Hand Transplant

What is a hand transplant?

A hand transplant (hand transplantation) is a surgical procedure to replace your hand or part of the upper limb with that of a donor. You may be interested in a hand/upper extremity transplant if you had your hand(s) or part of the upper extremity removed (an amputation).

Your hands are important parts of your body. They’re one of the most frequently used parts. You’re most likely using them right now to hold a device to read this article.

Hand transplants are a newer procedure and controversial in the medical community. This is because many risks come with this procedure. In addition, vital organ transplants (liver or kidney, for example) can help increase your lifespan and survival rate. You can survive without your hands. But a hand transplant can improve your quality of life.

A hand transplant can affect the way you look and feel. It can also allow you to do things like write or wave hello. Some transplant recipients reported that the procedure positively impacted their mental and emotional well-being.

What is a bilateral hand transplant?

A bilateral hand transplant is a double hand transplant. It involves replacing both your left and right hands or parts of your upper extremities with those of a donor. This type of hand transplant can take surgeons up to 24 hours to complete on both hands at the same time.

What does a hand transplant treat or manage?

Each person’s journey to undergo a hand transplant is different. A hand transplant can be a follow-up procedure to a hand amputation. A hand amputation is a surgical procedure to remove your hand(s). You may need a hand amputation after trauma or illness, like severe burns, a crushing injury or sepsis. You may look for a hand transplant if you experienced a congenital (present since birth) abnormality where a complication prevented or affected bone growth in your hands.

How common is a hand transplant?

Hand transplants aren’t common. More than 150 hand transplants occurred around the world since 1999.

How should I prepare for a hand transplant?

Before a hand transplant, you’ll meet with the transplant coordinator. If you meet the requirements for a transplant, you’ll meet the transplant team. They’ll evaluate whether you’re a good candidate for the procedure. They’ll perform a physical exam and learn more about your medical history. Your surgeon will recommend blood tests and imaging tests, like X-rays, as well.

Your provider will also recommend a mental health evaluation. A hand transplant requires lifelong care and it can take a toll on your mental health. It helps to build a strong support system before the procedure so you have reliable assistance when you need it.

Before your procedure, you’ll also need to follow specific instructions to reduce your risk of complications, like:

• Stop smoking. Ask your provider for resources to help you quit.
• Add, modify or adjust the dosage or types of medications or supplements you take, under your provider’s guidance.
• Participate in physical therapy or follow strengthening exercises that your provider recommends.
• Manage any underlying health conditions.
• Avoid using harmful substances like alcohol or unprescribed drugs.

When your care team approves you as a candidate for a hand transplant, they’ll place you on a waiting list. You’re waiting for a deceased donor hand to become available that matches your criteria, like blood type, skin color, age, etc. The amount of time you’ll wait varies and is usually unpredictable. Your care team may be able to give you a better timeline so you can make any arrangements that you need before the surgery. Once a donor is available, surgery follows quickly.

What happens during a hand transplant?

On the day of your surgery, you’ll receive anesthesia from an anesthesiologist. This will put you to sleep so you won’t feel pain. Your surgeon will ready the donor hand and your arm, making incisions (cuts) in both to attach them together. Your surgeon will connect the following parts of the donor hand to your arm:

• Bone.
• Tendon and muscles.
• Blood vessels.
• Nerves.
• Skin.

Your surgical team will use plates and screws to secure the bones together. Small stitches secure the other components together. When all pieces of the donor hand make a connection to your arm, your surgeon will close up all incisions in your skin.

How long does a hand transplant take?

A hand transplant can take up to 24 hours and sometimes more to complete.

What happens after a hand transplant?

After surgery, you’ll move to a recovery area, most likely an intensive care unit (ICU), for observation. You may need to stay in the hospital for up to two weeks following the procedure. Your providers may order multiple imaging tests, like X-rays, and bloodwork to monitor your recovery.

Your care team will check on you often, making sure you’re comfortable. You’ll receive pain medications for any discomfort.

Your providers will regularly check the function of your hand. This could include tapping on certain parts of your hand and arm and asking you to move your fingers. It could take some time before you’re able to move your fingers, so don’t feel discouraged if you can’t do it immediately following surgery. A hand transplant will likely improve the function of your upper extremity but it’s unlikely that your transplanted hand will function as fully as a non-transplanted hand.

Your care team will also explain what medications you need to take and when you need to take them. The most important are anti-rejection medications (immunosuppressants). These prevent rejection. You’ll need to take these medications as directed for the rest of your life. Talk to your provider about what you should do if you miss a dose and what side effects to look out for. Let them know if you experience any side effects or complications after surgery.

You’ll meet with a certified hand therapist during your recovery. They’ll help you exercise your hand to increase functionality. 

Some hand transplant recipients meet with a mental health professional to help them manage any stress or challenges they might face after surgery.

What are the benefits of a hand transplant?

The benefits of a hand transplant can include regaining or improving your:

• Hand functionality.
• Movement.
• Feeling.
• Self-esteem.
• Self-image.

Many people identify “quality over quantity.” While there are identifiable risks associated with this procedure, the impact that this procedure can have on a person’s mental and emotional health may outweigh other factors.

What is the hand transplant success rate?

It’s difficult to determine the success rate of hand transplants since it’s a newer procedure. Many hand transplants are successful. One study found that people who underwent a hand transplant experienced a survival rate of over 90%.

Another study found that hand transplant recipients regained function of their new hand in the following ways:

• All studied recipients could feel the sensation of pain in their hand.
• Up to 90% felt the sense of touch.
• Over 82% felt discriminative (fine) touch, like vibrations and pressure.

From the same study, an estimated 75% of recipients reported an improved quality of life after the procedure.

What are the risks or complications of a hand transplant?

The biggest risk associated with a hand transplant is rejection. Rejection happens when your body doesn’t accept the donor hand.

Surgery complications could include:

• Bleeding.
• Infection.
• Blood clots.
• Loss of transplant.
• Death.

Other complications may include:

• Skin color variation.
• Post-transplant lymphoproliferative disorder.
• Skin cancer.
• Psychological hand rejection (new hand doesn’t feel like part of your body).

You’ll need to take immunosuppressant medications to prevent rejection. This can cause the following side effects:

• Fatigue.
• Headache.
• High blood pressure.
• Nausea and vomiting.
• Upset stomach.
• High risk of infection.
• Development of metabolic conditions like diabetes and Cushing syndrome.

Your care team will weigh all of the possible complications and side effects to see if a hand transplant is right for you. Sometimes, the risks can outweigh the benefits of undergoing this procedure.

Hand transplant rejection

During a hand transplant rejection, your immune system treats your donor hand as a threat to your body. As a result, your immune system tries to destroy it. There are two types of hand transplant rejection:

• Acute: Acute rejection happens a few days after the procedure. Your immune system quickly destroys tissues and blood vessels in your new hand. It can cause pain, swelling and skin discoloration. Medications can treat this type.
• Chronic: Chronic rejection happens months to years after the procedure but can happen sooner. It occurs gradually. Immunosuppressants don’t effectively stop your immune system from attacking your new hand. This could cause failure of the transplanted hand.

Approximately 85% of hand transplant recipients develop acute rejection. Healthcare providers will test for rejection regularly and treat it with immunosuppressant therapy. You won’t necessarily lose your new hand if acute rejection happens. It’s treatable. Chronic rejection may lead to new hand loss.

What is the recovery time for a hand transplant?

The recovery time varies for each person after a hand transplant. You’ll first notice your surgical site healing within weeks after surgery. It could take six to eight weeks for your bone to heal.

You’ll participate in occupational and physical therapy following the procedure. You can expect to slowly build strength in your hand. Your hand therapist will help you build strength in your arm and hand to increase functionality. It could take up to eight weeks before you’re able to use your hand to do routine activities like holding an object.

Studies show that your body will adapt to the transplant, and your functionality and senses will continue to develop for up to five years after the procedure.

You’ll need to take immunosuppressants for the rest of your life after a transplant. Your care team will schedule regular checkups to make sure everything is healing, and you don’t experience complications.

When should I call my healthcare provider?

Contact a healthcare provider if you’re interested in a hand transplant. Your healthcare provider can evaluate your situation and let you know if you’re a good candidate for the procedure.

If you underwent a hand transplant procedure, contact your care team immediately if you notice any side effects or complications. Time is vital to treat complications to prevent rejection. If your surgical site isn’t healing or you experience the following symptoms, contact your provider:

• Skin discoloration.
• Skin rash.
• Pain.
• Swelling.
• Loss of previously gained hand functionality.

A note from Cleveland Clinic

It can be devastating to lose a hand — an important part of your body that you use to touch, feel, hold and so much more. Many people choose prosthetics after an amputation, but new procedures, like a hand transplant, are gaining popularity. Surgical teams around the world perform these procedures to improve a recipient’s quality of life, feeling and functionality. It can help you get back to how you felt before an amputation.

Transplant procedures can bring many emotions forward, so your care team may include mental health professionals alongside surgical experts. Maintenance treatment with medications will be lifelong. It reduces your risk of rejection so you can continue to shake hands and offer up a high five for the rest of your life without complications.