TRANSPLANTING A HAND. IS IT AN ETHICAL DECISION, BIOETHICAL, OR BOTH?

Julio Bermudez¹, Luis Latorre¹, Constanza Moreno¹.

¹Division of Hand and Microsurgery, Department of Orthopedics, Fundacion Santa Fe de Bogota University Hospital, Bogota, Colombia.

Currently, when doing clinical research for an innovative procedure (such as hand transplantation) and reviewing the ethical considerations in such treatment, the essays by Seigler, (1998) and Emmanuel (2000) should be considered, which define some criteria and requirements that determine whether is or not possible to conduct clinical research for the innovative procedure.

These criteria and requirements take into account the patient, the medical team and society. However, we believe there are still some considerations without sufficient emphasis to the indication of transplantation, which are mainly determined by the patient and his environment, among others quality of life, which includes social acceptance (according to cultural differences), appearance (body image), and function. However, there should be a balance between what the patient, the medical team and society consider.

On the other hand, progressive societies are responsible for the distribution of the resources necessary to carry out the procedure, keep the costs of the integral treatment, and ensure related investigations, thus facilitating the evaluation and advancement of innovative surgery. If these societies take also into account the criteria, requirements, patients’ cultural considerations, and costs involved, they can proceed with the indication of the hand transplantation.

Being a difficult and complex decision, it is imperative that it not only be taken by an individual or group, either the patient or medical team (ethical decisions), but in conjunction with society for public discussion (bioethical decisions) not only taking into account the risk-benefit, but also all the criteria to be considered, so the investigations should be at least technical, human, and social.