Psychological assessment in hand transplant patients: The Leeds hand transplant clinical psychology protocols

Hand loss is devasting, psychologically, socially and occupationally, and has been seen as irreversible. Hand and upper limb transplantation (HAUL-T) offers the potential for restoration of function, independence, completeness and improved quality-of-life. However, the risks of lifelong immunosuppressive medication make it controversial. Successful transplantation requires appropriate patient selection, with a degree of conformity to the "ideal patient" required, both psychologically and physically, to prevent rejection. Psychological assessment protocols are at present not published. The Clinical Psychology Protocols (UKCPP), designed for and used in the only centre in the UK undertaking HAUL-T are described here. We examine the attributes required of recipients using semi-structured interview and psychometric assessment. This involves detailed evaluation of several important areas: the patient's setting and personal attributes, the ability to undertake complex decision-making and informed consent, realistic expectations of post-operative physical and psychological outcome, strong motivation, an ability to cope with a complex and challenging process, and to adjust successfully. The UKCPP have now been used for over 60 patients and found to be fit for purpose.