Creating a Hand Transplant Program Bardia Amirlak, MD a , Ruben Gonzalez, MD a , Vijay Gorantla, MD a , Warren C. Breidenbach, III, MD a,b , Gordon R. Tobin, MD c, * Success of hand transplantation depends as much on the extensive care given to the patient fol- lowing the operation as it does on the procedure itself. Carefully monitored drug therapy, physical therapy, psychological support, and routine testing must be done to ensure the survival of the trans- planted hand. Some of these therapies must be given throughout the life of the graft. This article, discusses the personnel, protocols, and procedures involved in the management of a hand transplanta- tion system. The role of each team member is de- scribed briefly, as well as patient management, including pharmacologic treatments and physical, occupational, and psychological therapy. In addi- tion, donor selection and protocols are discussed, as are media/public relations. The recommenda- tions are based on the United States health care sys- tem, but similar infrastructure is needed for the successful setup of any composite tissue limb allotransplantation program. For a successful hand transplantation to have promising long-term results, in addition to a skilled hand transplantation team, a strong support system and appropriate immunosuppression and follow-up care are needed. Hand transplantation team Hand surgeon The hand surgeon is the leader of the hand trans- plantation process and the coordinator of the sur- gery team. The hand surgeon is responsible for the preoperative evaluation, postoperative evalua- tion, and follow-up of the transplantation patient with regard to hand function. He or she also may be the overall leader of the hand transplant team. Alternatively, the transplantation team may be led by the transplant surgeon or, in some instances, both surgeons. The authors’ recommendation is CLINICS IN PLASTIC SURGERY Clin Plastic Surg 34 (2007) 279–289 a Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, KY, USA b University of Louisville, Louisville, KY, USA c Division of Plastic Surgery, University of Louisville, Louisville, KY, USA * Corresponding author. Department of Surgery, University of Louisville, 323 East Chestnut Street, Louisville, KY 40292. E-mail address: gordon.tobin@louisville.edu (G.R. Tobin). - Hand transplantation team Hand surgeon Transplant surgeon Transplant psychiatrist Hand transplant coordinator - Organ donation process - Donor retrieval team and equipment - Hand transplantation equipment - Preoperative and postoperative patient care and nursing responsibilities - Physical and occupational therapy - Pharmacologic management and role of pharmacists - Laboratory and pathology - Psychosocial support - Cost and funding - Public relations - Summary - Acknowledgments - References 279 0094-1298/07/$ – see front matter ª 2007 Elsevier Inc. All rights reserved. doi:10.1016/j.cps.2007.01.002 plasticsurgery.theclinics.com