title: Psychosocial Evaluation for First Hand Allotransplantation in Taiwan.
abstract: Hand transplantation has raised ethical and psychological concerns. Few studies have focused on reasons for not selecting candidates on waiting lists. To describe the psychosocial evaluation of referred prospective hand transplant candidates, we investigated candidate suitability by using 22-month follow-up data regarding the first hand transplant recipient in Taiwan. Pretransplant psychosocial assessments comprised an interview with 2 psychiatrists, a social worker, and a psychologist, followed by intelligence quotient scoring with the Wechsler Adult Intelligence Scale and Taiwanese Depression Questionnaire. After team member consensus, of the 20 patients referred to our team to confirm their hand transplantation suitability during April 26, 2013, to March 19, 2015, 7 potential recipients were placed on the waiting list after completing all prehand transplant evaluations. On September 3, 2014, the left distal forearm and hand of a brain-dead man was transplanted to a 45-year-old man who had undergone traumatic amputation of the distal third of his right forearm 30 years previously. During a 22-month follow-up, he complied with scheduled visits, including routine posttransplant laboratory tests, skin biopsies, and intensive physical therapy. Moreover, he overcame repeated graft rejections, bacterial and viral infections, immunosuppressant side effects, considerable economic stress, and the difficulties associated with the adhesion of hand tendons. Finally, he regained some satisfactory function of the transplanted hand. Considering posttransplantation difficulties, suitable candidates for hand transplantation should have persistent motivation, appropriate expectations, patience, immediate availability, fair intelligence, fair social functioning, and adequate economic and familial support.
authors.affiliation: From the *Division of Psychosomatic Medicine, Department of Psychiatry, Kaohsiung Chang Gang Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine; †Division of Plastic Surgery, Departments of Surgery, ‡Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung; and §Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gang Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Nien-Mu
authors.initials: NM
authors.lastname: Chiu
authors.forename: Yur-Ren
authors.initials: YR
authors.lastname: Kuo
authors.forename: Yu
authors.initials: Y
authors.lastname: Lee
authors.forename: Chien-Chang
authors.initials: CC
authors.lastname: Chen
mesh_terms: D000328:Adult; D000066491:Clinical Decision-Making / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D063987:Hand Transplantation / Q000523:psychology*; D006801:Humans; D007361:Intelligence Tests; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D013624:Taiwan