THE HAND
The hand, an essential part of the upper extremity, weighs less than a pound and is composed of skin, muscle, bone, tendon, nerves and vessels. The hand consists of 27 bones, 28 muscles, 3 main nerves, 2 main arteries, tendons, veins and soft tissue. The skeleton of the hand consists of bones divided into three groups: the carpus, the metacarpal bones, and the phalanges. The muscles that power the hand are divided into extrinsic muscles, which act upon the hand as a whole and intrinsic muscles, which act upon individual parts of the hand. It includes three main nerves - median, ulnar, and radial. All three nerves are involved in control of the wrist, finger and thumb. The radial and ulnar arteries supply the hand with blood.

PATIENT SELECTION CRITERIA
Donor selection is similar to selection in solid organ donations. The primary criteria for hand transplantation is a patient between the age of 18 and 65 who has amputated part of their arm below the elbow and understands the advantages and risks involved in this experimental surgical technique. The goal of the procedure is to restore functional recovery to the patient with a transplanted hand. The patient will undergo clinical evaluations which will include a history and physical, x-ray evaluation, psychosocial evaluation, nerve conduction studies, tissue studies and laboratory studies.

DONOR SELECTION CRITERIA
Donors will meet the criteria of total and irreversible damage to the brain and the family will consent to organ donation. Donors will be screened according to Kentucky Organ Donor Affiliates guidelines and matched for gender, skin tone, race, age, viral status and blood type. Size and blood type are the only donor requirements which are mandatory. The gender, skin tone, race and age are more of an individual preference than a mandatory requirement.

THE SURGERY
Hand transplantation is an extremely complex procedure, but may not be as difficult as a hand replantation in that a replantation usually involves crushed or mangled bones, tendons, and ligaments. The surgeon will progress with tissue repair in the following order: bone fixation, tendon repair, artery repair, nerve repair, then vein repair. The surgery can last from 12-16 hours. In comparison, a typical heart transplant takes six to eight hours and a liver transplant, eight to twelve hours. Typical post-operative complications include blockage of the blood supply, infections and rejection.

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