Current evidence on the efficacy and safety of hand allotransplantation is inadequate in quantity. In addition, there are risks from the prolonged immunosuppression required after the procedure. Therefore, this procedure should only be used with special arrangements for clinical governance, consent and research.
Clinicians wishing to undertake hand allotransplantation should take the following actions.
Inform the clinical governance leads in their Trusts.
Ensure that patients and their carers understand the uncertainty about the procedure's safety and efficacy, in particular the need for and risks of long-term immunosuppression, and the fact that functioning of the transplant may be both delayed and limited. Patients should also be provided with clear written information. In addition, the use of NICE's information for the public is recommended.
Hand allotransplantation should be carried out only in units with surgical teams experienced in limb reimplantation and with experts in transplantation medicine. Patients' suitability for hand allotransplantation should be carefully assessed in line with practice recommended by NHS Blood and Transplant. Alternative methods of management should be discussed, as well as appropriate rehabilitation. Units carrying out the procedure should work within the provisions of the Human Tissue Act 2004.
Clinicians should submit data to the International Registry on Hand and Composite Tissue Transplantation and UK Transplant Registry.
Further research into hand allotransplantation should include data on long-term functional outcomes, and any occurrence of malignancy associated with long-term immunosuppression should be published. NICE may review this procedure on publication of further evidence.