History and ethics of hand transplants

Abstract

Hand transplantation is a form of composite tissue allotransplantation, whereby the hand of a cadaveric donor is transferred to the forearm of an amputee. The aim of such a procedure is to achieve better outcomes in terms of functionality and appearance when compared with prosthetics. The microsurgical techniques required have been well established for many years. In addition, advances in immunosuppressive therapy have meant that hand transplantation is a feasible therapeutic option. However this is not a life-saving procedure, requiring lifelong antirejection treatment with potentially serious side-effects. Hand transplantation is therefore a controversial concept with ethical, financial and psychological implications that need careful consideration. Before this treatment can be fully accepted, further research is still required; this should be directed towards achieving immunological tolerance, while minimizing costs and potential side-effects of post-transplant therapy.

Facial transplantation: the first 9 years

“…85 Because of the complexity of the procedure, and the unknown risks and benefi ts, the most important decision is still the selection of the candidate. The best candidate is one who: fully understands the implications of potentially lifelong immunosuppression and its serious morbidities, including infections, cancer, graft loss, and death; is motivated, committed, and compliant with intense post-operative rehabilitation, psychological treatment, and immunosuppression protocols; and has a strong social support system that will help them to address the many challenges, including media exposure, body image adaptation, and societal reintegration.…”

“…The best candidate is one who: fully understands the implications of potentially lifelong immunosuppression and its serious morbidities, including infections, cancer, graft loss, and death; is motivated, committed, and compliant with intense post-operative rehabilitation, psychological treatment, and immunosuppression protocols; and has a strong social support system that will help them to address the many challenges, including media exposure, body image adaptation, and societal reintegration. 1,10,25,66,85 Because face transplantation is not life-saving, it has been criticised for exposing otherwise healthy people to the risks of immunosuppression.…”

Symbrachydactyly

“…There are many risks to this operation, including the long-term need for immunosuppressive medication; in addition, psychological counseling is imperative beforehand. 14,37,54 These challenges, along with the uncertainty of growth potential, contraindicate this operation in children with unilateral hand conditions. Tissue engineering has the potential to address the challenge of limited tissue availability for reconstructing the congenitally malformed hand.…”

Uterus transplantation: ethical and regulatory challenges

“…The cost of the hand transplant compared with that of a prosthesis in terms of quality of life years (which is greater in prosthetics given the complications of immunosuppressive therapy) makes hand transplant difficult to justify in a national healthcare system such as the UK's. Prosthetics, however, may not offer the same technical manoeuvrability and cosmetic appearance as a hand transplant 23. It is ultimately the patient who has the right to choose between these two alternatives knowing the risks and benefits in a free-market healthcare system such as ours in the USA.…”