At Mayo Clinic, doctors from many specialties work as a team to develop the most appropriate treatment plan for you. Your team will take time to listen to your questions and concerns and provide comprehensive care, which includes nutritional, social, financial and spiritual issues. Mayo Clinic professionals follow you before, during and after your transplant, to ensure the best results and quality of care.
Before your transplant
Doctors trained in hand transplantation will evaluate you to determine whether a hand transplant may be an option for you. Hand transplant may be an option for people who have had one or both hands amputated, or who have lost one or both hands due to trauma.
Your evaluation may last several months and may include:
- Physical examination.
- Blood tests, including blood and tissue type analysis.
- X-rays.
- Physical and occupational therapy tests.
- Nerve function assessment.
- Psychological consultation.
- Consultations with specialists in hand surgery, transplant surgery, social services and others.
- Consultations with a financial coordinator to determine financial and insurance information for your transplant.
In addition, doctors will discuss with you what to expect after a hand transplant, including taking medications, lifestyle changes and other changes. Doctors also will explain to you the risks and benefits of transplant.
If doctors determine that you're eligible for a hand transplant, you'll be placed on a waiting list. Your transplant team will select a healthy hand from a deceased organ donor. Doctors consider your blood type, hand size, skin color and other factors when selecting a donor.
While on the waiting list, remain in close contact with the transplant team, and notify your transplant coordinator of any significant changes in your medical or social situation. Be prepared to get to the hospital quickly after you receive notice that a donor hand is available. Also, maintain your general health as much as possible.
Transplant surgery
A hand transplant is a lengthy procedure that may last 18 to 24 hours. In hand transplant, the hands and a portion of the forearms come from a donor. In this complex surgery, a team of surgeons reattaches bones, arteries, veins, tendons, muscles, nerves and skin.
After your surgery, you'll likely remain in the hospital 7 to 10 days. During your hospital stay, your transplant team will monitor your recovery process, including helping you manage your pain, assisting with emotional concerns, providing you with education and checking for signs of complications. Surgeons will monitor your skin coloration and blood circulation. You'll also begin hand therapy to help regain your function.
Your treatment team will provide you with instructions on post-transplant recovery, care, lifestyle changes and medications. You'll also be given contact information for your transplant doctor and transplant coordinator.
After your transplant
You'll need to stay near Mayo Clinic for several weeks after your transplant so that doctors can monitor your progress and recovery.
Follow-up care. After your hand transplant, you'll have regular appointments at Mayo Clinic, several days a week for several weeks. In follow-up appointments, doctors will conduct blood tests and other tests to check for signs of infection or rejection. Doctors may also remove very small pieces of your skin (skin biopsy) from the transplanted hand to check for signs of rejection. You'll also have hand therapy 5 to 7 days a week.
After you return home, you'll have regular follow-up appointments at Mayo Clinic once a year, or more frequently if necessary. Your doctor will update your primary healthcare provider about your progress and give recommendations for your care at home. You'll continue to participate in hand therapy to regain function and help you learn to use your new hand. Your hand may gain function after several months. In addition, a certified transplant nurse coordinator will provide you with follow-up care for many months. The nurse coordinator will be available to answer your questions and communicate with you and your primary healthcare provider.
Medications. You'll need to take immunosuppressive medications daily for life to keep your body from rejecting your donor hand. Your transplant team will discuss your new medications in detail. Mayo Clinic doctors study the effects of these medications, including their side effects and their effects on nerve recovery.
Nerve recovery occurs gradually in hand transplant. Nerve and hand function usually takes several months to recover after a hand transplant. Your hand function may continue to improve over several years.
One immunosuppressive medication, tacrolimus, may speed nerve recovery. Faster nerve recovery may reduce the amount of time before you begin to experience sensations in your hand, and your hand may return to function sooner. Doctors continue to study immunosuppressive medications to determine their effects on nerve recovery.
Returning to wellness. The transplant team considers your return to wellness after your transplant a priority. You'll be given specific guidelines to return to wellness through hand therapy to learn to use your new hand and a nutrition plan. Staff may give you other lifestyle recommendations, such as wearing sunscreen. Your transplant team will help you make healthy lifestyle choices to achieve an optimal transplant outcome.