When Jonathan Koch was rushed to a hospital, getting a hand transplant was the last thing his mind.

But within days, Koch became a leading candidate for a ground-breaking operation.

A Hollywood executive in top-notch shape, Koch’s sudden illness was a complete mystery to doctors at first. Koch was weak, freezing cold, and riddled with flu symptoms. Doctors pumped Koch full of IV fluids to keep him hydrated, but Koch was still parched and frequently asking for water.

As his organs began shutting down, the doctors stole blood from his limbs, leading to gangrene in his hands and feet. His white blood cell count fell. He went into septic shock.

Koch was dying, quickly. His doctor told him to contact his loved ones. All the while, they struggled to diagnose his illness.

Then a resident made the rounds into Koch’s room and finally figured it out: Koch had a rare immune disorder called hemophagocytic lymphohistiocytosis (HLH) that is usually triggered by a virus.

Once doctors had the diagnosis they were able to adequately treat Koch, and, after a month in the hospital, he recovered. But it was too late to stop the spread of necrosis in his limbs.

The Road To A Revolutionary Transplant

The first hand transplant with long-term success was performed almost 20 years ago and so far the operation has only been performed about 90 times worldwide. There are still limits to how well the new appendage functions once it’s in place.

But one of the doctors in the field, Kodi Azari, MD, had been waiting for the perfect patient to try a new approach to the procedure that he thought would help a transplanted hand have better range of motion and dexterity. 

Essentially, Azari, the surgical director of the UCLA Hand Transplant program, wanted to see what would happen if a hand amputation was performed in such a way that the limb was prepped for an eventual transplant. His plan was to carefully identify and label all of the nerves, veins, arteries, and tendons and then bundle them up neatly inside the limb before it was closed (until the transplant could be performed).

To pull off his new approach, however, Azari would have to find a transplant candidate who hadn’t had their appendage amputated yet. This was particularly challenging since most amputations happen after an accident or traumatic event and are performed in emergency conditions.

But Koch fit the bill.

After meeting Azari and agreeing to undergo the procedure, Koch had to first recover from several other operations, including the amputation of the fingers on his other hand and one of his legs. Once he was walking on his prosthetic leg and in better shape, the wait for a hand transplant began.

Several months later, Koch got the call that a suitable hand had been identified and Azari had his chance to finally try his procedure.

The Big Moment

Earlier this month, Koch’s story was featured on an episode of ABC’s 20/20, but he underwent the transplant last year.

The all-night operation wasn’t without its difficulties. Connecting Koch’s arteries and veins — which had withered due to the gangrene — was especially challenging. At times, newly attached arteries and veins would protrude and have to be sutured again so that they would be tighter. Throughout it all, Azari emphasized the need to attach the new hand in a way that would give Koch the best range of motion.

Finally, after nearly 18 hours, the new hand was in place.

It didn’t take long after Koch woke up and started rehab that the surgery was deemed a success.

According to a report in Los Angeles Magazine, Koch was squeezing a tennis ball within a week. After a few months he was tying his shoes. The recovery has been treacherous in many ways, but Koch has frequently exceeded Azari’s expectations.

For Azari and his team, pulling off the transplant has been exhilarating.

“When you see this dead, white hand, and then you see it start to swell up,” he told ABC, describing the operation. “It’s like a new life. It’s magical.”