As Aristotle eloquently said, "...the hand is the instrument of instruments." Through out my project, I never cease to demonstrate the important of the hands. It might be to communicate, to eat, to work, to learn, to create, to do almost anything, always the hands are required.

Hence, it is obvious that research in the hand reconstruction or transplant domain, has been very active in the past years.

In the structure part of my presentation, I briefly introduced the basic physiological components of the hand. To summarize, the hand is composed of 27 bones, 28 muscles, 3 main nerves, 2 main arteries, veins, tendons and soft tissue. Therefore, the renconstruction or attachment of the hand requires hard and meticulous work.

The first criteria for hand transplantation is that the patient must be between the age of 18 and 65, and he must have an amputated part of the arm, which is below the elbow. The patient must also understands the advantages and risks involved in this experimental surgical technique.

The goal of the surgical procedure is to restore functional properties of the amputated hand with the transplanted hand. before the procedure, the patient will undergo clinical evaluations which includes a history and physical, an x-ray evaluation, a psychosocial evaluation, nerve conduction studies, tissue studies and laboratory studies.

Typical post-operative complications include blockage of the blood supply, infections and rejectionof the new hand.

Also, before begining a hand transplantation, it is important to consider relevant psychological issues. The hand has many psychological issues that involve our sense of identity and our body-image. The loss of one hand is both a physical and psychological trauma that evokes powerful feelings and, potentially, conflicts that affect our self-image. The patient needs to adjust to the loss of a hand, that is, come to terms with a new body-image and sense of self.

A hand transplant may offer some patients an opportunity to gain a further sense of mastery over the trauma and loss. However, such a transplant may also present some special psychological challenges to patients. (7)

Patient selection

The surgery

The hand transplantation surgery can last from eight to twelve hours. In comparison, a typical heart transplant takes six to eight hours and a liver transplant, eight to twelve hours.

The steps of the procedure are summarized within this link: THE HAND TRANSPLANTION SURGERY STEPS.

The world's first hand was attempted in 1964 in Ecuador, South America. However, the hand transplant was rejected within two weeks.

A second hand transplant was performed on New Zealeader, Clint Hallam, in Lyons, France on September 23, 1998. This operation that made medical history, was performed by Jean-Michel Dubernard, M.D., who led a group of doctors flown in from around the world to perform the 13-hour procedure. On February 2, 2001, surgeons, in Britain, later amputated the hand at the patient's request. It was reported the patient failed to follow the correct anti-rejection treatment and physical therapy prescribed by his physicians.

"I've become mentally detached from it," the New Zealander said in an interview with British newspaper The Times. "As it began to be rejected, I realized that it wasn't my hand after all. If this is what I'm going to have for the rest of my life, I'd rather not have it."

One of the surgeons, Nadey Hakim, responded by saying: "We gave him the chance of a lifetime and he ruined it. I feel sorry for him, for us and for everyone who gave him so much and then found he was such a bad example. The selection was very strict but we chose the wrong patient."

On January 25, 1999, the Louisville team (members of the University of Louisville School of Medicine and members of the Jewish Hospital) performed the first hand transplant in the United States on Matthew Scott. This New Jersey man continues to do well gaining strength, control and range of motion in his new left hand.

Then in China on September 21, 1999, two single hand transplants were performed on a 39 year old male and a 27 year old male at the same time.

During a 13-hour procedure, Gerald Fisher, received the second american hand transplant in Louisville, Kentucky at the Jewish Hospital Rudd Heart. The operation was during the night of February 16 to the 17, 2001.

Doctors have been able to attach severed limbs for years, and today, thanks to advancements in technology, they are able to successfully move a limb from a dead donor to a living recipient. However, the procedure has raised questions from medical ethicists who question whether a non-vital body part, in other words, a part of a cadaver, should be transplanted.

It is certain that the ethical concerns are enormous, however, the procedure has the potential to restore hope to thousands of people with congenital defects and disfiguring injuries. Where does one start to decide what can and can not be done?