Hand transplantation: is it an ethical decision, a bioethical one, or both?

Essays by Seigler and Emmanuel define some criteria and requirements when doing an innovative procedure such as hand transplantation to determine whether it is possible to conduct clinical research. These criteria and requirements take into account the patient, the medical team, and society. However, we think that there are still other considerations that have not been given sufficient emphasis to justify an innovative procedure and are mainly determined by the patient and his environment, along with other quality-of-life issues, including social acceptance (according to cultural norms), appearance (body image), and function. There should be a balance between the patient, the medical team, and societal considerations in the decision process. Progressive societies are responsible for the distribution of the necessary resources to perform innovative procedures while controlling the costs of integral treatment and ensuring related investigations, thus facilitating the evaluation and advancement of innovative surgery. If these factors are taken into account along with the criteria already outlined involving the patient's cultural dimensions and the involved costs a decision can be made whether to proceed with hand transplantation. Being a difficult complex decision, it is imperative that it be made not only by an individual or group, either the patient or the medical team (ethical decision), but in conjunction with public discussion (bioethical decision) that not only takes into account the risks, benefits, and costs, but by including all criteria must also be at least technical, human, and social.