Hand transplantation: can we balance the risks and benefits?

Abstract

Asking ‘can we balance the risks and benefits?’ implies that a quantification of both risk and benefit in hand transplantation (here the terms hand transplant and hand transplantation refer to allotransplantation of the human hand or hand and part or all of the upper limb or limbs) is possible. Despite all we have learned in recent years about hand transplantation, much remains unknown. Even if reliable methods for quantification of risk and benefit were available, fundamental issues relating to effective communication across the gulf of lived experience between the (presumably) handed surgeon and the handless patient remain. Inherent complexities mean some consider hand transplantation an unsolved problem, but we believe the medical and technical considerations fall within the ambit of a competent multidisciplinary team, and that psychosocial and ethical challenges are open to management through robust frameworks for assessment and decision making, underpinned by an extended period of assessment and dialogue, with candid acknowledgement where uncertainty remains. This respects the patient’s autonomy while addressing the need for a prolonged period of informing consent. Level of evidence: V

Reaching New Heights: A Comprehensive Study of Hand Transplantations in Korea after Institutionalization of Hand Transplantation Law

“…Psychologically and socially, hand/arm amputations can be more debilitating and limiting than any other disability, not to mention inconvenient in everyday life. 9 24 25 26 27 28 29 30 31 32 However, hand/arm transplantation has drawn little medical interest as there is an alternative (prosthetic limbs) and the procedure has often been underestimated or ignored, especially in the field of transplantation, since the hand is not a vital organ. 29 …”

“…To do this, the researchers had to make many preparations–including persuading the donor’s family, receiving permissions, preparing the institutions, and securing funds–within each country’s environment and institutions. 1 9 38 Hand transplantation was then institutionalized after proving its stability and effectiveness. Although the United States has performed many hand transplantations since 1999, VCAs were only added to the definition of organs covered by federal regulations in 2014.…”

“… 1 5 6 Hand transplantation can also improve psychological well-being and social relationships. 7 8 9 Restoring motor and sensory control of the transplanted hand is crucial to regaining function. Unlike other solid tissue transplantations, hand transplantation achieves this restoration by providing nerve connections.…”