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BILATERAL HAND TRANSPLANTATION – INDICATION AND RATIONALE
INVITED COMMENT ON HAND TRANSPLANTATION
BILATERAL HAND TRANSPLANTATION – INDICATION AND RATIONALE the dosages of immunosuppressive agents are comparable to kidney transplants. We consider that hand transplantation for the loss of one hand is not an indication, since most patients get along fine with one healthy hand, and either a decorative or a functioning prosthesis. According to our criteria the demand for hand transplantation is definitely low. In Germany, we expect 2–5 patients per year to meet the criteria. We have screened ten patients in the last 9 months and none of them has matched our strict inclusion criteria. Our indications are concordant with a census among the representatives of the FESSH meeting in Barcelona in June 2000.
The first published hand transplantations have raised a fierce discussion about the rationale and ethics of such an operation. We have discussed this topic extensively in our team and have decided to pursue the concept of bilateral hand transplantation. We defined our indication and the patient profile as follows: 1. The patient should not be older than 45 years. 2. The loss of his/her hands should not date back more than 5 years. 3. All techniques of modern prosthetic supplementation should have failed, or have not been accepted by the patient. 4. The patient has to be psychologically stable and has to pass a series of psychological tests. 5. He has to be anatomically suited (preferably an amputation at the wrist level). 6. A video-taped informed consent is obtained on at least two occasions which covers all the potential immunological consequences.
Prof. Dr. G. Germann, Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Centre, Heidelberg, Germany
These indications are rather strict, but in cases of bilateral amputations we consider bilateral hand transplantation justified. The risk of secondary malignancies is comparable to kidney transplantations. From the data available so far,
# 2001 The British Society for Surgery of the Hand doi: 10.1054/jhsb.2001.0674, available online at http://www.idealibrary.com on
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BILATERAL HAND TRANSPLANTATION – INDICATION AND RATIONALE the dosages of immunosuppressive agents are comparable to kidney transplants. We consider that hand transplantation for the loss of one hand is not an indication, since most patients get along fine with one healthy hand, and either a decorative or a functioning prosthesis. According to our criteria the demand for hand transplantation is definitely low. In Germany, we expect 2–5 patients per year to meet the criteria. We have screened ten patients in the last 9 months and none of them has matched our strict inclusion criteria. Our indications are concordant with a census among the representatives of the FESSH meeting in Barcelona in June 2000.
The first published hand transplantations have raised a fierce discussion about the rationale and ethics of such an operation. We have discussed this topic extensively in our team and have decided to pursue the concept of bilateral hand transplantation. We defined our indication and the patient profile as follows: 1. The patient should not be older than 45 years. 2. The loss of his/her hands should not date back more than 5 years. 3. All techniques of modern prosthetic supplementation should have failed, or have not been accepted by the patient. 4. The patient has to be psychologically stable and has to pass a series of psychological tests. 5. He has to be anatomically suited (preferably an amputation at the wrist level). 6. A video-taped informed consent is obtained on at least two occasions which covers all the potential immunological consequences.
Prof. Dr. G. Germann, Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Centre, Heidelberg, Germany
These indications are rather strict, but in cases of bilateral amputations we consider bilateral hand transplantation justified. The risk of secondary malignancies is comparable to kidney transplantations. From the data available so far,
# 2001 The British Society for Surgery of the Hand doi: 10.1054/jhsb.2001.0674, available online at http://www.idealibrary.com on
521