5 ms·

Wow I didn’t realize so few people had hand transplants. For numbers that low in the human experience, I like to compare with the number of people who’ve been t

Wow I didn’t realize so few people had hand transplants. For numbers that low in the human experience, I like to compare with the number of people who’ve been to space. At 200 transplants, that is twice as rare as going to space!

nkkollaw 7y ago
Ha! That's neat.
Someone 7y ago
The technical part of hand transplants is hard; there’s a lot of nerves and muscles to connect. https://en.wikipedia.org/wiki/Hand_transplantation https://en.wikipedia.org/wiki/Hand_transplantation: ”The operation is quite extensive and typically lasts from 8 to 12 hours. By comparison, a typical heart transplant operation lasts 6 to 8 hours”. Apart from that, there’s the psychological aspect. Recipients must accept their new hand as theirs. That can require extensive psychological support. Then, there’s the ethical aspect. Unlike heart transplants, a hand transplant isn’t life-saving, but like it, it condemns patients to the life-long use of immunosuppressants, with the side effect of a weaker immune system. Prosthetics may be the better choice. It also is a lot cheaper. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3499956/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3499956/ claims ”The lifetime cost of a single hand transplantation is approximately $528,293; on average 62% of this total is due to expensive immunosuppressive therapy and postoperative management.18 The lifetime cost for a single prosthetic adaptation is approximately $20,653 […] The quality-adjusted life years (QALYs) of prosthetic adaptation exceed those for hand transplantation, due to the complications of immunosuppression.”
- deleted 7y ago
  [deleted]
- notRobot 7y ago
  Most of your comment makes sense to me, except this bit: > Then, there’s the ethical aspect. Unlike heart transplants, a hand transplant isn’t life-saving, but like it, it condemns patients to the life-long use of immunosuppressants, with the side effect of a weaker immune system. Prosthetics may be the better choice. Surely it's up to the transplant recipient to decide what will be best for them? I'm sure there are many people to whom the trade off will be worth it. How exactly do "ethics" come into play here?
  - djsumdog 7y ago
    I assume the doctors would make the patient aware the drugs that prevent rejection could compromise their immune system? I doubt many even get the opportunity with the prohibitive costs and difficulty of the surgery.
  - aaron695 7y ago
    > Surely it's up to the transplant recipient to decide what will be best for them? If they pay for it sure. When society pays then no. When society pays for things they have a right to pay when it statistically makes sense. Just because someone has a feeling they are different doesn't mean society should take large amounts of communal money from the disability sector to give to them.
  - Someone 7y ago
    It can be (and in his case has been) argued that (some) patients do not know what will be best for them. Patients typically are fairly shortly after traumatic injury, and don’t really know what either option entails. Combine that with the Hippocratic oath or its modern equivalent, which requires doctors to do what’s in the best interest of the patient, and there’s a clear conflict. (Couldn’t find an example directly related to this, but the general problem is https://en.wikipedia.org/wiki/Medical_ethics#Between_autonomy_and_beneficence/non-maleficence https://en.wikipedia.org/wiki/Medical_ethics#Between_autonom...)
- newyankee 7y ago
  I think it can also be argued that prosthetics will keep on getting better. Although i wonder when they will overtake natural limbs in dexterity or compensate it with other features.
- gameswithgo 7y ago
  Yes, between immunosupressants, likely limited life time, limited functionality, I would be inclined to go with a prosthetic personally. Even though I think I would be fine pyschologically. I think, hopefully I won't find out for sure!
  - tempestn 7y ago
    I expect the fact that it was both hands may have played a role. I imagine that a prosthetic can be great as a supplement to a working hand, but that it would be difficult to manage with two of them.
- hinkley 7y ago
  Do you suppose that reconnecting at the elbow like they did reduces the number of nerves involved? I figured the nerve bundles would be larger higher up.

nkkollaw 7y ago

Ha! That's neat.

Someone 7y ago

The technical part of hand transplants is hard; there’s a lot of nerves and muscles to connect. https://en.wikipedia.org/wiki/Hand_transplantation https://en.wikipedia.org/wiki/Hand_transplantation: ”The operation is quite extensive and typically lasts from 8 to 12 hours. By comparison, a typical heart transplant operation lasts 6 to 8 hours”. Apart from that, there’s the psychological aspect. Recipients must accept their new hand as theirs. That can require extensive psychological support. Then, there’s the ethical aspect. Unlike heart transplants, a hand transplant isn’t life-saving, but like it, it condemns patients to the life-long use of immunosuppressants, with the side effect of a weaker immune system. Prosthetics may be the better choice. It also is a lot cheaper. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3499956/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3499956/ claims ”The lifetime cost of a single hand transplantation is approximately $528,293; on average 62% of this total is due to expensive immunosuppressive therapy and postoperative management.18 The lifetime cost for a single prosthetic adaptation is approximately $20,653 […] The quality-adjusted life years (QALYs) of prosthetic adaptation exceed those for hand transplantation, due to the complications of immunosuppression.”

deleted 7y ago
[deleted]
notRobot 7y ago
Most of your comment makes sense to me, except this bit: > Then, there’s the ethical aspect. Unlike heart transplants, a hand transplant isn’t life-saving, but like it, it condemns patients to the life-long use of immunosuppressants, with the side effect of a weaker immune system. Prosthetics may be the better choice. Surely it's up to the transplant recipient to decide what will be best for them? I'm sure there are many people to whom the trade off will be worth it. How exactly do "ethics" come into play here?
- djsumdog 7y ago
  I assume the doctors would make the patient aware the drugs that prevent rejection could compromise their immune system? I doubt many even get the opportunity with the prohibitive costs and difficulty of the surgery.
- aaron695 7y ago
  > Surely it's up to the transplant recipient to decide what will be best for them? If they pay for it sure. When society pays then no. When society pays for things they have a right to pay when it statistically makes sense. Just because someone has a feeling they are different doesn't mean society should take large amounts of communal money from the disability sector to give to them.
- Someone 7y ago
  It can be (and in his case has been) argued that (some) patients do not know what will be best for them. Patients typically are fairly shortly after traumatic injury, and don’t really know what either option entails. Combine that with the Hippocratic oath or its modern equivalent, which requires doctors to do what’s in the best interest of the patient, and there’s a clear conflict. (Couldn’t find an example directly related to this, but the general problem is https://en.wikipedia.org/wiki/Medical_ethics#Between_autonomy_and_beneficence/non-maleficence https://en.wikipedia.org/wiki/Medical_ethics#Between_autonom...)
newyankee 7y ago
I think it can also be argued that prosthetics will keep on getting better. Although i wonder when they will overtake natural limbs in dexterity or compensate it with other features.
gameswithgo 7y ago
Yes, between immunosupressants, likely limited life time, limited functionality, I would be inclined to go with a prosthetic personally. Even though I think I would be fine pyschologically. I think, hopefully I won't find out for sure!
- tempestn 7y ago
  I expect the fact that it was both hands may have played a role. I imagine that a prosthetic can be great as a supplement to a working hand, but that it would be difficult to manage with two of them.
hinkley 7y ago
Do you suppose that reconnecting at the elbow like they did reduces the number of nerves involved? I figured the nerve bundles would be larger higher up.