|2009 Annual Meeting Abstracts
A Survey Of North American Hand Surgeons On Their Current Attitudes Towards Hand Transplantation
Robert E. Schlenker, M.D., David W. Mathes, Emilia Ploplys, M.D., Nicholas Vedder, MD.
University of Washington, Seattle, WA, USA.
Although composite tissue allotransplantation (CTA) is unparalleled in its potential to reconstruct "like with like," the risk-benefit ratio and clinical indications are difficult to determine. We examined current attitudes regarding the emerging field of CTA, in particular hand transplantation, from those who treat complex hand injuries.
A web based survey regarding CTA was sent to members of the ASSH which identified their demographics and practice profiles. Respondents support for CTA and their assessment of the level of risk associated with these procedures were addressed. Additional questions focused on the clinical application of CTA with current immunosuppression, ethical issues surrounding CTA, and the indications for hand transplantation. Finally, four clinical situations that closely mirrored past transplantations were presented and members evaluated their suitability for either hand or face allotransplantation.
474 Surgeons responded to the survey who were divided in their opinion of hand transplantation with 24% in favor, 45% against, and 31% undecided. The majority (69%) consider this surgery to be a high-risk endeavor, however, a large percentage (71%) still believe it to be an ethical procedure when performed on properly selected patients. The most accepted indications for hand transplantation were loss of bilateral hands (78%) and amputation of a dominant hand (32%). Only 16% were in favor of performing transplants with the current immunosuppression available today. In response to the clinical situation, 66% would offer transplantation to a bilateral hand amputee while only 9% would offer transplantation to a diabetic who had lost his dominant hand.
This survey demonstrates support for the use of hand allotransplantation as a solution for dominant hand and bilateral hand amputees. However, surgeons continue to be concerned about the adverse effects of immunosuppression and the risks of acute and chronic rejection, and many want to wait for the development of better immunologic treatment options.