Vascularized Composite Allotransplantation of the Hand and Upper Extremity (Hand Transplant)

Inclusion Criteria: * Recent (≥6 months) or remote (i.e., several decades) unilateral or bilateral upper limb loss from trauma or other causes desiring limb transplantation * Below-shoulder amputation * Male or female and of any race, color or ethnicity * Aged 18-69 years * Willing and able to understand and sign informed consent form * No co-existing medical condition which, in the opinion of the study team, would place them at high risk for the surgical procedure, immunosuppression protocol, or functional results * No co-existing psychosocial problems (i.e., alcoholism, drug abuse, lack of social support) or issue identified during psychosocial battery of testing * Negative for malignancy for past 5 years * Negative for hepatitis C virus or HIV at transplant * Negative crossmatch with donor * If female of child-bearing potential, negative serum pregnancy test * If female of child-bearing potential, consent to use reliable contraception for at least one year following transplantation * Willing and able to sign consents for tissue studies * Willing to comply with Intermediate System (IS) and hand therapy protocols Exclusion Criteria: * Conditions that, in the opinion of the investigators, would place patient at unacceptably high risk for the surgical procedure, immunosuppression protocol, or functional results * Sensitized recipients with high levels (\>70%) of panel-reactive human leukocyte antigen (HLA) antibodies * Conditions that may impact the success of the surgical …