Corrinne Hutton, who had four limbs amputated due to sepsis, and who has since been an enduring campaigner for both amputees and organ donation, has now had a successful double hand transplant at Leeds General Infirmary (https://www.bbc.co.uk/news/uk-scotland-glasgow-west-46814473). Whilst hand transplantations have been possible since the late nineties (Dubernard et al., 1999), relatively few have been conducted, in part due to the challenges of finding appropriate limb donors for such surgeries. Whilst discussions around organ donation have become more prominent and the consultation on opt in organ donation in England (https://www.organdonation.nhs.uk/supporting-my-decision/the-opt-out-system ) has further highlighted the need and importance of donation for those needing new organs, when we think of organ donation we still primarily perhaps think of internal organs, rather than limbs.
Whilst the need for organs (particularly internal organs) through donation, often relates to a pressing life and death need brought about by illness or disease in the patient, the donation of limbs can have a substantial impact on the quality of life of those who have lost a limb through trauma or illness, and on their ability to engage in work, personal care and social activities. Currently, limb donation is not part of the organ donation registration process, in that potential donors are not able to express their wishes around whether they would be willing to donate their limbs after death. This means that limb donation can only occur through consent from relatives after the death of any potential donor. Corrinne Hutton herself took part in campaigning in 2016 to make people aware of the organs and tissue that can be donated from human bodies (https://www.bbc.co.uk/news/uk-scotland-37292529 ). Amputation of any limb is seen as a ‘violent intervention’ (Shildrick, 2008) to the body, thus for the recently bereaved family, consent to donate limbs may be a difficult prospect to consider, especially if the wishes of the deceased around limb donation were not known.
Limb matches are also subject to further complexities due to the need to match skin tone and hand size to the patients original limbs in order to try and navigate the possible psychological side effects of receiving donated limbs. Hands are after all such a visible body part, used in the most intimate and personal of gestures, thus navigating the potential psychological risks associated with acceptance of the donated limb is critical. Professor Simon Kay, the surgeon who completed Corrinne Hutton’s hand transplants notes the significance associated with the donation of limbs; “[Corrinne] realises what a remarkable life-affirming gift she has received from an unknown family devastated by grief and I know she will be forever grateful.” (https://www.bbc.co.uk/news/uk-scotland-glasgow-west-46814473). Thus the gifting of limbs through donation is seen as a hugely significant gesture, and given the lack of awareness and insight of the possibility of limb donation after death, the decision for a family to have done so is further compounded in this magnitude.
Although limb donation is more about restoring patient quality of life and increasing their abilities to participate in tasks and activities, than saving a life, it could well play an important role in overcoming the grief of the previously lost limb. Limb donation is, and will remain a different type of donation to organ donation, and the focus on raising awareness about organ donation in order to save lives through organ donation should remain the key focus. Limb donation and transplants of limbs does however illuminate the importance of having more open dialogue around the donation of limbs, so that it is demystified for patients and their families and that conversations around limb donation can take place amongst families so that the wishes of any potential donors may be known in advance. Our continued lack of societal openness around limbs once they are no longer part of the corporeal whole and specifically about their disposal or reuse through donation means that the ability for patients to enact their preferences is severely restricted. This can then mean that patients waiting for limb transplants, are subject to further delays in seeking the possibility of having new hands.
Dubernard, J.M., Owen, E., Herzberg, G., Lanzetta, M., Martin, X., Kapila, H., Dawahra, M. and Hakim, N.S.(1999). Human hand allograft: report on first 6 months. The Lancet, 353(9161): 1315-1320.
Shildrick, M. (2008). Corporeal Cuts: Surgery and the Psycho-social. Body & Society. 14(1): 31–46