More evidence is needed on the possible risks and benefits of hand transplant surgery, according to NICE's specialist committee on surgical procedures.

Hand transplantation is a rare and fairly new procedure which aims to provide a person with a replacement hand from a recently deceased donor, following a severe injury or disease which has led to their own limb being amputated. The transplanted hand can be more natural-looking than a mechanical prosthesis and may provide better dexterity and sensation.

The National Institute for Health and Clinical Excellence (NICE) was asked to look into how safe the operation is and how well it works. However, its specialist committee found that there is currently not enough evidence to allow it to draw firm conclusions.

In new guidance out today (23 March), NICE expects healthcare professionals to explain the uncertainties and possible risks (e.g. limb rejection, blood clots and infection) to all patients who are considering the operation before they give their consent. This includes the need for lifelong immunosuppressive treatment to reduce the chance of the new hand being rejected.

The guidance also calls for specialist surgical teams to get permission from their hospital's medical director (or other clinical governance lead) beforehand and to review the clinical outcomes so that more can be learnt about the procedure.

Professor Bruce Campbell, Chair of the committee which developed the guidance for NICE said: "Hand allotransplantation may offer carefully selected patients a hand which looks more natural than a mechanical prosthesis and which restores some sensation and movement. People who agree to the procedure must be prepared for prolonged rehabilitation and the need to take medication for the rest of their lives. NICE recognises that the procedure should only be carried out in experienced units and that considerable teamwork is required in order to achieve worthwhile results. We would welcome the opportunity to review this guidance once further research has been published."


About the NICE guidance

1. NICE is asking doctors to send information about everyone who has the procedure and what happened to them afterwards to the International Registry on Hand and Composite Tissue Transplantation and Transplant UK, so that the safety of the procedure and how well it works can be checked over time. For further information, visit here.

2. The procedure is carried out with the patient under general anaesthetic. The donor limb is surgically removed below the elbow joint and prepared for transplantation. The donor forearm bones are joined to those of the patient, followed by the blood vessels, nerves, tendons and skin. Following the procedure, the limb may be set in plaster for several weeks. The patient will need intensive rehabilitation, including physiotherapy, occupational therapy and possibly electrostimulation to restore as much function to the transplanted hand as possible. Long term immunosuppressive drugs are needed to reduce the possibility of the patient's body rejecting the donor hand.

About Interventional Procedures guidance

1. NICE's Interventional Procedures guidance applies to NHS healthcare settings in England, Northern Ireland, Scotland and Wales. The guidance makes recommendations on the safety of a procedure and how well it works.

2. Interventional Procedures guidance does not cover whether or not the NHS should fund a procedure. Decisions about funding are taken by local NHS bodies after considering how well the procedure works and whether it represents value for money for the NHS.


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