Candidates Screened For Hand Transplant U.s. Team Looks To Follow The French Lead. Others Here Have Concerns.

Sometime later this year a U.S. patient will likely get a hand - literally - from another human being.

Doctors in Louisville, Ky., are screening patients to find the best candidates for this pioneering hand-transplant surgery.

Last week surgeons in France announced they had already reached that milestone, attaching a hand and forearm from a cadaver onto a man who had lost his hand in an accident.

``The potential benefit, and what we hope for, is a profound improvement in a severe disability,'' said Gordon R. Tobin, chairman of the division of plastic surgery at the University of Louisville Medical School, where the U.S. hand transplant is being organized. ``Imagine being without two hands, what the difficulty is in putting on clothes, feeding yourself and all the fundamental daily activities.''

So far, about 100 patients have undergone extensive screening by the Louisville team - which also involves the Jewish Hospital in Louisville - and a number of them will be accepted as potential candidates for a hand transplant.

The candidates likely will be adults who lost both hands and part of their arms. They will have used artificial limbs.

And they will have passed hours of grilling by doctors to make sure they have the mental makeup to cope following the unusual transplant operation.

``They have to be well-motivated,'' Tobin said. ``They have to be psychologically structured so they are at low risk to experience psychological trauma when they are looking at a hand that is originally not theirs.''

The French team last week transplanted a hand and forearm onto a 48-year-old Australian businessman. His doctors gave the operation a 50 percent chance for success.

The pioneering work in France and soon to be in Louisville is viewed uneasily by other doctors who appreciate its revolutionary potential but are dubious about the tradeoffs it poses to patients. Their concern centers on drugs patients will have to take indefinitely to prevent the new hand from being rejected by their body. Because the drugs suppress the immune system, they leave patients vulnerable to diseases and infection.

While the side effects of the drugs are considered acceptable for patients receiving a vital organ such as a heart or lung, doctors are uncomfortable with the same risks for an elective transplant. After all, they say, a patient can survive without a hand, but not without a heart.