Boston Children's Hospital, a home to the world's largest research enterprise, has started recruiting subjects for the world's first paediatric hand transplant programme. The Boston Children's Hand Transplant Programme is a research-based programme that will offer bi-lateral hand transplants for children living without two functioning hands.

The Programme will be led by principal investigators Amir Taghinia, MD, and William Harmon, MD of the Hospital.

The Hand Transplant Programme operates under a research protocol reviewed and approved by the hospital's Institutional Review Board. Potential subjects will be children over 10, in good overall health, who for one or more years have been missing both hands. In addition, children who are missing one hand but are already on immunosuppression medication for a functioning solid organ transplant, or missing one hand and the other hand is poorly functioning, will also be considered.

"In recent years, medical knowledge, expertise and technology have evolved to a place where we are able to offer this as an experimental option to patients on a research basis," said Taghinia, who serves as the programmes principal investigator and surgical director and has participated in several adult hand transplant surgeries. "We hope that for some children, hand transplants will improve their quality of life, allowing them the ability to be more independent and perform daily tasks - tasks that many of us take for granted."

The complex surgery requires a multidisciplinary team and will be followed by extensive therapy and follow-up care. The process will include a rigorous screening evaluation ensuring that a child is in good health and likely to comply with all treatment protocols.

The programme combines the expertise and experience of the hospital's pediatric hand surgeons and the Paediatric Transplant Centre. The hospital currently offers programmes for heart, liver, lung, kidney, and intestine and multivisceral transplants.

"It has been shown in adults that hand transplants can be safe and effective; the time is right to bring this to a younger population," said Harmon, the co-investigator and medical director of the programme, whose body of research has helped form the basis for defining the immune process in organ transplantation. "We know from experience that kids can regenerate nerves better than adults and believe that their immature immune systems can learn to adapt to a transplant successfully."

To date, only one hand transplant has occurred in a child - a twin-to-twin transplant in Malaysia in which one twin passed away and one of the twin's arms was used to replace a missing limb in the surviving twin. There have been no transplants from a donor to a genetically different pediatric patient.

The transplant team will work with organ procurement organisations in the region and across the country to coordinate the donation process.

"For nearly 45 years, New England Organ Bank has partnered with hospitals to advance the field of transplantation to the benefit of tens of thousands of recipients," said Richard S Luskin, president and CEO of New England Organ Bank. "We look forward to working closely with Boston Children's Hospital to bring the possibility of hand transplantation to young patients in need."

Boston Children's Hospital is now a 395 bed comprehensive centre for paediatric and adolescent health care grounded in the values of excellence in patient care and sensitivity to the complex needs and diversity of children and families. Boston Children's is also the primary pediatric teaching affiliate of Harvard Medical School.