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Mental Health Changes

How Can Your Mental Health Change After Hand/Arm Transplantation?

Mental health considerations during decision-making

  • It is important for people who experienced a traumatic upper limb loss injury to take time to process their experience with a mental/behavioral health professional prior to pursuing hand/arm transplantation and carefully consider the potential impact that the transplant may have on their mental health and lifestyle.1-7
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“I want to learn to crochet again. I want to be able to ride a bike again. It’s going to be difficult, but I still am that person that wants to get out there and do things. I want to do things for myself.”
- Debra Kelly, 61-year-old female who received bilateral hand transplants in 2018

 

Mental health changes among transplant recipients

  • Hand/arm transplant recipients have experienced stress during the recovery and rehabilitation processes due to:
    • Changes in identity and family relationships8,9
    • Increased dependence on caregivers8,9
    • National and international media attention9

  • Hand/arm transplant recipients have also experienced mood changes, depression, and anxiety after the frequency of surgical follow-up has decreased.8
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“With my stumps, I was forever at the dentist to get my fillings fixed because I would open bottles and things with my teeth. I’ve had to retrain myself in using my new hands – even though it may be quicker using the skills I developed with stumps. About three weeks ago I finally felt like my new hands were better than my stumps. I’m looking forward to doing more. I used to love gardening and am keen to get back to doing bigger jobs when I have more feeling.”

- Corinne Hutton, 49-year-old female who received bilateral hand transplants in 2019

How Can Your Personal Identity Change After Hand/Arm Transplantation?

Identity considerations during decision-making

  • People with recent upper limb loss may have a hard time getting used to the look and feel of their residual limb and loss of function.10,11

  • By losing a part of their body, some people may feel like they have lost a part of their self; consequently, this may distort their body image, identity, and autonomy.12,13

  • Despite the risks of hand/arm transplantation, some people may feel empowered to pursue hand/arm transplantation because they are taking action to improve their quality of life.2
 

Mr. White, with unilateral, below-elbow limb loss (6 years after amputation), describes his positive mindset about his upper limb loss.

 

Identity considerations among transplant recipients

  • Hand/arm transplant recipients may need time to get used to the hand/arm transplant and see it as part of themselves.

  • It is important for recipients to accept the transplant as part of their own body, instead of seeing it as a separate limb attached to their body.1,12,14-16

  • Recipients who accept the transplanted limb as part of themselves are generally better able to achieve the self-care and lifelong commitments necessary for their transplant’s success.
 

Ms. Skinner, with unilateral, below-elbow limb loss (5 years after amputation), discusses her thoughts on how a person’s sense of identity might change after hand/arm transplantation.

 

Appearance considerations

  • It is important to consider that the hand/arm transplant is physically visible.

  • Transplant teams do their best to match donor upper limbs to the recipient on the basis of sex/gender, skin tone, body size, hair color, and many other factors.17

  • Hand/arm transplant recipients will need to feel comfortable with having a hand/arm skin and hair color that looks a little different from the rest of their body.4,13

  • Differences in skin tone, hair color, and hand/arm size may be more noticeable for patients who receive one hand/arm transplant than for patients who receive double hand/arm transplants.
 

Dr. Dumanian, Chief of Plastic Surgery, talks about how a hand/arm transplant may look.

 
 

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References

  1. Benedict JL. Vascularized Composite Allotransplantation. In: Weisstub DN, Cooley DR, eds.  A Revised Consent Model for the Transplantation of Face and Upper Limbs: Covenant Consent. Cham, Switzerland: Springer, 2017: Ch 2.

  2. Dumont M, Sann L, Gazarian A. Bilateral Hand Transplantation: Supporting the Patient's Choice. Journal of Plastic, Reconstructive & Aesthetic Surgery 2017;70(2):147-151.

  3. Hautz T, Brandacher G, Engelhardt TO, et al. How Reconstructive Transplantation is Different from Organ Transplantation—and how it is not. Transplantation proceedings 2011;43(9):3504-3511.

  4. Kumnig M, Jowsey-Gregoire SG, Moreno E, et al. An Overview of Psychosocial Assessment Procedures in Reconstructive Hand Transplantation. Transplant International 2014;27(5):417-427.  

  5. Meyer TM. Psychological Aspects of Mutilating Hand Injuries. Hand Clinics 2003;19(1):41-49.

  6. Schley MT, Wilms P, Toepfner S, et al. Painful and Nonpainful Phantom and Stump Sensations in Acute Traumatic Amputees. The Journal of Trauma: Injury, Infection, and Critical Care. 2008; 65(4):858-864.

  7. Smith CP. How should Surgeons Balance Transplantation Innovation with Acceptance of a Trauma Survivor’s Appearance? AMA Journal of Ethics. 2019;21(11):953-959.  

  8. Jowsey-Gregoire SG, Kumnig M, Morelon E, et al. The Chauvet 2014 Meeting Report: Psychiatric and Psychosocial Evaluation and Outcomes of Upper Extremity Grafted Patients. Transplantation 2016;100(7):1453-1459.  

  9. Kumnig M., Jowsey-Gregoire SG., DiMartini A. F. Psychological Aspects of Hand Transplantation. Current Opinion in Organ Transplantation 2014;19(2):188-195.

  10. Bradbury E. Understanding the Problems. In: Lansdown R, Rumsey N, Bradburry E, et al. eds. Visibly Different: Coping with Disfigurement. Oxford: Butterworth-Heinemann, 1997:180.

  11. Kumnig M, Jowsey-Gregoire SG, Rumpold G, et al. The Psychological Assessment of Candidates for Reconstructive Hand Transplantation. Transplant International 2012;25(5):573-585.  

  12. Klapheke MM, Marcell C, Taliaferro G, et al. Psychiatric Assessment of Candidates for Hand Transplantation. Microsurgery: Official Journal of the International Microsurgical Society and the European Federation of Societies for Microsurgery 2000;20(8):453-457. 

  13. Klapheke MM. Transplantation of the Human Hand: Psychiatric Considerations. Bulletin of the Menninger Clinic 1999;63(2):159-173.

  14. Errico M, Metcalfe NH, Platt A. History and Ethics of Hand Transplants. Journal of the Royal Society of Medicine Short Reports 2012;3(10):1-6.

  15. Petruzzo P, Lonzetta M, Dubernard JM, et al. The International Registry on Hand and Composite Tissue Transplantation. Transplantation 2008; 86(4): 487-492.  

  16. Slatman J, Widdershoven G. Hand Transplants and Bodily Integrity. Body & Society. 2010;16(3):69-92.  

  17. McDiarmid SV. Donor and Procurement Related Issues in Vascularized Composite Allograft Transplantation. Curr Opin Organ Transplant 2013;18(6):665–671.