Paediatric upper limb transplantation: A new frontier of surgery, immunology, and ethics


Hand transplantation is a technique to reconstruct absent and functionless upper limbs using cadaveric donor limbs.

In the 20 years since the world’s first hand transplant, the technique has developed into a reliable and valuable option for carefully selected adult amputees. The downside is the need for immunosuppression with its inherent risks (metabolic, infective, neoplastic, and renal impairment) for the duration of the transplant.

This grand round presentation will summarise the international experience with adult hand transplantation to date, discuss key principles for this form of transplant, and critically evaluate whether this technique can and should be applied to children. Open audience discussion will be invited on ethical challenges raised by the prospect of offering hand transplants to children. These challenges include the comparative benefits and risks for children specifically, and questions of whether this is something that parents could validly consent to for a child.



Dr Daniel Wilks recently relocated from Leeds, UK to work fulltime as a consultant plastic surgeon at The Royal Children’s Hospital.

In Leeds, Dan worked as a consultant plastic surgeon and some 10 years ago, began exploring the possibility of offering hand transplantation in the UK. After extensive planning and consultation, the Leeds-based programme was approved as the sole UK provider by NHS England. Between 2012 and 2019, the UK team, with Dan as one of the lead surgeons, transplanted 10 limbs in 6 patients – currently one of the largest cohorts in the world. Dan’s other areas of interest are children’s hand surgery, nerve surgery, and microsurgery.

Professor Lynn Gillam is a clinical ethicist at RCH, and Academic Director of the Children’s Bioethics Centre.



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