Hand transplantation is a surgical procedure to transplant a hand from one human to another. The donor hand usually comes from a brain-dead donor and is transplanted to a recipient who has lost one or both hands/arms. Most hand transplants to date have been performed on below elbow amputees, although above elbow transplants are gaining popularity. Hand transplants were the first of a new category of transplants where multiple organs are transplanted as a single functional unit, now termed vascularized composite allotransplantation or VCA. The operation is quite extensive and typically lasts from 8 to 12 hours. By comparison, a typical heart transplant operation lasts 6 to 8 hours. Surgeons usually connect the bones first, followed by tendons, arteries, nerves, veins, and skin. Use of immunosuppressive drugs afterwards The recipient of a hand transplant needs to take immunosuppressive drugs similar to other transplants such as kidneys or livers, as the body's natural immune system will try to reject, or destroy, the hand. These drugs cause the recipient to have a weaker immune system which may lead to an increased risk of infections and some cancers. There have been many advances in solid organ transplantation over the years that have made these medications quite tolerable. After the transplant, there is a period of extensive hand therapy/rehabilitation which helps the recipients regain function of the transplanted hand. Those patients who are compliant to taking the medications and performing the physical therapy following a hand transplant have had remarkable success in regaining function of the new hands/arms. History A hand transplant was performed in Ecuador in 1964, but the patient experienced transplant rejection after only two weeks due to the primitive nature of the immune-suppressing medications at that time. September 23, 1998 hand transplant The first short-term success in human hand transplant surgery occurred with Clint Hallam, from New Zealand. Hallam lost his hand in an accident while in prison. The operation was performed on September 23, 1998, in Lyon, France, by a team assembled from different countries around the world led by French Professor Jean-Michel Dubernard, including Professor Nadey Hakim, from the UK. A microsurgeon on the team, Earl Owen from Australia, was privy to the detailed basic research, much of it unpublished, that had been carefully gathered by the team in Louisville. After the operation, Hallam wasn't comfortable with the idea of his transplanted hand and failed to follow the prescribed