In the spring of 1999, Jeff Kepner lay in a hospital bed and faced a living nightmare.

He had lost his hands and feet.

He says he was fortunate.

The rare, drug-resistant strep A infection that had shut down his organs and plunged him into a three-week coma narrowly missed killing him.

Doctors amputated his extremities in a bid to save his life.

Outfitted with prosthetic hands and feet, Kepner fought his way back.

He learned how to walk, dress himself and drive a car.

He adapted.

Now, he says, he's probably going to have to adjust again — to somebody else's hands.

The 57-year-old Lancaster native is poised to make history as the country's first double-hand transplant recipient.

The operation at the University of Pittsburgh Medical Center has yet to be scheduled.

Extensive testing has been performed on Kepner, said medical center spokeswoman Amy Dugas Rose. Doctors are completing their assessment.

Afterwards, a specialized donor must be found.

"This is their first crack at it," Kepner said. "It's going to be interesting."

If all goes well, Kepner will eventually ride an Angel Flight plane from his Augusta, Ga., home to the medical center.

A team of 11 surgeons will spend some 14 hours joining the new hands to Kepner's forearms. They'll use a groundbreaking strategy to trick his body into accepting the attachments.

And then the months of real work will begin.

Kepner might be able to wiggle his fingers in a few weeks. But how much function he gains, and how rapidly, is on him, he added. "It depends on how hard I work to get things going."

Relatives in Lancaster are closely following his progress.

"To think," said his aunt, Arline Rutt, "he's going to have real live hands."

An uncle, Fred Hiepler, said the personable, even-keeled Kepner is an excellent choice for the revolutionary procedure.

"He's a terrific guy," Hiepler said. "I couldn't think of a better candidate to go through this than a guy like Jeff."
Phantom hands
Only a few bilateral hand transplants have ever been performed.

The first operation took place in France in 2000, two years after the first single-hand transplant was conducted there.

Ironically, connecting nerve, muscle and bone is not the biggest challenge.

"That part's been figured out," Rose said. But science is still working on a better way to keep patients' immune systems from attacking grafts.

Previously, doctors relied on a three-drug cocktail of anti-rejection medication that increases the risk of such disorders as diabetes and hypertension.

"The drugs work but they are known to be pretty toxic," Rose said.

And so Dr. W.P. Andrew Lee, the head of the UPMC transplant team, is taking a new tack.

Under the two-phase "Pittsburgh Protocol" developed by Lee during 20 years of research, Rose said, the patient will receive antibodies to counteract the intitial barrage of immune system response.

Then, seven to 10 days after the surgery, he'll get a bone marrow infusion from the donor.

The bone marrow cells are expected to target specific cells that could reject the hands, according to the UPMC.

Rose said Lee's technique should reduce the need for harsh drugs and allow doctors to maintain low-grade immune system suppression with a single medication, tacrolimus.

The drug debuted more than 20 years ago as an immunosuppressant for liver transplant patients.

Kepner said he learned of the UPMC research after his wife, Valarie, read about it last year on the Internet.

"She called from work ... I thought 'what?' "

He said his immediate reaction was lukewarm, to his wife's chagrin.

His only previous impression of a double transplant involved a French man, who Kepner said suffered complications and eventually had his new hands amputated.

"I thought, 'I don't want to go through that,' " Kepner said.

But talking with Lee put the transplant idea in a more positive light.

Kepner said he was inspired to learn about a double-hand transplant recipient who has ridden his motorcycle around the world.

He has since corresponded online with the man, Theo Kelz, of Innsbruck, Austria. "I'd like to meet this guy," Kepner said.

Shortly before Thanksgiving, Kepner drove to UPMC for a battery of tests.

"They wanted to look me over," he said. "They wanted to see my arms. They took a lot of blood, 16 vials."

Kepner went back for more tests in December. He returned again two weeks ago to have white blood cells extracted and stockpiled, among other tasks.

"I'm a little overweight," Kepner said. Everything else checked out all right.

Because Kepner's case is part of a clinical study, he added, UPMC will pay for the operation and some of his out-of-pocket expenses.

Two other patients, a man and a woman, are candidates to receive single-hand transplants at the center.

All recipients will be expected to stay in Pittsburgh for three months of post-operative physical rehabilitation.

Kepner still feels "phantom" hands, he said.

"I can still wiggle my fingers. I can still make a fist. The brain thinks it's still there."

But his mind will have to be retrained.

"I'll have to just think about the [new] fingers moving" to help make it happen, he said. Doctors told him they'll use electrical shocks to stimulate the digits, he added.

"I said, 'Like Frankenstein?' "

"They said, 'Yeah, kinda.' "
Quiet guy
Kepner retired as a noncommissioned Air Force officer in 1990.

He married his second wife, a former Air Force officer, in 1992, and then followed her as she a pursued a career as a federal corrections officer.

"I'm still following her," said Kepner, who has lived in Augusta since 1998.

He has worked as a mortician's assistant, a bus driver and stay-at-home dad, he said, and he is employed periodically at Borders books.

He earned a degree in pastry arts from the Pennsylvania College of Technology in Williamsport but got sick before he could use his culinary skills.

Born and raised in Lancaster, Kepner attended McCaskey High School. He quit school during his senior year in 1970 and joined the military.

His parents, Ellsworth Kepner and Doris Schafer, and two brothers, James and Dan, still live here, as do many members of his extended family.

"Jeffy" Kepner is the youngest of three boys.

"He was always the more laid-back, quieter one, pleasant and happy, interested in sports," his mother said.

He played ball in the Lancaster Rec League and for the former Covenant United Brethren Church league.

He went on to become a star softball pitcher in the Air Force, competing on bases from Alaska to Germany.

He enjoyed golf and bowling, among other sports.

Losing his hands and feet was a giant blow that his energetic wife has helped him weather, Doris Schafer said.

Members of his church in Georgia, Burns United Methodist, have also rallied around him, his mother said.

Hundreds of people in the community have raised more than $2,700 for the Jeff and Valarie Kepner Hand Transplant Fund.

Kepner's own sense of purpose has sustained him from the start, his mother added.

Kepner walked on prosthetic limbs the first day he got them, she said.

The last time she visited him in Georgia, she recalled, he jokingly challenged an elderly church colleague to a race out the door.

"She giggled and laughed," Schafer said.

The hand transplant promises to vastly improve Kepner's quality of life.

But he's going to have to summon all of his good humor and determination to successfully adapt to the gift, his mother predicted.

"It is going to take all he's got ... I think he's looking forward to this and he's not, you know what I mean?"

Finding a donor is the first big hurdle, said Holly Bulvony, a spokewoman for the Center For Organ Recovery & Education, in Pittsburgh.

In addition to the usual clinical standards for matching blood and tissue types, she said, the donor hands will have to meet cosmetic criteria, such as size and skin color.

CORE donor families have yet to be contacted about the project, Bulvoniy said, but "I have every faith" that they will be generous.

"We're very excited about it. I think it's going to open new frontiers."

Amen, said Kepner.

He said he's looking forward to holding his 13-year-old daughter, Jordon, who was 3 when he became ill.

"She never really knew me other than without my hands and feet."