A hand transplant is a surgical procedure in which the hand from one person is attached to the forearm of another person. It differs from a hand reattachment or “replant,” in which a person’s own hand is reattached after having been severed. The first hand transplant was performed in 1964 in Ecuador, but after only two weeks, the hand was rejected by the patient’s body. The first such operation performed in the United States took place in January 1999, and by 2009, 40 hands had been transplanted onto 32 patients worldwide. The first double hand transplant in the United States took place in May, 2009.
A hand transplant is different from an organ transplant. In an organ transplant, the focus is on one type of tissue. In a hand transplant, a variety of tissue types, including blood vessels, bone, cartilage, fat, muscle, nerves, skin, and tendons must be connected. This leads to the name composite tissue allotransplantation.
This type of transplant depends on matching a suitable patient with a suitable donor. A suitable patient is usually between the ages of 18 and 65 and has lost his or her arm at a point below the elbow. The patient must also be in good enough health to endure the surgical procedure. In addition, the patient must understand the risks and benefits of the procedure and be psychologically prepared for the experience and aftermath of the hand transplant.
The risks involved include the need to be on immunosuppressant drug therapy and to avoid risks of infection, which may seriously limit activities. In addition, the patient must come to terms with having lost his or her own hand, as well as having a body part from a person who has passed away and the self-image issues that may arise with both of those factors.
Donor selection criteria are stringent. Donor family consent to organ donation is required, and total, irreversible brain damage is as well. Matching between donor and patient is done for a variety of factors, some of which are mandatory — such as size and blood type — other important health factors — such as viral status — and factors that are more a matter of personal preference, such as age, gender, race, and skin tone.
The hand transplant operation generally takes from 12 to 16 hours, and moves in a standard progression from bones to tendons, to arteries, to nerves, to veins. The complications that are typical include blood supply blockage, rejection, and infection.