Reconstructive hand and arm transplants are for adults who have suffered an amputation or extreme loss of function of their hand and arm due to injury or illness. You may require a transplant if you have almost no function of your hands and are not a candidate for alternative or conventional reconstructive surgery.

You may be a candidate for reconstructive transplant if you have lost either one hand or both at any level from the hand to the upper arm. Individuals who have only lost fingers or have lost the entire arm from the shoulder are not currently eligible for this type of transplant.

More than 130 patients have received hand and arm transplants at institutions around the world. The longest surviving hand/arm transplant is the first U.S. recipient at 11 years.

The human hand consists of 27 bones, 28 muscles, 3 major nerves, 2 major arteries, multiple tendons, veins and soft tissue. Hand transplant surgery is complex and can last from 8-10 hours. It involves bone fixation, reattachment of arteries and veins and repair of tendons and nerves.

Patients waiting for a hand donation can be called into the hospital for surgery at any time. After surgery, you will be placed in a surgical intensive care unit (SICU) for several days. Once the surgical team feels comfortable with you being moved out of the SICU, you will move to a transplant unit, where you will receive care specialized for transplant recipients. You can expect to be in the hospital anywhere from four weeks to three months. The amount of time spent in the hospital depends on a number of factors, including the amount of support and assistance you have at home, the distance from your home to the hospital for follow-up care, and any delays that might occur in recovery.

Hand and arm donation is not included in driver’s license organ donation registry. Hand and arm donation involves a special and sensitive consent process with donor families. For Johns Hopkins patients, this process is facilitated through specially trained and experienced coordinators from the Living Legacy Foundation of Maryland, which is the organ procurement organization for the state of Maryland (with the exception of Charles, Montgomery and Prince Georges counties, which are covered by the Washington Regional Transplant Community).

In addition to matching blood type and immunological parameters like in solid organ transplantation, hand donation involves careful emphasis on matching skin color, skin tone, gender, ethnicity/race, and the size of the hand/arm.

Once you are approved for a hand transplant, you will have to wait for a matching donor to become available. This can range from a few weeks to several months. The donor must have matching blood and tissue types as well as matching skin color, skin tone, gender, ethnicity, race and size of hand.

Hand and arm transplant patients should be prepared for an intensive rehabilitation process. You will be involved in some form of rehabilitation for the rest of your life and patients are educated before surgery on the critical importance of rehabilitation in improving functional outcome after the procedure.

Patients are encouraged to start moving the hand early (usually within 24 to 48 hours) to reduce edema and stiffness. All patients will be required to attend directed hand therapy for more than 6 hours each day, 5 days a week, for the first 3-6 months after the transplant. Therapy will be tailored to your needs and abilities; however, you should understand that full-time care and rehabilitation after your transplant is required for the first 1-2 years after the procedure.

Rejection refers to the body’s immune response towards the newly transplanted limb. Believing the tissues to be foreign, the body’s natural response is to attack and can occur within days to months after transplant.

Rejection can appear as a rash that could be spotty, patchy or blotchy. It could appear anywhere on the transplant and is usually painless. As rejection almost always appears first in the skin, patients are encouraged to carefully watch for the signs and report to the physician for timely biopsy and treatment. Unlike internal organ transplants, it is easy to detect and monitor signs of rejection in the hand and arm. This allows for early medical intervention.

No patient taking his/her immunosuppression drugs on time and as advised has lost a transplanted hand and arm.