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Transplants for non-lethal conditions: a case against hand transplantation in minors
  1. Charles E Hedges1,
  2. Philip M Rosoff1,2,3
  1. 1 Duke Initiative for Science and Society, Duke University, Durham, North Carolina, USA
  2. 2 Trent Center for Bioethics, Humanities and History of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
  3. 3 Departments of Pediatrics and Medicine, Duke University Medical Center, Durham, North Carolina, USA
  1. Correspondence to Dr Philip M Rosoff, 108 Seeley G. Mudd Building, 10 Bryan-Searle Drive, Duke University Medical Center, Durham, NC 27710, USA; philip.rosoff{at}


Human allografts for life-threatening organ failure have been demonstrated to be lifesaving and are now considered to be standard of care for many conditions. Transplantation of non-vital anatomic body parts has also been accomplished. Hand transplantation after limb loss in adults has been shown to offer some promising benefits in both functional and psychological measures in preliminary studies. It has been suggested to expand eligibility criteria to include minors, with one such operation having already been performed. With this in mind, we examine the current state of hand transplantation research in the context of available alternatives. We examine the ethics of carrying out these operations in minors, including under the protections of clinical research. We argue that children should not be considered for this surgery due to the substantial risks of immunosuppressive medication, the likelihood that the graft will need to be replaced during the patient’s lifetime and the lack of significant compensatory advantages over modern prosthetics.

  • transplantation
  • children

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  • Contributors Both authors contributed equally to the crafting and writing of the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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