up to a matching apparatus? How much more functionality would the patient gain, and how rapidly would he or she gain it? Azari believed this fantasy patient would awaken post-op, look at the new hand, and be able to move the fingers right away.
Azari found the ideal patient in Jonathan Koch, a television executive who experienced full-blown septic shock and needed several limbs amputated. Amy Wallace tells his story in Los Angeles Magazine.