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Hand transplantation

Hand transplantation, or simply a hand transplant, is a surgical procedure to transplant a hand from one human to another. The donor hand, usually from a brain-dead donor, is transplanted to a recipient amputee. Most hand transplants to date have been performed on below-elbow amputees, although above-elbow transplants are gaining popularity. Hand transplants were the first of a new category of transplants where multiple organs are transplanted as a single functional unit, now termed vascularized composite allotransplantation (VCA).

The operation is quite extensive and typically lasts from 8 to 12 hours. In comparison, a typical heart transplant operation lasts 6 to 8 hours. Surgeons usually connect the bones first, followed by tendons, arteries, nerves, veins, and skin.

Use of immunosuppressive drugs afterward[edit]

For a hand transplant to succeed the recipient is required to take immunosuppressive drugs,[1] as in other organ transplants such as kidney or liver, to minimize rejection, or risk destruction of the hand by the recipient's natural immune system. These drugs risk weakening the recipient's immune system, which may increase the risk of infections and some cancers. Many recent advances in solid organ transplantation have made these medications more tolerable.


A period of extensive hand therapy/rehabilitation after transplantation helps the recipient gain function of the transplanted hand.[2] Compliance with immunosuppressive medications and intensive physical therapy after hand transplants is associated with significant success in regaining the function of the new hands/arms.

Long-term functionality[edit]

The long-term functionality varies patient to patient and is affected by several factors including level of amputation and transplant and participation in occupational therapy post hand transplant surgery. Hand transplant recipient Jonathan Koch was able to pick up a napkin and a tennis ball with his newly transplanted hand 7 days after his 17-hour surgery and by day 9, he was able to pick up a bottle of water and take a drink. 3 months after surgery, Koch was able to use his transplanted hand to tie his shoe.[35]

Survival rates[edit]

Although the one-year survival rate of transplanted hands has been excellent at institutions that are fully committed to the procedure, the number of hand transplants performed after 2008 has been small due to drug-related side effects, uncertain long-term outcome, and the high costs of surgery, rehabilitation and immunosuppression.[36]

Programs[edit]

United States[edit]

The Johns Hopkins University School of Medicine Hand and Arm Transplant Program was approved by the Johns Hopkins Medicine Institutional Review Board in July 2011. This is one of only two programs in the United States approved to perform hand/arm transplants using an immunomodulatory protocol, which enables patients to take one drug (instead of three) after the transplant to maintain the hand or arm. The program is funded by the US Army Medical Research and Materiel Command (MRMC) Armed Forces Institute of Regenerative Medicine (AFIRM) to transplant up to six Wounded Warriors or civilians who have a hand or arm amputation on one or both sides.


The Southern Illinois University School of Medicine Hand Transplant Program is located in Springfield, Illinois. The program was officially launched in January 2014 after receiving IRB approval and grant funding to transplant five patients, unilateral or bilateral, at minimal cost to the patients.


The UCLA Hand Transplant Program, located in Los Angeles, California, was launched July 28, 2010. At the time, it was the only one on the West Coast and one of only four in the country.[37]

United Kingdom[edit]

In 2016, it was announced that NHS patients in England were to become some of the first in the world to benefit from publicly funded pioneering hand and upper arm transplants delivered by a specialist team at Leeds General Infirmary.[38]

Meniscus transplant

Heart transplant

Head transplant

Kidney transplant

Amirlak B, Gonzalez R, Gorantla V, Breidenbach WC, Tobin GR (April 2007). "Creating a hand transplant program". Clin Plast Surg. 34 (2): x, 279–289. :10.1016/j.cps.2007.01.002. PMID 17418677.

doi

Lanzetta M, Petruzzo P, Dubernard JM, et al. (July 2007). "Second report (1998–2006) of the International Registry of Hand and Composite Tissue Transplantation". Transpl Immunol. 18 (1): 1–6. :10.1016/j.trim.2007.03.002. PMID 17584595.

doi

Jones JW, Gruber SA, Barker JH, Breidenbach WC (August 2000). . N Engl J Med. 343 (7): 468–473. doi:10.1056/NEJM200008173430704. PMID 10950668.

"Successful hand transplantation. One-year follow-up. Louisville Hand Transplant Team"