Critics castigate surgical team that performed first hand transplant for "showmanship," lack of planning.

The international team of surgeons who performed the world's first successful hand transplant in Lyons, France last September have been criticized for carrying out the breakthrough procedure behind closed doors.

Robert Beasley, MD, director of New York University's hand surgery department, characterized the action as "a grossly unethical act of showmanship" and castigated the team for its apparent lack of planning. Mark Siegler, PhD, director of the MacLean Center for Clinical Medical Ethics at the University of Chicago, criticized the surgeons for avoiding prior public and professional review, saying that such review is vital because no regulatory agencies oversee new operations.

Arthur Caplan, PhD, director of the Center for Bioethics at the University of Pennsylvania, accused the team of acting "in a completely irresponsible way." Caplan said his main concern was that the surgeons provided no opportunity for public consideration of its plans, and that this could jeopardize support for organ donations.

Earl Owen, M.D. the Australian microsurgeon who led the international team, dismissed the criticism, noting that public discussion didn't precede such innovations as the first kidney or heart transplant and isn't necessary now. He suggested that the team at the University of Louisville, who had hoped to be the first to perform a hand transplant, discussed its protocol publicly in order to generate publicity for the surgeons and the institution.

Jerome Kassirer, MD, editor-in-chief of the New England Journal of Medicine, seemed to side with Owen, saying that while prior public, discussion "probably is worthwhile...I don't think it's necessarily essential." Kassirer said that the ethical concerns surrounding organ transplants have been thoroughly discussed and "our society is comfortable" with the transplant process. And he pointed out that most medical breakthroughs have been reached without prior public debate and simply announced afterward. "I don't see it as a totally egregious thing to do," he said. "Doctors are a competitive lot. They would very much like to be the first in any medium."

The American Society for Surgery of the Hand has called for a ban on hand transplants because the risks of the procedure outweigh the benefits.