Process of Obtaining Social Consensus and 3-Year Functional Outcomes of the First Hand Allotransplantation in Korea

Abstract

Background: On February 2, 2017, the surgical team of ten board-certified hand specialists of W Hospital in Korea successfully performed the nation's first hand transplantation at Yeungnam University Medical Center (YUMC). This paper reports on the legal, financial, and cultural hurdles that were overcome to open the way for hand transplantation and its functional outcomes at 36 months after the operation. Methods: W Hospital formed a memorandum of understanding with Daegu city and YUMC to comply with government regulations regarding hand transplantation. Campaigns were initiated in the media to increase public awareness and understanding. With the city's financial and legal support and the university's medical cooperation, a surgical team performed a left distal forearm hand transplantation from a brain-dead 48-year-old man to a 35-year-old left-handed man. Results: With this successful allotransplantation, the Korean Act on Organ Transplantation has now been amended to include hand transplantation. Korean national health insurance has also begun covering hand transplantation. Functional outcome at 36 months after the operation showed satisfactory progress in both motor and sensory functions. The disabilities of the arm, shoulder, and hand score were 23. The final Hand Transplantation Score was 90 points. Functional brain magnetic resonance imaging shows significant cortical reorganization of the corticospinal tract, and reinnervation of intrinsic muscle is observed. Conclusions: Hand transplantation at the distal forearm shows very satisfactory outcomes in functional, aesthetical, and psychological aspects. Legal and financial barriers against hand transplantation have long been the most burdensome issues. Despite this momentous success, there have been no other clinical applications of vascularized composite allotransplantation due to the limited acceptance by Korean doctors and people. Further public education campaigns for vascularized composite allotransplantation are needed to increase awareness and acceptance.

History and Recent Advances in Microsurgery

“…In South Korea, despite ethical and legal challenges, the first case of hand transplantation was performed in 2017 [59], followed by a second successful case in 2021 by the Severance Hospital team. However, controversy still exists regarding the practice of such transplantations for non-life-threatening reasons, considering the risk of side effects of lifelong immunosuppressive therapy.…”

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

“…The first hand transplantation was unofficially performed in Korea in 2017. 3 This operation achieved good results for the patient, improving public opinion of the procedure, and hand transplantation was finally included in the Organ Act in 2018. 4 With this amendment and the finalization of the Implementing Rules in 2019, hand transplantation was officially covered by the national insurance of Korea since 2019.…”

“…Hand procurement and transplantation in this study were performed similarly to many previous experiences. 3 7 18 19 There are varying opinions on the order of hand procurement within the organ procurement process. 42 However, in Korea, the law stipulates that hand procurement can be performed simultaneously with intraperitoneal organ procurement after an intrathoracic organ is procured.…”

“… 1 2 In Korea, the first hand transplantation was performed in 2017, though the procedure was not legally recognized until 2018. 3 4 Vascularized composite tissue allotransplantation (VCA), including hand transplantation, has been widely practiced in Europe and the United States; it began relatively late in Korea due to the different perception of death and disfigurement in the East 3 as well as the Korean healthcare system’s emphasis on safety over effectiveness.…”

Vascularized Composite Allograft Versus Prosthetic for Reconstruction After Facial and Hand Trauma

“…76 Overall, at 1-year follow-up, return of sensation and protective reflex sensation occurred in all grafted hands, which ultimately allowed the recipients to perform most activities of daily life. Woo et al 77 reported on the functional outcome at 36 months after the first hand allotransplantation in Korea in 2017 and showed satisfactory progress in both motor and sensory functions. These results correlated with functional brain magnetic resonance imaging showing significant cortical reorganization of the corticospinal tract, as well as reinnervation of intrinsic muscles.…”