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Dr. Pedro Cavadas, who led teams performing Spain's first double hand transplant in 2006 and first face transplant in 2009, recently led a team of 35 professionals at La Fé Hospital in Valencia to achieve the world's first transplant of two legs.

Innovative Transplant Procedure Widely Questioned

The recipient, identified only as a man in his 20's who lost both legs "high above the knees" was reportedly elated to see new legs when he woke up from the 10-hour surgery. A chorus of medical critics, question the ethics and efficacy of the procedure.



Wouldn't Artificial Legs Be Better?

Almost as soon as the procedure was announced, medical experts outside of Spain voiced strident objections. The most common criticism of Dr. Cavadas' daring procedure was that artificial legs should be just fine.

The fact is, millions of people use prosthetic devices to replace missing legs with great success. There are amputees who walk, run, ski, skydive, and even participate in track and field events with their artificial legs. The process of adjusting to an prosthetic limb, however, is always fraught with difficulty.

One of the most commonly overlooked problems after the loss of a limb is the need for more nutrients, rather than less. Many amputees fall into even poorer health because of the body's demand for protein and calories to repair the whole-body trauma caused by the amputation event.

One of the most widely reported problems after the loss of a limb is the need for a good fit. There has to a be a socket into which to fit the leg. High-leg amputations don't leave an easily usable stump.

In addition to inevitable problems with attachment, there are also frequent problems with alignment, suspension, and usability. The first prosthetic offered to the amputee simply may not work. All of the problems around the use of the artificial limb have to be worked out while the patient is still recovering  physically and mentally from the trauma of losing the leg or legs.

Dr. Cavadas simply states that prosthetic limbs were not an option for this patient, and that the patient was very happy to receive the transplant. Any further comment would compromise the privacy of the patient. Concern for patient confidentiality has not restrained critics from around the world from claiming that it was unethical to subject this patient to a clearly experimental procedure, but a better question might be, is it likely to work?

The Long Road to Recovery After Double-Leg Transplant

Chances are that neither Cavadas nor his patient will know whether the transplant was successful for at least 1 to 2 years. The arterial and venous "plumbing" of the legs were connected to the recipient's body during the 10-hour surgery. Connection of the new legs to the patient's central nervous system may take several years.

The reason full recovery may be very slow, if it happens at all, is that nerves grow very slowly. The nerves from the patient's spine have to grow into the patient's new legs, and the progression will be typically just 1 inch (25 mm) a month. Touch sensation and motor control are likely to be reestablished from the tops of the legs down.

Meanwhile, it is critical for the patient to be treated with anti-rejection drugs, so his immune system does not destroy the legs as foreign tissue.

Will the procedure work? We simply don't know yet. Are real legs preferable to artificial limbs? If nerves regenerate, muscles work, and transplant rejection can be held at bay, there is no doubt they would be.

  • de Lago, M. World's first double leg transplantation is carried out in Spain. BMJ. 2011 Jul 18
  • 343:d4541. doi: 10.1136/bmj.d4541.