Updated November 30, 2014.

Upper limb transplantation is a lesser known procedure in which a person with hand or arm amputation receives a transplanted portion of a deceased donor's arm or hand. These procedures are typically done for people with below elbow amputation however there have been a handful of people receiving transplantation of arms above the elbow. 

Historically, hand and arm transplantation has been done primarily since the late 1990s.

The first hand transplantation was actually done in 1964, but failed in two weeks due to the ineffective nature of immune suppression medication at the time. 

There are multiple centers around the United States that are currently doing this procedure including the Kleinert Kutz Hand Care Center; Jewish Hospital; and University of Louisville, Emory Healthcare, Johns Hopkins, and The Mayo Clinic, among others. These, and many other sites, are beefing up their hand transplant programs as the success of these procedures improves each year. 

In order for a patient to be considered for hand or arm transplantation, he or she must meet a set of criteria put out by the individual transplant center. In general, the hand transplant procedure is indicated for people who have experienced amputation as the result of trauma or other interventions done in critical illness to prevent death (such as when patients are treated for septic shock and experience lack of blood flow to their limbs resulting in amputation).

Transplantations are not done for finger transplantation alone (must be whole hand). Patients should be in general good health and must have resources to support the extensive medical care required for any type of transplant such as health insurance and good social support. 

Prior to transplant, multiple tests must be done for evaluation of candidacy. These tests typically include x rays of the residual limb, extensive blood work to ensure lack of underlying infection or blood disorders, physician evaluation with limb measurements and general health exam, and consultation with a psychiatrist with psychological testing. 

Psychiatry evaluation prior to transplantation may be the most important component of pre transplant screening. The arms and hands are extremely important parts of a person's identity and having another person's transplanted arms or hands can have a major negative psychologic impact if a person isn't prepared. The first successful hand transplant was done in France in 1998 to a patient who wasn't comfortable with the idea of his transplanted hand and discontinued the use of his immunosuppressant therapy because of this. He ultimately underwent amputation of the transplanted had due to multiple rounds of rejection. This situation sheds light on the ethical dilemma associated with these very personal transplantation and the importance of psychological evaluation for patients prior to surgery. 

After transplantation, a person can expect to go through a lengthy period of rehabilitation. The hand and arm are complex structures consisting of bones, muscles, blood vessels, and nerves which must be connected to the recipient's own residual limb. Immediately after transplant, the hand and arm do not function normally as healing and regrowth of nerve must occur. It can take months to years for patients to gain meaningful function from their transplanted limbs. Also after transplant, patients can expect to take anti-rejection medications for life and undergo biopsy procedures of the transplanted limb for monitoring of rejection. 

Hand and arm transplantation have become increasingly successful procedures resulting in more patients receiving them as time goes on. Whether this becomes standard practice is still yet to be decided.