{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,4]],"date-time":"2026-04-04T07:05:57Z","timestamp":1775286357100,"version":"3.50.1"},"reference-count":40,"publisher":"BMJ","issue":"10","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Med Ethics"],"accepted":{"date-parts":[[2018,5,31]]},"published-print":{"date-parts":[[2018,10]]},"abstract":"<jats:p>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\u2019s lifetime and the lack of significant compensatory advantages over modern prosthetics.<\/jats:p>","DOI":"10.1136\/medethics-2018-104819","type":"journal-article","created":{"date-parts":[[2018,6,14]],"date-time":"2018-06-14T12:20:53Z","timestamp":1528978853000},"page":"661-665","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Transplants for non-lethal conditions: a case against hand transplantation in minors"],"prefix":"10.1136","volume":"44","author":[{"given":"Charles E","family":"Hedges","sequence":"first","affiliation":[{"name":"Duke Initiative for Science and Society, Duke University, Durham, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip M","family":"Rosoff","sequence":"additional","affiliation":[{"name":"Duke Initiative for Science and Society, Duke University, Durham, North Carolina, USA"},{"name":"Trent Center for Bioethics, Humanities and History of Medicine, Duke University School of Medicine, Durham, North Carolina, USA"},{"name":"Departments of Pediatrics and Medicine, Duke University Medical Center, Durham, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,6,14]]},"reference":[{"key":"2025092413585673000_44.10.661.1","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1080\/23723505.2015.1133268","article-title":"Reconstruction for All: The Case for Pediatric Hand Transplantation","volume":"2","author":"Colen","year":"2015","journal-title":"Vascularized Composite Allotransplantation"},{"key":"2025092413585673000_44.10.661.2","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1016\/j.hcl.2011.07.006","article-title":"Ethical, financial, and policy considerations in hand transplantation","volume":"27","author":"Chang","year":"2011","journal-title":"Hand Clin"},{"key":"2025092413585673000_44.10.661.3","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1016\/j.transproceed.2012.06.075","article-title":"Unilateral hand transplant-results after 41 months","volume":"45","author":"Jablecki","year":"2013","journal-title":"Transplant Proc"},{"key":"2025092413585673000_44.10.661.4","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1007\/s10856-016-5771-9","article-title":"Technology and vascularized composite allotransplantation (VCA)-lessons learned from the first bilateral pediatric hand transplant","volume":"27","author":"Momeni","year":"2016","journal-title":"J Mater Sci Mater Med"},{"key":"2025092413585673000_44.10.661.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.transproceed.2009.01.013"},{"issue":"1-2","key":"2025092413585673000_44.10.661.6","doi-asserted-by":"crossref","first-page":"11","DOI":"10.4161\/23723505.2014.973798","article-title":"Hand Transplantation in Its Fourteenth Year: The Innsbruck Experience","volume":"1","author":"Weissenbacher","year":"2014","journal-title":"Vascularized Composite Allotransplantation"},{"key":"2025092413585673000_44.10.661.7","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1016\/j.jhsb.2005.05.012","article-title":"Cortical motor activation patterns following hand transplantation and replantation","volume":"30","author":"Brenneis","year":"2005","journal-title":"J Hand Surg Br"},{"key":"2025092413585673000_44.10.661.8","unstructured":"Wpa L . Human Upper Extremity Allotransplantation. A Hand and Arm Transplant Research Study Baltimore. 2018 https:\/\/www.hopkinsmedicine.org\/transplant\/programs\/reconstructive_transplant\/hand_transplant.html#total_transplants2017 (accessed 9 Apr 2018)."},{"key":"2025092413585673000_44.10.661.9","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1007\/s10856-017-5880-0","article-title":"Outcomes after hand and upper extremity transplantation","volume":"28","author":"Shores","year":"2017","journal-title":"J Mater Sci Mater Med"},{"key":"2025092413585673000_44.10.661.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2009.01.021"},{"key":"2025092413585673000_44.10.661.11","doi-asserted-by":"publisher","DOI":"10.1001\/jama.283.20.2701"},{"key":"2025092413585673000_44.10.661.12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s10730-014-9264-2","article-title":"In defense of (some) altered standards of care for Ebola infections in developed countries","volume":"27","author":"Rosoff","year":"2015","journal-title":"HEC Forum"},{"key":"2025092413585673000_44.10.661.13","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1080\/15265161.2015.1010995","article-title":"Caring for the suffering: meeting the Ebola crisis responsibly","volume":"15","author":"Rosoff","year":"2015","journal-title":"Am J Bioeth"},{"key":"2025092413585673000_44.10.661.14","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000000892"},{"key":"2025092413585673000_44.10.661.15","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0162507","article-title":"Functional and Psychosocial Outcomes of Hand Transplantation Compared with Prosthetic Fitting in Below-Elbow Amputees: A Multicenter Cohort Study","volume":"11","author":"Salminger","year":"2016","journal-title":"PLoS One"},{"key":"2025092413585673000_44.10.661.16","doi-asserted-by":"publisher","DOI":"10.1177\/0309364614554030"},{"key":"2025092413585673000_44.10.661.17","doi-asserted-by":"publisher","DOI":"10.1097\/01.TP.0000079458.81970.9A"},{"key":"2025092413585673000_44.10.661.18","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1007\/s40137-016-0128-3","article-title":"Hand Transplantation Versus Hand Prosthetics: Pros and Cons","volume":"4","author":"Salminger","year":"2016","journal-title":"Curr Surg Rep"},{"key":"2025092413585673000_44.10.661.19","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1111\/tri.12220","article-title":"An overview of psychosocial assessment procedures in reconstructive hand transplantation","volume":"27","author":"Kumnig","year":"2014","journal-title":"Transpl Int"},{"key":"2025092413585673000_44.10.661.20","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1016\/j.surg.2016.02.037","article-title":"Adding a little transplant surgery to the Central: The nation\u2019s first hand transplant","volume":"160","author":"Gruber","year":"2016","journal-title":"Surgery"},{"key":"2025092413585673000_44.10.661.21","doi-asserted-by":"crossref","first-page":"2053","DOI":"10.1097\/TP.0000000000001248","article-title":"Chronic Rejection in Human Vascularized Composite Allotransplantation (Hand and Face Recipients): An Update","volume":"100","author":"Kanitakis","year":"2016","journal-title":"Transplantation"},{"key":"2025092413585673000_44.10.661.22","doi-asserted-by":"crossref","first-page":"2914","DOI":"10.1007\/s00268-012-1757-z","article-title":"Effects of graft quality on non-urgent liver retransplantation survival: should we avoid high-risk donors?","volume":"36","author":"Marti","year":"2012","journal-title":"World J Surg"},{"key":"2025092413585673000_44.10.661.23","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1136\/bmj.324.7343.971","article-title":"A tale of two novel transplants not done: the ethics of limb allografts","volume":"324","author":"Benatar","year":"2002","journal-title":"BMJ"},{"key":"2025092413585673000_44.10.661.24","doi-asserted-by":"crossref","first-page":"398-407","DOI":"10.1111\/j.1399-3046.2005.00358.x","article-title":"Medication non-adherence in the adolescent renal transplant recipient: a clinician\u2019s viewpoint","volume":"9","author":"Rianthavorn","year":"2005","journal-title":"Pediatr Transplant"},{"key":"2025092413585673000_44.10.661.25","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.med.58.061705.145143"},{"key":"2025092413585673000_44.10.661.26","doi-asserted-by":"crossref","first-page":"68","DOI":"10.18773\/austprescr.2009.035","article-title":"Long-term management of patients taking immunosuppressive drugs","volume":"32","author":"Hsu","year":"2009","journal-title":"Aust Prescr"},{"key":"2025092413585673000_44.10.661.27","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2016-3893"},{"key":"2025092413585673000_44.10.661.28","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1053\/j.sempedsurg.2017.07.002","article-title":"Post-transplant lymphoproliferative disorder after solid-organ transplant in children","volume":"26","author":"Absalon","year":"2017","journal-title":"Semin Pediatr Surg"},{"key":"2025092413585673000_44.10.661.29","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1097\/MOT.0000000000000453","article-title":"Pediatric and congenital hand transplantation","volume":"22","author":"Amaral","year":"2017","journal-title":"Curr Opin Organ Transplant"},{"key":"2025092413585673000_44.10.661.30","doi-asserted-by":"crossref","first-page":"2096","DOI":"10.1111\/ajt.12313","article-title":"Association Between Steroid Dosage and Death With a Functioning Graft After Kidney Transplantation","volume":"13","author":"Opelz","year":"2013","journal-title":"American Journal of Transplantation"},{"key":"2025092413585673000_44.10.661.31","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1542\/peds.89.3.411","article-title":"Pediatric organ donation: the paradox of organ shortage despite the remarkable willingness of families to donate","volume":"89","author":"Morris","year":"1992","journal-title":"Pediatrics"},{"key":"2025092413585673000_44.10.661.32","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0b013e3181668605"},{"key":"2025092413585673000_44.10.661.33","unstructured":"Hospital BCs. Hand Transplant Program Boston. 2018 http:\/\/www.childrenshospital.org\/Centers-And-Services\/Programs\/F-_-N\/hand-transplant-program (accessed April 9 2018)."},{"key":"2025092413585673000_44.10.661.34","doi-asserted-by":"crossref","first-page":"2153","DOI":"10.1016\/S0140-6736(13)62632-X","article-title":"Facial transplantation: the first 9 years","volume":"384","author":"Khalifian","year":"2014","journal-title":"The Lancet"},{"key":"2025092413585673000_44.10.661.35","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1097\/00006534-200201000-00003","article-title":"After plastic surgery: adolescent-reported appearance ratings and appearance-related burdens in patient and general population groups","volume":"109","author":"Simis","year":"2002","journal-title":"Plast Reconstr Surg"},{"key":"2025092413585673000_44.10.661.36","doi-asserted-by":"crossref","first-page":"57","DOI":"10.4103\/0974-2077.155091","article-title":"Cosmetic surgery in teenagers: To do or not to do","volume":"8","author":"Singh","year":"2015","journal-title":"J Cutan Aesthet Surg"},{"key":"2025092413585673000_44.10.661.37","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1097\/PSN.0b013e31821ee2dd","article-title":"Ethical and Legal Considerations in Teen Aesthetic Surgery","volume":"32","author":"Wilhite","year":"2012","journal-title":"Plastic Surgical Nursing"},{"key":"2025092413585673000_44.10.661.38","doi-asserted-by":"crossref","first-page":"072","DOI":"10.1055\/s-0033-1343999","article-title":"Cosmetic and reconstructive breast surgery in adolescents: psychological, ethical, and legal considerations","volume":"27","author":"Crerand","year":"2013","journal-title":"Semin Plast Surg"},{"key":"2025092413585673000_44.10.661.39","doi-asserted-by":"crossref","first-page":"135e","DOI":"10.1097\/PRS.0b013e3182362bb8","article-title":"Cosmetic Surgery in the Adolescent Patient","volume":"129","author":"Larson","year":"2012","journal-title":"Plast Reconstr Surg"},{"key":"2025092413585673000_44.10.661.40","doi-asserted-by":"publisher","DOI":"10.1016\/j.jadohealth.2008.04.018"}],"container-title":["Journal of Medical Ethics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/medethics-2018-104819","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T20:59:06Z","timestamp":1758747546000},"score":1,"resource":{"primary":{"URL":"https:\/\/jme.bmj.com\/lookup\/doi\/10.1136\/medethics-2018-104819"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,6,14]]},"references-count":40,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2018,9,25]]},"published-print":{"date-parts":[[2018,10]]}},"alternative-id":["10.1136\/medethics-2018-104819"],"URL":"https:\/\/doi.org\/10.1136\/medethics-2018-104819","relation":{},"ISSN":["0306-6800","1473-4257"],"issn-type":[{"value":"0306-6800","type":"print"},{"value":"1473-4257","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,6,14]]}}}