Surgical and Logistical Aspects of Donor Limb Procurement in Hand and Upper Extremity Transplantation

Hand and upper extremity transplantation offers a promising reconstructive solution for select patients lacking a functional upper limb. For such an endeavor, it is imperative that multiple medical and surgical specialties and teams work in concert to achieve a common goal. Sixteen years from the first successful hand transplantation, the number of centers performing or planning to perform hand transplantation worldwide has increased considerably. This procedure may become the standard of care for properly selected patients in the not-too-distant future. To facilitate this transition, unified protocols are required. In this manuscript, we focus on the donor limb procurement process, including the sequence of events, logistics, and inter-specialty team interaction. Through review of the current literature, we acknowledge and address possible variations, and provide an illustrative overview of the operation. It is important that all members involved in this procedure, including the Organ Procurement Organization (OPO), solid organ procurement teams, and donor hospital staff, are aware of this process. Opportunities for future research in this field are further discussed.