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Notable Moments in Limb and Face Transplant History

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In 2008, surgeons completed two procedures that could forever change transplant surgery. In August, doctors in Munich announced that a farmer was recovering from a double-arm transplant—the first double-arm transplant in the world. In December, the Cleveland Clinic announced they'd replaced about 80 percent of a woman's face. Many surgeons think that arm, hand, and face replacements are the next logical steps in transplants. Is the world ready?

Being first isn't always best

In 1964, physicians around the world were attempting transplants of all kinds when doctors in Ecuador performed the first hand transplant. Unfortunately, like early organ transplants, it didn't work—within two weeks the hand was rejected and doctors had to remove it.

Being second isn't much better

In 1998, doctors performed delicate microsurgery on New Zealander Clint Hallam. For 13 hours at Edouard Herriot Hospital, an international team of scientists led by French surgeon Jean Michel Dubernard stitched a cadaver's forearm and hand to Hallam's upper arm. Completing the hand transplant required microsurgery skills and patience—doctors knitted medial nerve to medial nerve, radial artery to radial artery, radius to radius. Like with other transplants, both donor and recipient must share the same blood type.

After years of studying transplant pioneers and earning a PhD based in xenographs research (he transplanted organs from one species of monkeys to another), Dubernard felt he was prepared to perform a hand transplant on a human. When he was unable to find a suitable French candidate, an Australian colleague recommended Hallam. Fourteen years earlier, Hallam had lost his forearm in a circular saw accident. It was later revealed the accident actually occurred in jail and that Hallam was a longtime con-man.

hands.jpgCritics claimed that Dubernard performed the surgery for the media attention, but the surgeon argued he and his staff did a thorough psychological evaluation of Hallam as well as a background check. (Unsurprisingly, Dubernard had a role in the first partial face transplant, also surrounded by controversy.)


At first, the forearm and hand worked well for Hallam, although he hated that the donor limb was larger than his other arm and a different skin tone. He hid his freak arm as much as he could. Hallam's arm wasn't just grotesque-looking, though; it began itching and flaking, and he was plagued daily by pins and needles. He begged the doctors to remove it, but they refused. Hallam felt emotionally detached from his hand. Finally, a group of British surgeons agreed to remove the limb in 2001. The physicians from France claimed the only reason Hallam's arm rejected is because he failed to take his immunosuppressant drugs and exercise it.

From hands to a face

Frenchwoman Isabella Dinore received the first partial face transplant in 2005.

After taking too many sleeping pills, Dinore had passed out. As she lay unconscious on the floor, her black Lab chewed off her nose, mouth, and lower face. Without lips, muscles, and skin on the bottom half of her jaw, Dinore struggled to speak and eat—she had to eat through a tube. Physicians couldn't help her with traditional plastic surgery and thus felt she would be a good candidate for a face transplant.

Bernard Devauchelle, a French maxillofacial surgeon at Lyon University, saw a picture of a brain-dead woman with a mouth, nose, and lips similar to Dinore's features. He removed a triangle of Maryline St. Aubert's skin with its arteries, nerves, and veins and spent hours graphing the skin onto Dinore's face.

Dinore.jpgIt was rumored St. Aubert was brain-dead because she tried to kill herself. Many people thought Dinore had attempted suicide, too. Dubernard, who had worked alongside Devauchelle in the surgery, argued Dinore accidentally overdosed. Physicians criticized the decision to give a suicidal woman a face transplant. People once again alleged Dubernard had performed the surgery for media attention—Corbis had an exclusive deal for photos—and some urged an ethics investigation.

Dubernard oversaw Dinore's recovery. Shortly after the surgery, he injected some of St. Aubert's stem cells (from her bone marrow) into Dinore in the hopes her body wouldn't reject the transplant, but the stem cell infusion failed. Dinore suffered two bouts of rejection, contracted herpes and a pox virus, and struggled with kidney failure.

A year later, Dinore appeared in the media, showing off her new face. She used her new lips to smoke again.

Full-face transplant

Coler.jpgLaurent Lantieri, head of plastic surgery at Henri-Mondor Hospital in France, spent 16 hours stitching new lips, cheeks, nose, and mouth to Pascal Coler's face. Since Coler was six years old, large masses had been growing on his nerves because of a condition called neurofibromatosis. As the masses increased in size, Coler's face became less recognizable. Strangers pointed at him because of his misshapen visage.


The large masses compressed the nerves, arteries, and fat in Coler's face, causing lasting damage; the transplanted cadaver's face stops the masses from developing. Lantieri didn't alter Coler's bone structure, so Coler looks as he would if he never had the disease.

What the doctors say

When a patient receives a lung or a liver, the body's white blood cells attack the new organ because the body believes it is an invader. That's why immunosuppressant drugs are so important for transplant patients: immunosuppressants mollify the immune system. When a transplant includes so many different tissues, organs, veins, arteries, nerves, fat, and bones, the body targets the limb even more ferociously than it attacks one organ—the white blood cells believe the more transplanted tissue means there are more invaders.

In 2007, a study was published with the results of 18 transplants of 24 hands/digits/forearms. (11 folks received one hand, four received two hands, two received two forearms, and one received one thumb.) The good news: limb transplantation has a 100 percent survival rate. (In the early days of organ transplantation, most patients died.) And graph survival is also 100 percent for the first two years. The bad news: 12 patients suffered acute rejection and six Chinese recipients had their hands removed. All patients had enough nerve function in their new limbs that they knew when they were hurt, but few used fine motor skills or had sophisticated nerve function.

Some experts wonder if limb transplants should be conducted when prosthetic limbs are available. Fifteen people in the 2007 study said the limbs improved their quality of life, but many suffer with lingering problems from the immunosuppressant drugs, kidney failure, diabetes, and infections.

One thing is certain, though: Dubernard won't be performing any more limb transplants. He reached the maximum age to practice medicine in France.

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AMNH // R. Mickens
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science
What It’s Like to Write an Opera About Dinosaurs
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AMNH // R. Mickens

There are many challenges that face those writing the lyrics to operas, but figuring out what can rhyme with dinosaur names isn’t often one of them. But wrangling multisyllabic, Latin- and Greek-derived names of prehistoric creatures into verse was an integral part of Eric Einhorn’s job as the librettist behind Rhoda and the Fossil Hunt, a new, family-friendly opera currently running at the American Museum of Natural History in New York City.

Created by On Site Opera, which puts on operas in unusual places (like Madame Tussauds Wax Museum) across New York City, in conjunction with the Lyric Opera of Chicago and the Pittsburgh Opera, Rhoda and the Fossil Hunt follows the true story of Rhoda Knight and her grandfather, the famous paleoartist Charles R. Knight.

Knight worked as a freelance artist for the American Museum of Natural History from 1896 until his death in 1953, creating images of extinct species that paved the way for how we imagine dinosaurs even now. He studied with taxidermists and paleontology experts and was one of the first to paint dinosaurs as flesh-and-blood creatures in natural habitats rather than fantastical monsters, studying their bones and creating sculptural models to make his renderings as accurate as contemporary science made possible.

In the 20-minute opera, singers move around the museum’s Hall of Saurischian Dinosaurs, performing among skeletons and even some paintings by Knight himself. Einhorn, who also serves as the director of On Site Opera and stage director for the opera, wrote the libretto based on stories about the real-life Rhoda—who now goes by Rhoda Knight Kalt—whom he met with frequently during the development process.

Soprano Jennifer Zetland (Rhoda) sings in front of a dinosaur skeleton at the American Museum of Natural History.
AMNH // R. Mickens

“I spent a lot of time with Rhoda just talking about her childhood,” he tells Mental Floss, gathering anecdotes that could be worked into the opera. “She tells this great story of being in the museum when they were unpacking the wooly mammoth,” he says. "And she was just there, because her grandfather was there. It's being at the foot of greatness and not even realizing it until later.”

But there was one aspect of Rhoda’s childhood that proved to be a challenge in terms of turning her story into a performance. “Unfortunately, she was a really well-behaved kid,” Einhorn says. “And that doesn't really make for a good opera.”

Knight Kalt, who attended the opera’s dress rehearsal, explains that she knew at the time that if she misbehaved, she wouldn’t be allowed back. “I knew that the only way I could be with my grandfather was if I was very quiet,” she says. “Sometimes he would stand for an hour and a half discussing a fossil bone and how he could bring that alive … if I had interrupted then I couldn't meet him [at the museum anymore].”

Though Knight Kalt was never an artist herself, in the fictionalized version of her childhood (which takes place when Rhoda is 8), she looks around the museum for the missing bones of the dinosaur Deinocheirus so that her grandfather can draw them. The Late Cretaceous dino, first discovered in 1965, almost didn't make it into the show, though. In the first draft of the libretto, the dinosaur Rhoda is searching for in the museum was a relatively new dinosaur species found in China and first unveiled in 2015—zhenyuanlong suni—but the five-syllable name proved impossible to rhyme or sing.

Rhoda Knight Kalt stands next to the head of a dinosaur.
Rhoda Knight Kalt
Shaunacy Ferro

But Einhorn wanted to feature a real dinosaur discovery in the opera. A paleontologist at the museum, Carl Mehling, suggested Deinocheirus. “There are two arms hanging right over there,” Einhorn says, gesturing across the Hall of Saurischian Dinosaurs, “and until [recently] the arms were the only things that had ever been discovered about Deinocheirus.” Tying the opera back to an actual specimen in the museum—one only a few feet away from where the opera would be staged—opened up a whole new set of possibilities, both lyrically and otherwise. “Once we ironed that out, we knew we had good science and better rhyming words.”

As for Knight Kalt, she says the experience of watching her childhood unfold in operatic form was a little weird. “The whole story makes me laugh,” she says. But it was also a perfectly appropriate way to honor her grandfather. “He used to sing while he was painting,” she says. “He loved the opera.”

Performances of Rhoda and the Fossil Hunt will be performed at the American Museum of Natural History on Fridays, Saturdays, and Sundays until October 15. Performances are free with museum admission, but require a reservation. The opera will later travel to the Lyric Opera of Chicago and the Pittsburgh Opera.

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iStock
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Animals
11 Buoyant Facts About Humpback Whales
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iStock

Humpback whales are some of the most intelligent animals on the planet. Hunted almost to extinction during the 19th and early 20th centuries, their populations are slowly recovering, and now they’re a favorite sight for whale-watchers. Here are 11 facts you might not have known about the mysterious marine giants, who are known for their acrobatics and for sidling right up alongside boats to get a good look at their human observers.

1. THEY’RE LONGER THAN A SCHOOL BUS.

North American school buses max out at about 45 feet long. Female humpback whales—which are larger than males—can be up to 60 feet long, and their pectoral fins alone can be 15 feet long. At birth, humpbacks weigh around 1 ton, doubling in size during their first year of life and eventually reaching up to 40 tons.

2. THEY HAVE HUGE MOUTHS.

In keeping with the rest of their bodies, their mouths are huge—their tongue alone is the size of a small car. But the opening to their throat is only about the size of a grapefruit, according to the Hawaiian Islands Humpback Whale National Marine Sanctuary, so they can’t swallow large prey. Instead, they eat krill, small fish, and plankton. They can eat up to a ton of food per day, according to the 2015 documentary Humpback Whales.

3. THOSE BUMPS ARE HAIR FOLLICLES.

Each of the distinctive bumps along a humpback’s head holds a single hair that the whale uses to sense the environment around it. These hairs help the whale glean information about water temperature and quality.

4. THEIR FLUKES ARE LIKE FINGERPRINTS.

Like human fingerprints, humpback tails can be used to identify individuals. The pigmentation and scarring on their flukes is unique, and scientists document these markings to keep track of certain whales that they see repeatedly during their research trips.

5. THEY LIVE A LONG TIME, BUT NOT AS LONG AS MANY OTHER WHALES.

Most humpback whales make it into their 60s, but scientists estimate that they may live up to 80 years. Still, that’s nothing compared to bowhead whales, a species whose oldest known individuals have lived to be 200 years old.

6. THEY HAVE THE LONGEST MIGRATIONS OF ANY MAMMAL.

Each year, humpbacks migrate from their feeding grounds in cold waters toward warm breeding areas—Alaskan whales head to Hawaii, while Californian whales head to Mexico and Costa Rica, and Australian whales migrate to the Southern Ocean. These biannual journeys can involve distances of up to 5000 miles, which is officially the longest known migration of any mammal on earth.

The fastest documented migration of a humpback whale was observed in 1988, when a humpback traveled from Sitka, Alaska to to Hawaii in just 39 days—or possibly less, depending on how soon it left Alaskan waters after the researchers sighted it the first time [PDF]. That’s a journey of about 2750 miles point to point.

7. THEY HAVE BEEN KNOWN TO DEFEND OTHER SPECIES FROM ORCAS.

In 2009, marine ecologist Robert Pitman watched two humpback whales rescue a seal from a group of orcas that were pursuing it. The seal ended up on one of the humpbacks’ chests, and when it began to fall off, the whale even nudged it back on with a flipper, indicating that it was an intentional act of altruism. Though it’s not entirely clear why they would do so, it appears to be an offensive response on the part of the humpbacks, who may intervene whenever they hear killer whales fighting, whether one of their own is involved or not.

8. ONLY THE MALES SING.

Their songs may have made the species famous, but not every humpback sings. It’s strictly a male behavior, and plays an important part in courtship displays. There’s plenty of mystery that still surrounds the science of whale songs, but in 2013, researchers discovered that it’s a group activity that involves even sexually immature males. Both young and mature whales sing in chorus, giving the immature whales a lesson in singing and courtship behavior, and helping older whales amplify their songs to draw females to the area from afar. Other research has found that these songs change over times, and whales learn them much like a human learns a new song, bit by bit.

9. BREACHING IS LIKE YELLING

Though humpbacks are famous for their songs, that’s not the only way they communicate. Scientists only recently discovered that breaching—when whales jump up into the air, crashing back down into the water—is a way to keep in touch with far-away friends. Humpbacks leap higher and more often than other whales, and while spectacular to witness, the moves come at a cost: It takes a lot of energy, especially when the whales are fasting. But after 200 hours observing humpbacks migrating past the Australian coast, a team from the University of Queensland found that the whales were more likely to breach when the nearest group of other humpbacks was more than two and a half miles away, and that they were more likely to do so when it was windy out. It appears that breaching is a way to communicate over long distances when there is a lot of competing noise.

10. THEIR SONGS ARE INCREDIBLY COMPLEX …

Humpback songs aren’t just showy. They have their own grammar, and their songs are hierarchical, like sentences. In human language, this means that the meaning of sentences depends on the clauses within them and the words within them. In 2006, mathematical analysis found that humpbacks use phrases, too. And they remix their tunes, too, tweaking them and changing them over time, often combining new and old melodies. Humpback songs have even been visualized as sheet music.

11. … AND HELPED END WHALING.

Researchers estimate [PDF] that prior to the whaling boom of the 19th and 20th centuries, there were around 112,000 humpbacks in the North Atlantic alone, but that by the time commercial whaling was banned in the region in 1955, there were less than 1000 individuals left. Between 1947 and the 1970s, the USSR alone killed an estimated 338,000 humpbacks, falsifying data it was required to submit to the International Convention for the Regulation of Whaling to disguise the illegal magnitude of its hunting operation. It has been called “one of the greatest environmental crimes of the 20th century.”

While the populations have grown and humpbacks have been taken off the endangered species list, some estimates put the worldwide humpback population at only 40 percent of what it was before the whaling era. Whaling was banned throughout the rest of the world in 1966, though Norway, Iceland, and Japan still practice it.

Roger Payne, one of the scientists who first discovered that humpbacks sing songs, later became instrumental in pushing to protect the species in the 1960s. In 1970, he released his recording of humpback songs as a record, which remains the best-selling nature recording in history. In 1972, the songs were played at a Greenpeace meeting, and ended up galvanizing a new movement: Save the Whales. “It certainly was a huge factor in convincing us that the whales were an intelligent species here on planet Earth and actually made music, made art, created an aesthetic,” as former Greenpeace director Rex Weyler told NPR in 2014. The campaign gained traction with other organizations, too, and helped lead to the International Whaling Commission’s 1982 whaling ban.

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