Current Ethics of Hand Transplants in Non-Immunocompromised Children

Although hand transplantation in the adult population is increasingly recognized as an acceptable reconstructive treatment, the ethical trade-offs of performing hand transplants in the pediatric population require closer scrutiny. This analysis applies the concepts of the best interest standard, the Harm Principle, and protections for vulnerable populations to weigh the risks and benefits of immunocompetent pediatric hand transplantation. As only two pediatric hand transplants have been performed to date, much of the outcome data has been extrapolated from the adult population. Such comparisons are problematic given differences in physiology, psychosocial development, adherence, and increased risks of lifelong immunosuppression-including infection, organ failure, and early mortality. Given these uncertainties and our current ethical analysis, immunocompetent pediatric hand transplantation remains ethically impermissible outside of rigorously designed and transparent clinical trials.