Using Decision Analysis to Understand the Indications for Unilateral Hand Transplantation

Author:

McClelland Brett1,Novak Christine B.1,Hanna Steven1,McCabe Steven J.1

Affiliation:

1. University of Toronto, Toronto, ON, Canada

Abstract

Background: Upper extremity transplantation has been performed to improve quality of life, the benefit which must be traded off for the risk created by life-long immunosuppression. We believe the process of decision analysis is well suited to improve our understanding of these trade-offs. Method: We created a decision tree to include a branch point to illustrate the expected recovery of useful function in the transplant, using the best estimates for utility and probability that exist. Results: Our model revealed that when the probability of achieving a good result, graded as Chen level one or two is greater than 73%, transplantation is preferred over no transplantation. The decision is sensitive to the probability of major complications and the utility of a transplanted limb with minimal function. Conclusions: The results of this analysis show that under some circumstances given a high probability of satisfactory functional recovery, unilateral hand transplantation can be justified.

Publisher

SAGE Publications

Subject

Orthopedics and Sports Medicine,Surgery

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