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Composite tissue allotransplantation (CTA) is a transplant procedure in which multiple tissues are involved, such as skin, muscle, tendon, bone, cartilage, fat, nerves, and blood vessels. CTA is primarily used at this time for hand and abdominal wall transplants. Although the field of hand transplantation is fairly new (to date, 4 hand transplants have been performed in the US), the surgical teams performing these procedures are confident that they are at the forefront of an emerging field that will gain popularity in the coming years. The attachment of a new hand (harvested from a brain dead donor) is very similar to the surgery performed to reattach a severed hand, so the technical skills are not unknown to hand surgeons. With a hand transplant, however, surgeons join at least 3 nerves from the transplanted hand to nerves in the recipient’s arm. Post-transplant, the nerves from the donor hand die, and the recipients’ nerves grow down into the new hand, giving the recipient function and control in the transplanted hand. Full arm transplants can also be performed, although the nerves have to grow much farther down for the transplant recipient to gain motor function. The recipient also must take immunosuppressive drugs after the transplant, just as with organ transplantation, to prevent rejection of the foreign tissue. Such drugs weaken the immune system and can shorten the transplant recipient’s life expectancy. While with organ transplantation, in which the new organ is vital to survival, such a risk is justified, in the case of CTA, which improves quality of life rather than saving a life, many feel the risks are not justified. There are also the enormous costs to consider: hand-transplant surgery with 3 months of postsurgical care costs roughly $250,000, followed by a lifetime of expensive immunosuppressive drugs. Pioneers in the hand transplant field are currently trying to use new immunosuppressant research performed on kidney transplant patients and apply it to their own patients. If a method for performing transplants without administering a lifelong course of immunosuppressants is discovered, it will surely radically change the field of CTA, as well as other types of transplants.

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