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Perceptions of Upper Limb Transplantation Benefits and Risks: The Amputee Perspective
Sally E. Jensen, PhD; Zeeshan Butt
Department of Medical Social Sciences, Department of Surgery (Organ Transplantation), Northwestern University Feinberg School of Medicine, Chicago, IL

Introduction: Upper limb (UL) transplantation is life-enhancing rather than life-saving; thus, patients and clinicians must weigh the potential risks and benefits. Little research has investigated how UL amputees perceive these benefits and risks. Thus, we interviewed UL amputees to obtain their feedback.

Materials & Methods: 22 UL amputees (Age range = 24-73 years old) participated in either a focus group (n = 5) or semi-structured interview (n = 17). Participants described their perceptions of the benefits and risks of UL transplantation. We analyzed transcribed interviews using a grounded theory approach.

Results: Benefit and risk themes are presented in Table 1. Many participants noted that functioning would only be beneficial if the level of improvement met their expectations, which varied considerably. A subset (n = 6) who used percentages to describe their expectations defined a median of 90% (range 40%- 90%) functionality as satisfactory, in comparison to their original limb, intact limb, prosthetic, or current level of functioning. They described appearance as a potential benefit, although nearly half noted that appearance was less important than functioning. Participants varied in the level of importance of sensation as a benefit for unilateral amputees. Most participants emphasized potential health consequences as risks. Psychological risks also commonly emerged, with emphasis on coping with the risk of rejection and re-amputation.

Conclusions: These findings elucidate how potential UL transplant candidates weigh benefits and risks. The findings can also inform assessment of post-transplant patient-reported outcomes, given that some of these benefits and risks may not be consistently assessed when evaluating the success of UL from the patient perspective. Table 1. Frequency of upper limb transplantation benefits and risks perceived as important by upper limb amputees

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