Hand Transplantation

Inclusion Criteria: * Candidates may be male or female patients between the ages of 18 and 60 who are missing all or part of one or both hands and forearms * Must be HIV negative at the time of transplant * Crossmatch is negative between donor and recipient * Women who are of child bearing potential must have a negative pregnancy test (urine test is acceptable) within 48 hours of transplant and agree to use reliable contraception for one year following transplant * Subjects must give written informed consent * Subjects who are poor candidates for prosthesis and eligible for hand transplant - prosthesis failure or non acceptance/poor satisfaction with trial of prosthesis Exclusion Criteria: * Uncontrolled infection or severe concomitant diseases which would exclude the recipient from transplantation * Substance abuse disorders not currently under control (as determined by the Michigan Alcohol Screening Test) * Active severe psychiatric illness such as Psychosis or Depression * Body Dysmorphic disorder (see Appendix K for screening tool). Less severe psychiatric conditions are addressed on a case by case basis * Co-existing medical or psycho-social problems relevant to tissue allotransplantation: * Positive serology for HIV; Hepatitis B/C Antigen * Subjects with any cognitive deficits related to a TBI (traumatic brain injury) and or any organic neurological disorders * Active malignancy within 5 years * Unstable social situation as evidenced by lack of stable housing and/or lack of a supportive significant other * Cognitive limitations affecting patients ability * Recent history of medical nonadherence * Any other psychological status that would hinder the success or safety of the transplantation. * Level of amputation proximal to mid-humerus: some presence of proximal muscles is required to motor a functioning hand * Congenital Abnormalities: co-existent absence/atrophy/agenesis of any tissue may affect post transplant results * History of amputation of less than six months: subject must be allowed to attempt prosthetic use prior to hand transplantation. This can be waived in cases where the recipient requires amputation/revision of the transplant site at the time of transplantation. However, if at all possible it is highly encouraged that the patient has ruled out prosthetics as an alternative to transplantation. * Blindness: blind amputees may be poor candidates because sensory return in the hand may not provide sufficient protective sensation * Pregnancy