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Who is Eligible for Hand/Arm Transplantation?

Dr. Jaimie Shores, Hand/Arm Transplant Surgeon, talks about how the transplant team decides who is eligible for a hand/arm transplant.

Hand/arm transplants may be a treatment option for people with unilateral or bilateral upper limb loss below the shoulder.
For people with congenital limb loss (i.e., born without a hand/arm), there currently is not enough evidence to support hand/arm transplantation as a treatment option—but it may become an option in the future.

What Are Common Eligibility Criteria for Hand/Arm Transplantation?

Transplant teams decide if a patient is eligible for a hand/arm transplant on a case-by-case basis. Most transplant programs expect that patients have first used or have attempted to use a prosthetic before considering them as a candidate for hand/arm transplantation. If the prosthetic did not work and did not improve the patient’s quality of life, then hand/arm transplantation may be a suitable treatment option.^1,2

Inclusion and exclusion criteria for hand transplant recipients used by several US hand/arm transplant centers:^2,3

Inclusion Criteria

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Age 18-69

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Willingness to consent to blood and biopsy sample collection and storage

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Greater than 6 months since extremity injury with an attempt at rehabilitation

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General good health

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Willingness and ability to participate in hand therapy

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Willingness and ability to take medicines for as long as you have the transplant

Exclusion Criteria

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Age < 18 or  > 69

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Certain medical conditions

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Certain nerve problems

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Cancer in the past 5 years

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Blood disorders

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Immune system problems 

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Psychosocial issues 

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Health issues identified during screening

What Other Factors Do Transplant Teams Consider?

Type of Amputation - 
People who lost both of their limbs often face increased challenges with functioning and may have lower quality of life.4

Extent of Amputation - 
Hand/arm transplants are more frequently performed to restore below-elbow or wrist-level amputation. The distance for nerve regrowth for below-elbow amputations is relatively short. Above-elbow amputations (trans-humeral) are not excluded from eligibility for hand/arm transplant, but some amputations at the scapular/shoulder level are excluded. Hand/arm transplants for more proximal amputations may result in poorer functioning.4

Physical Health - 
Transplant recipients’ bodies will need to “bounce back” from the surgery and endure a lengthy rehabilitation period to regain function in the new arm. Transplant candidates must go through a physical screening process to make sure they are healthy  enough for the transplant.

Cognitive Function and Psychosocial Factors - Transplant candidates must go through a psychological screening process to make sure they will be able to handle the transplant emotionally and mentally, and will be motivated to follow their medicine regimen and make the transplant successful. Transplant candidates need to be able to understand the procedure, risks, and potential benefits in order to make an informed treatment decision.

Commitment - Candidates will need to take time off from work and other duties to go through the evaluation process, the transplant surgery and recovery, and the post-transplant hand therapy. Candidates or recipients may need to temporarily relocate to be closer to their transplant center or rehabilitation center.

Alternative Treatment Options - Transplant teams consider other treatment options, in addition to transplantation. Some patients may have better outcomes with a prosthetic device, or after undergoing reconstructive surgery. Others may fare better by adapting to life without their arm and not receiving further treatment. For this reason, people with congenital amputations, who were born without a hand(s)/arm(s) and have lived their whole life without their limb(s), are not generally considered for transplant.

Are Active Service Members in the US Military Candidates for Hand/Arm Transplantation?

Dr. Dumanian, Chief of Plastic Surgery, talks about hand/arm transplantation for wounded warriors.

While active service members may be identified as good candidates for hand/arm transplantation, they may need to be medically retired prior to undergoing transplantation for the following reasons:
- Hand/arm transplantation requires life-long immunosuppression (anti-rejection medications), which is an automatic disqualifying condition for deployment.⁵
- Extensive rehabilitation time and recovery over multiple years is required, which is not likely compatible with continued active duty service.

A retired Staff Sgt. explains his prosthetic arm to service members. He was injured by an improvised explosive device while traveling in Baghdad.*

*The appearance of U.S. Department of Defense (DoD) visual information does not imply or constitute DoD endorsement.

Click Below for More Videos

Videos of Health Care Professionals

Dr. Jaimie Shores, Hand/Arm Transplant Surgeon, describes characteristics of a good candidate for hand/arm transplantation.

Dr. Dumanian, Chief of Plastic Surgery, discusses who may be the best candidates for hand/arm transplantation.

References

Sources

Salminger S, Roche A, Sturma A, et al. Hand Transplantation Versus Hand Prosthetics: pros and cons. Current Surgery Reports. 2016;4(2):8.
Tintle, SM., Potter BK, Elliott RM, et al. Hand Transplantation. Journal of Bone and Joint Surgery. 2014;2(1):1-9.
Alolabi N, Augustine H, Thoma A. Hand Transplantation: Current Challenges and Future Prospects. Transplant Research and Risk Management. 2017;9:23-29.
Kubiak CA, Etra JW, Brandacher G, et al. Prosthetic Rehabilitation and Vascularized Composite Allotransplantation Following Upper Limb Loss. Plast Reconstr Surg. 2019;143(6):1688-1701.
USCENTCOM. USCENTCOM Individual Protection and Individual-Unit Deployment Policy, Modification Fifteen, 091923Z, Apr 2020. Accessed September 15, 2022. https://media.defense.gov/2020/Aug/29/2002487210/-1/-1/0/USCENTCOM%20MOD%2015.PDF