Donorarm

Donorarm is the transplanted upper limb graft taken from a deceased donor as part of vascularized composite allotransplantation (VCA). The donor limb typically includes skin, soft tissue, muscle, forearm and hand bones, nerves, and blood vessels. It is transplanted to a recipient with extensive upper-limb loss when conventional prosthetics or reconstructive methods cannot restore functional sensation and movement to an acceptable level.

Donorarm limbs are recovered from brain-deceased donors after matching for anatomy, blood type, and immunologic compatibility, with assessment for infection risk and overall suitability. The transplant procedure requires microsurgical connection of arteries and veins, fixation of bones, and repair of nerves and tendons, followed by soft-tissue coverage and skin closure. Patients undergo structured rehabilitation, and long-term immunosuppression is necessary to prevent rejection.

Outcomes are highly variable. Some recipients achieve sensory return and partial motor function, but full restoration is uncommon. Nerve regeneration is slow, and meaningful function can take months to years. Risks include graft rejection, infection, cancer, and other complications of lifelong immunosuppression, as well as surgical complications and psychosocial challenges.

Ethical considerations include donor consent, balancing risks and benefits, access and cost, and managing expectations. Donorarm transplantation remains a specialized option for select patients with severe upper-limb loss, pursued when potential functional gains justify the risks and commitment of lifelong therapy.