Hand Transplantation and Psychiatric Issues

Martin M. Klapheke, M.D.
Transplant Psychiatrist
Jewish Hospital Transplant Center

As reconstructive surgeons plan to begin hand transplantation, it is important to consider relevant psychological issues. The hand has a "psychology" that involves issues of one's body-image and sense of identity. Loss of the hand is both a physical and psychological trauma that evokes powerful feelings and, potentially, conflicts that affect one's self-image. Personality factors and one's support system will impact on how one adjusts to the loss of a hand, that is, how one "mourns" the loss and comes to terms with a new body-image and sense of self. A hand transplant may offer some patients an opportunity to gain a further sense of mastery over the trauma and loss. However, such a transplant may also present some special psychological challenges to patients. A transplant candidate will, of course, have to be able to accept a new hand from a donor that has just passed away, and this could make some patients uncomfortable, especially as the new hand will, unlike other transplanted organs, always be visible.

Candidates for hand transplantation, like many candidates for other forms of transplantation, will receive a psychiatric consultation as part of the pre-transplant evaluation. The psychiatrist will evaluate the psychological benefits and risks of hand transplantation for each patient and make any recommendations to optimize each patient's candidacy for transplantation.

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