Using Decision Analysis to Understand the Indications for Unilateral Hand Transplantation. (December 2016)

• Record Type: Journal Article
• Authors: McClelland, Brett; Novak, Christine B.; Hanna, Steven; McCabe, Steven J.
• Is Part Of: Hand. Volume 11:Number 4(2016)
• Page Start: 450
• Page End: 455
• Publication Date: 2016-12
• Subjects: hand transplantation -- decision analysis -- unilateral -- utility -- quality of life; Hand -- Surgery -- Periodicals; Hand -- Surgery; Periodicals; 617.57005
• DOI: 10.1177/1558944715628008
• Languages: English
• ISSNs: 1558-9447

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.