A Hand Transplant Candidate Status Designation System

Abstract

Introduction: Over the past few years there has been an exponential increase in the number of hand transplant programs in the United States. With this increase, patients have greater choice in programs at which to pursue their evaluation. It is likely that some patients will pursue evaluation at multiple programs. Hand transplantation, unlike solid organ transplantation is life enhancing but not life saving or prolonging. The field is also in its early stages. As such there is no pressure to urgently proceed to transplant. Patients may be deemed as; “excellent candidates” who could proceed to transplant immediately, unsuitable for transplant due to multiple coomorbidities, potential candidates once the fields advances more or if certain relative contraindications can be resolved. Various programs will have different acceptance criteria and different centers may place the same candidate into a different category. Nurturing trust and confidence in this field necessitates clear communication with patients and also among different programs. Methods: We reviewed our current experience in evaluating hand transplant candidates and how we can group them into distinct categories that reflect our action plan for each patient. Results: We propose that each hand transplant candidate at the end of the evaluation be given one of four designations. Class A: Approved and listed awaiting a donor. Class B: anatomically acceptable candidate. Some medical or psychosocial goals need to be resolved or met before listing e.g. smoke cessation, availability of caregiver. The candidate is expected to meet these goals within one year. Class C: At this time the program does not want to proceed but may consider the patient in the futures. This could be due to the level of amputation, awaiting improved immunosuppression, post-traumatic stress disorder, very young age, psychological immaturity etc. Class D: patient not a transplant candidate and will not be considered by the program in the future, e.g. too old, active malignancy, peripheral neuropathy. Conclusion: The four designations will make it easier to communicate the status of patients both among the various programs and to patients. This will limit misunderstanding and engendering trust.