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Psychological aspects of hand transplantation

Kumnig, Martina; Jowsey, Sheila G.b; DiMartini, Andrea F.c

Current Opinion in Organ Transplantation: April 2014 - Volume 19 - Issue 2 - p 188–195
doi: 10.1097/MOT.0000000000000047
ETHICAL, LEGAL AND FINANCIAL CONSIDERATIONS: Edited by Kathy L. Coffman

Purpose of review: Psychosocial aspects are important indicators for reconstructive hand transplantation (RHT). They warrant further research attention given the influence of psychosocial factors on the success of RHT. This review will contrast RHT with solid organ transplantation, provide information to guide selection of RHT candidates and ethical implications, share information on psychological outcomes, and address the importance of a multicenter research approach.

Recent findings: Previously published RHT reports have tried to identify psychosocial factors that are essential to guide selection of RHT candidates and that predict psychosocial outcomes. These issues in RHT are receiving increased attention, but standardized psychosocial evaluation and follow-up protocols are still needed. Recent study highlights the potential for a multicenter research approach that uses standardized assessment strategies and also emphasizes the need for a shared assessment approach to understand psychosocial outcomes.

Summary: RHT combines the technical rigors of hand surgery and microsurgery with the complex multidisciplinary care that defines modern transplantation medicine. As recent work has provided a more complete picture of the complexities of the psychosocial factors in RHT, a psychosocial assessment protocol developed with input across the centers currently performing this procedure would capitalize on the collective diverse clinical experiences and standardize the assessment and follow-up protocol. With such standardized procedures in place, psychosocial risk factors for both poor psychosocial and medical/surgical outcomes can be identified which can inform the selection or preparation of future candidates.

aInnsbruck Medical University, Department of Medical Psychology, Center for Advanced Psychology in Plastic and Transplant Surgery, Innsbruck, Austria

bPsychiatry, Mayo Graduate School of Medicine, Mayo Clinic, Rochester, Minnesota

cDepartments of Psychiatry and Surgery, University of Pittsburgh, School of Medicine, Starzl Transplant Institute at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA

Correspondence to Dr Kumnig Martin, PhD, MSc, Department of Medical Psychology, Innsbruck Medical University, Head of the Center for Advanced Psychology in Plastic and Transplant Surgery, Schöpfstraße 23a, 6020 Innsbruck, Austria. Tel: +43 512 50427709; fax: +43 512 585418; e-mail: martin.kumnig@i-med.ac.at

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins