The debate over hand transplantation.

Abstract

The news of the first human hand transplant from Lyon, France, in September 1998 was greeted largely with skepticism in the hand surgery community. The subsequent discovery that the patient had falsified his story of hand injury and was not compliant with rehabilitation and medication regimen only reinforced the impression that hand transplant was ill advised. Far from being a breakthrough in surgery, hand transplant was described by a respected leader in hand surgery as a triumph of “technology over good sense,” that was premature, misconceived, and even unethical. Position statements from the American Society for Surgery of the Hand also expressed concerns over the associated morbidities and functional outcome for hand transplantation. In the ensuing period of just over 3 years, however, at least 8 more patients, including 3 bilateral amputees, have received 11 hand transplants in centers in the United States, China, and several European countries. These motivated patients followed intensive rehabilitation regimens. Immunosuppressant medications were carefully monitored and adjusted for transient episodes of allograft rejection occurring primarily in the skin. As these patients emerged with transplanted hands capable of functional tasks, genuine satisfaction with their early results, and apparently good health, many paused to consider the merits of hand transplantation. Yet even as the initial, often emotional, outcry about hand transplant has subsided, serious questions remain on this important subject facing the discipline of hand surgery. A systematic examination of the relevant issues took place in the debate on “The Role of Hand Transplantation in the 21st Century” at the 2001 annual meeting of the American Society for Surgery of the Hand. Both debaters, Dr. Neil F. Jones and Dr. Warren C. Breidenbach, are experienced hand surgeons who have also conducted research in composite tissue transplantation. In the following articles, these 2 surgeons present and contrast their viewpoints in 4 key areas.