Using Decision Analysis to Understand the Indications for Unilateral Hand Transplantation.
Background:Upper extremity transplantation has been performed to improve quality of life, the benefit which must be traded off for the risk created by life-long immunosuppression. We believe the process of decision analysis is well suited to improve our understanding of these trade-offs.Method:We created a decision tree to include a branch point to illustrate the expected recovery of useful function in the transplant, using the best estimates for utility and probability that exist.Results:Our model revealed that when the probability of achieving a good result, graded as Chen level one or two is greater than 73%, transplantation is preferred over no transplantation. The decision is sensitive to the probability of major complications and the utility of a transplanted limb with minimal function.Conclusions:The results of this analysis show that under some circumstances given a high probability of satisfactory functional recovery, unilateral hand transplantation can be justified.
University of Toronto, Toronto, ON, Canada.
Brett
B
McClelland
University of Toronto, Toronto, ON, Canada.
Christine B
CB
Novak
University of Toronto, Toronto, ON, Canada.
Steven
S
Hanna
University of Toronto, Toronto, ON, Canada.
Steven J
SJ
McCabe
D003661:Decision Support Techniques; D003663:Decision Trees; D063987:Hand Transplantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007165:Immunosuppression Therapy; D011336:Probability; D011788:Quality of Life; D016896:Treatment Outcome
decision analysis; hand transplantation; quality of life; unilateral; utility