Sleight of hand

Clint Hallam is on the run. The 49-year-old New Zealander, sought by Australian police over his role in an alleged £400,000 fuel scam, has gone to ground, taking with him one of the most valuable surgical relics of the late 20th century: his right hand.

If you come across him in a bar somewhere in the world, shake that hand. Is it cold? Stiff? Withered, perhaps - even beginning to rot? Well, it wasn't always his. It was sewn on to his forearm in a 13-hour operation in Lyon on September 23 1998, the first successful hand transplant operation.

It is said that the hand is in danger of going bad. But the source of this rumour - Hallam himself - is not necessarily reliable. Doctors involved in the case say that last month, before Hallam skipped his adoptive home of Australia, the hand was tested in hospital and was given the all-clear. Press reports that his body was rejecting the hand, the doctors say, had been spread by Hallam in the hope of teeing up lucrative media interest in the US.

It sounds like a typical bluff by a chancer who has spent years playing surgeons, fraud squads and journalists off against each other. But this bluff could turn sour. If Hallam isn't careful, if he doesn't take his medicine, he might set another record. He might be the first man ever to have his right hand amputated three times.

There was joy among surgeons in France two years ago at their achievement. The donor, a motorcyclist whose brain was irreparably damaged in a road accident, had his arm cut off, chilled and whisked to the Edouard-Herriot hospital in Lyon. On the operating table Hallam, who had lost his hand in a sawmill accident 14 years earlier, had the new limb connected up - first bones, then arteries and veins, then tendons and muscles, then nerves, then skin.

"He is in excellent shape," Dr Jean-Michel Dubernard, the French doctor who co-led the international team of surgeons, told journalists the following day. "The grafted hand is warm and has taken on colour."

Hallam was certainly in fighting form. But his mercurial character has since proved too much for the world of medicine, which prefers its guinea pigs to be unremarkable innocents, obedient to their doctors' commands and opening their mouths in public only to show a little dignified gratitude. It wasn't long before the surgical team began to regret choosing this charming, gentle man as their hand transplant pioneer. For Hallam suffers from another serious condition: he lies. This guinea pig turned round and bit science on the nose.

If only, says Professor Nadey Hakim, a British surgeon who took part in the operation, they had picked a patient like the explosives worker who received two new arms at the Edouard-Herriot hospital earlier this year. "He's a decent man," says Hakim, who was part of that transplant team too. "He stays in. He listens to his doctors' advice. He takes his medicine."

Not so Hallam. Last time Hakim spoke to him it was by phone. Hallam was calling from Las Vegas. Hakim begged him to look after the hand, to take his medication, to travel - as he was supposed to - to a university in Chicago that had promised to pay him in exchange for being able to perform experiments on him.

"He said, 'Yeah, yeah, I'm in charge of my arm,'" says Hakim. "What does he mean? I don't know. It wasn't the ideal choice of patient. But who is ideal? No one's perfect. But ideally it would have been better not to have an ex-convict."

The surgeons didn't know Hallam had done time when they put him forward for a new hand. When details of his past emerged, the Australian microsurgeon who brought him to France, Professor Earl Owen, said: "I mean this in the nicest way, but he is a liar of extraordinary talent."

Hallam had been telling the truth when he said his hand had been severed in 1984. But it was not, as he claimed, an accident on a building site. The mishap with a circular saw had occurred in Rolleston, a New Zealand prison where Hallam had been serving a two-and-a-half-year sentence for fraud.

His severed hand was sewn back on after the accident but it never took, and five years later he decided to have it amputated, to clear the site for a new and better human hand.

Lying in his hospital bed in Lyon shortly after the 1998 operation, familiarising himself with his new hand by stroking it with his old one, he told a French journalist that he had long been obsessed with the idea of a transplant.

"For years, I had just one fixed idea: I'm going to get a transplant, I'm going to get a transplant. And I was prepared to go to the ends of the earth to meet the medical team capable of giving me my hand," he said. "I did tons of research and then I wrote, faxed, phoned a whole lot of doctors."

One of those doctors was Owen, a tirelessly self-promoting wizard of knife and needle who had been sewing on severed limbs and fingers since 1970 and who shared Hallam's burning desire to see the first hand transplant happen.

Owen, now in his 60s, helped forge the modern assumption that if a part of you gets chopped off, you take it to the hospital with you and they'll sew it back on. Often they can, but it is an exceptionally tricky operation. One of the hardest parts is rejoining the nerves, which are no thicker than hairs and have to be fixed under a microscope.

Without the nerves, the limb is merely a paralysed appendage. With them, remarkable recoveries can take place. One of Owen's patients, who had his hand twisted off in a lathe, has gone back to his old job as a garage mechanic. Another, now working again as a carpenter, lost his hand in a concrete mixer. The hand had to be extracted from a solidified block of concrete.

In all these cases, the accidental amputee had one critical advantage. Their own hand was being restored, not someone else's. Microsurgeons held back from the next stage - transplanting a donor hand on to a host stump - for decades, knowing that the body's immune system would attempt to reject the alien hand.

In the 1990s came a breakthrough - a new suite of immunosuppressant drugs strong enough to restrain the human immune system without killing the patient. Owen and Hakim were ready to go ahead, and in Hallam they thought they had found the perfect patient - strong, determined and cheerful.

The transplant was to have taken place at Hakim's London base, St Mary's. But the various committees who have to give permission for experimental surgery were sceptical, and the venue was switched to Lyon.

The risks were high. The only thing donor hand and host arm had in common was blood type. The immunosuppressant drugs would make Hallam more vulnerable to infection, and could give him diabetes (in fact, it did.) But Hallam knew the risks, and still wanted the hand. So they gave it to him.

Medically, the surgeons and the patient were delighted with the results. Hallam has recovered sensation in the hand and been able to flex his new fingers to the point where he can grip and raise a beer glass and even write with a fattened pen. But legally, it was not looking so good.

The team of doctors that had lauded Hallam's "courage and determination" learned of his fraud conviction and prison sentence in New Zealand, where he is still barred from doing business. They learned that a last-minute panic before Hallam Australia for Lyon - when he claimed to have forgotten to renew his pass port and made a frantic appeal for emergency travel documents - was in fact due to his having surrendered his passport to an Australian court during investigations into his alleged involvement in a fuel racket.

When Hallam - now a man with two different sets of fingerprints - returned to France for medical tests last October, he was seized by police at his hotel in Lyon over a separate allegation, that he had walked off with £20,000 from a French liver transplant patient, Thierry Decottignies, who befriended and helped him while he was in hospital.

Decottignies said the New Zealander had gone on a spending spree with his American Express card. Hallam paid back some of the money and was eventually able to leave France. But he was still being pursued by police in Australia over the alleged fraud, which involved bogus cards for buying fuel. Last month, just a few days before New South Wales police put out warrants for his arrest, he fled the country, leaving his second wife and four children behind. Hallam is still wanted in New Zealand, too, over outstanding financial mysteries.

A criminal past is no bar to being a medical pioneer. What frustrates Owen, Hakim, Dubernard and the other doctors involved is their patient's unpredictability, the mystery of his whereabouts and his conviction that he knows what is best for his hand. He could be in Chicago. He could be in Las Vegas. He could be anywhere. All that reaches the medics is the occasional phone call, the occasional email.

He is supposed to have regular checkups and take a cocktail of three immunosuppressant drugs a day. But does he? Only when he feels like it.

The original plan was for Hallam to rest in France under medical supervision before returning to Australia. Instead, he flew to the US a few weeks after his operation and did the rounds of chat shows. Later, he spent time in London. He didn't return to Australia until March last year.

Owen tries to emphasise the bright side. There have now been six hand and arm transplants in total, including the double arm transplant. Two have taken place in China, one in the US and one in Austria. According to Owen, Hallam's rootlessness doesn't seem to have led to serious degradation of the donor hand.

"Clint Hallam has taken trips away from his doctors for up to three months at a time; he left last month on a trip without us being 100% sure where he is. And yet 20 months since his transplant, without regular sessions with a physiotherapist, he has a grip which allows him to hold door knobs and to learn to ride a motorcycle. It all shows that hand transplants are here to stay," says Owen.

"It's quite true we didn't know he was the character he was before the operation. We have found out a lot about him since.

"He's an absolutely charming chap. He's clever enough to have fooled a great many people in his many careers. However, it would be a good idea for him to perhaps contact me - as he has often promised to do - on a weekly basis. Otherwise he has voluntarily left the support and care of his concerned surgical team."

The Lyon team has come under fierce attack from specialists around the world for ever having carried out such an operation. They say that given the burden on the patients of having to take a lifetime of potentially harmful drugs, the costly, unproven technique of transplanting limbs should not be put on the same level as kidney or heart transplants, which can give desperately ill people a new lease of life.

Owen's answer to his critics is the drawers in his desk in Sydney, bulging with appeals from the handless, armless and legless to be included on the transplant list. "It's hard enough in this world to survive and have a good, useful life if you're perfectly fit. It's desperately difficult if you have a major physical deformity or loss," he says.

Hallam did not reply to the Guardian's email request for an interview. But in the past he has never failed to show gratitude and pride in his new hand. "I can button my shirt and do the washing-up," he said a year after the operation. "Most of all, I can hold both my children's hands at the same time."