The Ethics of Hand Transplantation: A Systematic Review

Carisa M. Cooney; Charalampos Siotos; Jeffrey W. Aston; Ricardo J. Bello; Stella M. Seal; Damon S. Cooney; Jaimie T. Shores; Gerald Brandacher; W. P.Andrew Lee

doi:10.1016/j.jhsa.2017.08.004

The Ethics of Hand Transplantation: A Systematic Review

Carisa M. Cooney, Charalampos Siotos, Jeffrey W. Aston, Ricardo J. Bello, Stella M. Seal, Damon S. Cooney, Jaimie T. Shores, Gerald Brandacher, W. P.Andrew Lee

Research output: Contribution to journal › Article › peer-review

23 Scopus citations

Abstract

Purpose We conducted a systematic review to document ethical concerns regarding human upper extremity (UE) allotransplantation and how these concerns have changed over time. Methods We performed a systematic review of 5 databases to find manuscripts addressing ethical concerns related to UE allotransplantation. Inclusion criteria were papers that were on the topic of UE allotransplantation, and related ethical concerns, written in English. We extracted and categorized ethical themes under the 4 principles of bioethics: Autonomy, Beneficence, Nonmaleficence, and Justice. We assessed theme frequency by publication year using Joinpoint regression, analyzing temporal trends, and estimating annual percent change. Results We identified 474 citations; 49 articles were included in the final analysis. Publication years were 1998 to 2015 (mean, 3 publications/y; range, 0–7 publications/y). Nonmaleficence was most often addressed (46 of 49 papers; 94%) followed by autonomy (36 of 49; 74%), beneficence (35 of 49; 71%), and justice (31 of 49; 63%). Of the 14 most common themes, only “Need for More Research/Data” (nonmaleficence) demonstrated a significant increase from 1998 to 2002. Conclusions Upper extremity transplantation is an appealing reconstructive option for patients and physicians. Its life-enhancing (vs life-saving) nature and requirement for long-term immunosuppression have generated much ethical debate. Availability of human data has influenced ethical concerns over time. Our results indicate that discussion of ethical issues in the literature increased following publication of UE transplants and outcomes as well as after meetings of national societies and policy decisions by regulatory agencies. Clinical relevance Because UE transplantation is not a life-saving procedure, much ethical debate has accompanied its evolution. It is important for UE surgeons considering referring patients for evaluation to be aware of this discussion to fully educate patients and help them make informed treatment decisions.

Original language	English (US)
Pages (from-to)	84.e1-84.e15
Journal	Journal of Hand Surgery
Volume	43
Issue number	1
DOIs	https://doi.org/10.1016/j.jhsa.2017.08.004
State	Published - Jan 2018
Externally published	Yes

Keywords

Ethics
VCA
composite tissue allotransplantation
hand transplantation
upper extremity allotransplantation

ASJC Scopus subject areas

Surgery
Orthopedics and Sports Medicine

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10.1016/j.jhsa.2017.08.004

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@article{b8e3e67cb1834159ad6f63e04b3c02dc,

title = "The Ethics of Hand Transplantation: A Systematic Review",

abstract = "Purpose We conducted a systematic review to document ethical concerns regarding human upper extremity (UE) allotransplantation and how these concerns have changed over time. Methods We performed a systematic review of 5 databases to find manuscripts addressing ethical concerns related to UE allotransplantation. Inclusion criteria were papers that were on the topic of UE allotransplantation, and related ethical concerns, written in English. We extracted and categorized ethical themes under the 4 principles of bioethics: Autonomy, Beneficence, Nonmaleficence, and Justice. We assessed theme frequency by publication year using Joinpoint regression, analyzing temporal trends, and estimating annual percent change. Results We identified 474 citations; 49 articles were included in the final analysis. Publication years were 1998 to 2015 (mean, 3 publications/y; range, 0–7 publications/y). Nonmaleficence was most often addressed (46 of 49 papers; 94%) followed by autonomy (36 of 49; 74%), beneficence (35 of 49; 71%), and justice (31 of 49; 63%). Of the 14 most common themes, only “Need for More Research/Data” (nonmaleficence) demonstrated a significant increase from 1998 to 2002. Conclusions Upper extremity transplantation is an appealing reconstructive option for patients and physicians. Its life-enhancing (vs life-saving) nature and requirement for long-term immunosuppression have generated much ethical debate. Availability of human data has influenced ethical concerns over time. Our results indicate that discussion of ethical issues in the literature increased following publication of UE transplants and outcomes as well as after meetings of national societies and policy decisions by regulatory agencies. Clinical relevance Because UE transplantation is not a life-saving procedure, much ethical debate has accompanied its evolution. It is important for UE surgeons considering referring patients for evaluation to be aware of this discussion to fully educate patients and help them make informed treatment decisions.",

keywords = "Ethics, VCA, composite tissue allotransplantation, hand transplantation, upper extremity allotransplantation",

author = "Cooney, {Carisa M.} and Charalampos Siotos and Aston, {Jeffrey W.} and Bello, {Ricardo J.} and Seal, {Stella M.} and Cooney, {Damon S.} and Shores, {Jaimie T.} and Gerald Brandacher and Lee, {W. P.Andrew}",

note = "Publisher Copyright: {\textcopyright} 2018 American Society for Surgery of the Hand",

year = "2018",

month = jan,

doi = "10.1016/j.jhsa.2017.08.004",

language = "English (US)",

volume = "43",

pages = "84.e1--84.e15",

journal = "Journal of Hand Surgery",

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T1 - The Ethics of Hand Transplantation

T2 - A Systematic Review

AU - Cooney, Carisa M.

AU - Siotos, Charalampos

AU - Aston, Jeffrey W.

AU - Bello, Ricardo J.

AU - Seal, Stella M.

AU - Cooney, Damon S.

AU - Shores, Jaimie T.

AU - Brandacher, Gerald

AU - Lee, W. P.Andrew

PY - 2018/1

Y1 - 2018/1

N2 - Purpose We conducted a systematic review to document ethical concerns regarding human upper extremity (UE) allotransplantation and how these concerns have changed over time. Methods We performed a systematic review of 5 databases to find manuscripts addressing ethical concerns related to UE allotransplantation. Inclusion criteria were papers that were on the topic of UE allotransplantation, and related ethical concerns, written in English. We extracted and categorized ethical themes under the 4 principles of bioethics: Autonomy, Beneficence, Nonmaleficence, and Justice. We assessed theme frequency by publication year using Joinpoint regression, analyzing temporal trends, and estimating annual percent change. Results We identified 474 citations; 49 articles were included in the final analysis. Publication years were 1998 to 2015 (mean, 3 publications/y; range, 0–7 publications/y). Nonmaleficence was most often addressed (46 of 49 papers; 94%) followed by autonomy (36 of 49; 74%), beneficence (35 of 49; 71%), and justice (31 of 49; 63%). Of the 14 most common themes, only “Need for More Research/Data” (nonmaleficence) demonstrated a significant increase from 1998 to 2002. Conclusions Upper extremity transplantation is an appealing reconstructive option for patients and physicians. Its life-enhancing (vs life-saving) nature and requirement for long-term immunosuppression have generated much ethical debate. Availability of human data has influenced ethical concerns over time. Our results indicate that discussion of ethical issues in the literature increased following publication of UE transplants and outcomes as well as after meetings of national societies and policy decisions by regulatory agencies. Clinical relevance Because UE transplantation is not a life-saving procedure, much ethical debate has accompanied its evolution. It is important for UE surgeons considering referring patients for evaluation to be aware of this discussion to fully educate patients and help them make informed treatment decisions.

AB - Purpose We conducted a systematic review to document ethical concerns regarding human upper extremity (UE) allotransplantation and how these concerns have changed over time. Methods We performed a systematic review of 5 databases to find manuscripts addressing ethical concerns related to UE allotransplantation. Inclusion criteria were papers that were on the topic of UE allotransplantation, and related ethical concerns, written in English. We extracted and categorized ethical themes under the 4 principles of bioethics: Autonomy, Beneficence, Nonmaleficence, and Justice. We assessed theme frequency by publication year using Joinpoint regression, analyzing temporal trends, and estimating annual percent change. Results We identified 474 citations; 49 articles were included in the final analysis. Publication years were 1998 to 2015 (mean, 3 publications/y; range, 0–7 publications/y). Nonmaleficence was most often addressed (46 of 49 papers; 94%) followed by autonomy (36 of 49; 74%), beneficence (35 of 49; 71%), and justice (31 of 49; 63%). Of the 14 most common themes, only “Need for More Research/Data” (nonmaleficence) demonstrated a significant increase from 1998 to 2002. Conclusions Upper extremity transplantation is an appealing reconstructive option for patients and physicians. Its life-enhancing (vs life-saving) nature and requirement for long-term immunosuppression have generated much ethical debate. Availability of human data has influenced ethical concerns over time. Our results indicate that discussion of ethical issues in the literature increased following publication of UE transplants and outcomes as well as after meetings of national societies and policy decisions by regulatory agencies. Clinical relevance Because UE transplantation is not a life-saving procedure, much ethical debate has accompanied its evolution. It is important for UE surgeons considering referring patients for evaluation to be aware of this discussion to fully educate patients and help them make informed treatment decisions.

KW - Ethics

KW - VCA

KW - composite tissue allotransplantation

KW - hand transplantation

KW - upper extremity allotransplantation

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The Ethics of Hand Transplantation: A Systematic Review

Abstract

Keywords

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