From beginning to end, Clint Hallam's landmark hand transplant embarrassed nearly everyone involved.
The story began in September 1998 when Mr. Hallam, then 48, flew halfway around the world from his home in Perth, Australia, for the operation in Lyon, France. There, a team of microsurgeons from four countries spent 14 hours delicately connecting scores of nerves, tendons, muscles, arteries and veins from a dead Frenchman's forearm to give Mr. Hallam a new right hand.
The story ended on Feb. 2 in London. In 90 minutes, Dr. Nadey Hakim amputated the very hand that he had helped attach and that Mr. Hallam had sought so desperately but did not do enough to keep.
In a telephone interview on Sunday night after Dr. Hakim removed the stitches from the stump, Mr. Hallam said he felt the best he had in two and a half years. But he acknowledged that he was far from the perfect patient.
''I hold myself responsible for a good part in that I allowed this to happen,'' Mr. Hallam said.
A chief reason for losing the hand, he said, was that he did not live in the same city where he had the transplant and thus could not maintain the constant medical supervision that he needed and pledged to seek. He said he now lived in Las Vegas, worked on a limited basis for a New Zealand company that he declined to name and traveled widely.
Before receiving the donated hand, Mr. Hallam agreed to adhere to a regular schedule of physical therapy to train it, a regimen of drugs to prevent its rejection and to undergo tests to monitor nerve regeneration and hand function.
Doctors have successfully transplanted hearts, kidneys, livers, lungs and other tissues for many years. Yet the only reported hand transplant before Mr. Hallam's was in 1964 in Ecuador, and it failed because it took place before development of today's potent anti-rejection drugs.
Since Mr. Hallam's transplant, nine other people have received new hands in six countries, and all are reported to be doing well. Three patients have received left and right hands in double transplants. Doctors at Jewish Hospital in Louisville have given two patients new hands, the most recent on Feb. 17. The Lyon team performed its second transplant in January 2000. Three hand transplants have been performed in China and one each in Austria, Italy and Malaysia. Doctors hope hand transplants will become as standard as other organ transplants.
Mr. Hallam advised candidates for transplants, ''Go for it, don't lose that dream, and don't give up.''
Because any transplant depends on public appeals for organ and tissue donors, a recipient is obligated to aid such a procedure's success. But the obligation has to be balanced with a cardinal rule of human experimentation -- that a participant can withdraw from a trial at any time no matter how awkward it may be for the patient or the doctor.
Mr. Hallam reiterated in the interview what he wrote in a note at the request of his doctors explaining why he wanted the hand removed. He said he had taken his drugs only intermittently during the past year and none for the last 60 days.
''Therefore, I am fully responsible for the rejection of this hand, which was satisfactory before I stopped my drugs,'' Mr. Hallam wrote.
Reminded of his earlier desire to become a role model for people with lost limbs, Mr. Hallam said, ''that is probably the saddest part'' of the amputation.
''People have condemned me for not strictly sticking to the directions that the doctors had given me and not totally complying with the medication regimen that they had put me on,'' Mr. Hallam said. But, he said, ''In my own mind I believe that the transplant is not a failure and was not a failure.'' Further research may explain the rejection, he said.