Attitudes of Hand Surgeons and Hand Reconstruction Patients Toward Hand Allotransplantation in Taiwan

Abstract

Background Recent advances in immunosuppressive protocols have increasingly made hand allotransplantation a realistic reconstructive option with more than 100 cases performed worldwide. While attitudes toward allotransplantation have been assessed for North American surgeons and patients alike, similar assessments have previously remained unconducted in Asia in general and Taiwan in specific. This study examines the perceptions of both Taiwanese hand surgeons and hand reconstruction patients. Methods An email-based survey was sent to all active members of the Taiwanese Society for Surgery of the Hand. Surgeon training backgrounds and practice profiles were gathered as well as current beliefs on indications, risks, ethicality, priority of psychosocial issues, and obstacles to implementation. Patients receiving rehabilitation at Chang Gung Memorial Hospital Linkou after severe upper extremity injuries were invited to complete a patient survey. Demographics, injury characteristics, understanding of allotransplantation and immunosuppression, willingness to donate, and willingness to receive transplantation were assessed. Results Forty-four hand surgeons responded (24.3% response rate). The majority (61.4%) considered hand allotransplantation to be a high-risk operation, although 40% supported the development of hand allotransplantation under current techniques and immunosuppression. Bilateral hands loss was the most commonly accepted indication for transplant (90.9%), whereas dominant hand loss was less frequently accepted (43.2%). Treatment compliance and functional outcomes were the most frequent psychosocial issues of concern regarding patient counseling. Patient respondents were mostly in the fifth decade of life (29.5%) with at least a high school education (75.0%). Most were aware of the feasibility of hand transplantation (68.2%). Patients were more likely than surgeons to consider nondominant hand, multiple-digit, and thumb-only amputations as indications for transplantation. Functional outcomes and financial considerations were the most frequent patient concerns. Conclusions This study indicates there is support for hand allotransplantation as a solution for limb loss in both hand surgeons and hand patients in Taiwan. This study adds to the lack of knowledge regarding surgeon and patient attitudes toward allotransplantation in Asia, although further work is required to assess the willingness of broader Taiwanese medical to refer candidates and for the general population to donate.

Vascularized Composite Allotransplantation of the Hand

“…The field of HT is exceptionally dynamic and scientific advancement will inevitably drive changes in eligibility criteria, one past example is the age of eligibility. Historically, most centers placed strict age Akdeniz University Hospital 15,16 Antalya, Turkey 2021 Amrita Institute of Medical Sciences 17,18 Kochi, India 2017 Boston Children's Hospital 19 Boston, MA 2022 Brigham and Women's Hospital [20][21][22][23][24][25][26][27] Boston, United States 2011-2022 Chang Gung Memorial Hospital [28][29][30][31] Children's Hospital of Philadelphia 5,[32][33][34][35][36] Taipei, Taiwan Philadelphia, PA 2016-2020 2016-2022 Clinica Cavadas [37][38][39][40][41] Valencia, Spain 2009, 2011 Duke University [42][43][44][45][46][47][48][49] Durham, USA 2011, 2018, 2021, 2022 Emory University 50,51 Atlanta, United States 2015 Hacettepe University 52 Ankara, Turkey 2014 Harbin Medical University 53 Harbin, China 2016 Hôpital Edouard Herriot 9,[54][55]…”

Applying Health Utility Outcome Measures and Quality-Adjusted Life-Years to Compare Hand Allotransplantation and Myoelectric Prostheses for Upper Extremity Amputations

“…These findings are comparable to previously reported data from Taiwan whereby 66 percent of patients with replantation procedures considered bilateral amputation to be an indication for hand transplantation as opposed to 27 percent for unilateral nondominant hand amputation. 34…”

“…These findings are comparable to previously reported data from Taiwan whereby 66 percent of patients with replantation procedures considered bilateral amputation to be an indication for hand transplantation as opposed to 27 percent for unilateral nondominant hand amputation. 34 Because health utility outcome measures are dependent on certain assumptions and scenarios, some limitations of this study need to be addressed. First, none of the patients with unilateral or bilateral amputations have been offered the possibility of undergoing a hand transplantation in our province, whereas some have been exposed to some degree to upper extremity prostheses (mostly body-powered) as part of their rehabilitation program.…”

Evaluating Treatment Preferences and Perceptions of a Prosthetic Versus a Transplanted Hand

“…As the decision to undergo a hand transplant carries a significant psychological burden, medical advancements should be paralleled by studies that delineate treatment preferences to provide high-quality patient-centered care 40–43 . Previous studies have found that only 15% to 40% of surgeons support performing a hand transplant with currently available immunosuppression regimens 40,41 .…”

“…As the decision to undergo a hand transplant carries a significant psychological burden, medical advancements should be paralleled by studies that delineate treatment preferences to provide high-quality patient-centered care. [40][41][42][43] Previous studies have found that only 15% to 40% of surgeons support performing a hand transplant with currently available immunosuppression regimens. 40,41 However, as vascularized composite tissue allotransplantations transforms into a clinical reality, 44,45 few studies have attempted to clarify treatment preferences when weighing the risk-benefit ratio of a prosthetic or transplanted hand.…”