From the time we begin our search for a qualified hand/arm transplant recipient to the continuing care we provide following surgery, a significant amount of time, expertise and attentiveness is contributed toward making the procedure a progressive success. Below is an overview of what happens before, during and after a hand/arm transplant procedure. For a more thorough discussion of what a BWH hand transplant patient should expect, please review our Hand Transplant Patient Guide.
Hand/arm transplant candidates go through an extensive screening process that is likely to last several months. This screening includes a psychiatric and social support evaluation and a series of imaging tests to help determine a patient’s physical and mental readiness for the procedure.
If, upon completion of the screening process, it is determined that a patient is a suitable candidate, we will place the patient on a transplant waiting list. We will then begin working with the New England Organ Bank (NEOB) team to find a donor who matches the recipient’s tissue requirements – e.g., similar age, correct blood type. This search could take many months, and, if a suitable donor is not found within one year, we will speak with the patient to determine whether they’re willing to continue waiting.
When a donor is found, we will immediately inform the patient about when to arrive at the hospital for the operation. As the timing for this type of procedure is extremely important, patients are expected to be readily available, i.e., reside within a 12-hour travel radius of BWH.
The parts most likely to be reconstructed during a hand/arm transplant include the hand and partial forearm, and in some cases, if necessary, the elbow and arm below the shoulder joint.
One surgical team will work on removing the hand from the donor as another team simultaneously prepares the arm on the recipient. Surgeons will then connect the donor hand’s blood vessels to the patient's blood vessels under a microscope to restore blood circulation before connecting nerves and other tissue, such as bone, tendons, and muscles, as needed.
Immediately after surgery, the transplant recipient will be taken to the Intensive Care Unit (ICU) for observation. The patient will typically stay in the ICU for one or two days and then be moved to a private room. At this point, a physical therapist will start working with the patient to rehabilitate the transplanted hand/arm, and a psychiatrist will discuss any psychological concerns.
The patient will stay in the hospital until both the plastic surgery and medical transplant teams agree that it is safe for the patient to return home. This post-operative stay is anticipated to be approximately 7-14 days, but can vary due to a number of factors. Rehabilitation with the physical therapist will take several hours a day while the transplant recipient is at the hospital.
Following their discharge, hand/arm transplant patients will need to return to BWH for routine visits. These visits will include monitoring transplant drug levels (immunosuppressants) through regular blood tests, rehabilitative therapy, imaging tests, assessing quality of life, and checking for the return of sensation and movement to the hand. Rehabilitation visits will take place daily for several months, whereas the other visits will typically take place on a weekly basis for the first three months and then at least once a month for the first year following surgery. In a case where the patient lives far away from BWH, we are anticipating that video conferences with collaborating medical centers will replace lengthy commutes.
After the first year, it is expected that upper extremity transplant patients will need to visit the hospital less frequently. However, patients must be prepared to make a lifetime commitment to immunosuppressants to help prevent the rejection of the transplanted hand.
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