An NHS trust in Leeds will be the first hospital in England to offer hand transplants.
Leeds Teaching Hospitals NHS Trust will begin assessing patients and performing the operation from April 2016.
Hand transplants are the "only method of reconstruction that looks and functions like a normal hand", say the NHS. When successful, the replaced limb moves with almost as much strength and dexterity as a non-transplanted hand, can sense surroundings, is warm to the touch and is able to heal itself when injured.
Patients have to be carefully screened for the procedure, and it is estimated that between two and four patients will be listed for surgery every year.
"The NHS are leading the world in offering this cutting edge procedure, which has been shown to significantly improve the quality of life for patients who meet the criteria," said Jonathan Fielden, Director of Commissioning at NHS England.
After patients are psychologically screened, a limb must be found that matches the patient in terms of blood type, immunology, arm size and skin tone. The procedure itself takes around six to twelve hours, depending on complexity of the case, and involves four teams of surgeons working simultaneously. The two bones in the upper arm are attached to each other with titanium plates, and tendons and muscles are attached. Key blood vessels, including two arteries in the upper arm, are also connected so that blood can flow into and out of the limb as quickly as possible.
The hospital was home to the UK's first hand transplant in 2012. The recipient, Mark Cahill, has now regained "almost complete use of his hand", allowing him to tie his shoelaces, carry his granddaughter and drive. He describes his quality of life since the transplant as "fantastic".
Around 80 hand transplants have been performed throughout the world, with high success rates when patients are psychologically and physically prepared. Patients also have to take medication to prevent limbs being rejected. Like Mark Cahill, most recipients have been happy with the results of the operation; two in five said the results had been "excellent", 53 percent said "good" and 7 percent rated the outcome as "fair", with none giving a negative score.
