A Boston hospital is opening the first ever hand transplant program for children. “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,” Dr. Amir Taghinia, surgical director and principle investigator of the program, said in a statement.

Potential subjects must be ten years of age or older and have been missing two hands for a period of a year or more. Children missing one hand may also be eligible for the program under certain conditions.

The only hand transplant to ever be performed on a child was in Malaysia. In that case, involving twins, one of the siblings passed away. The surviving twin, who was a missing a limb, received the arm of her deceased sister.

However, there have been no transplants between a donor and a patient who are not related.  One of the risks of the surgery is the side effects from medicines given to prevent rejection of the new hand.  In the case of the twins, the drugs were not needed.

The loss of a hand may occur after an accident or an infection. Some children are born without hands.

Dr. William Harmon is a co-investigator and medical director of the program. He says, “We know from experience that kids regenerate nerves better than adults and believe that their immature immune systems can learn to adapt to a transplant successfully.”

A human hand contains more than 25 bones, 20 tendons, three major nerves and many veins and arteries. The surgery can take anywhere from 12 to 18 hours and requires two surgical teams. After the procedure, teams of doctors, nurses, social workers and psychologists help the patient through the first stages of the recovery process.

The hospital will cover the cost of the pre-transplants screenings, the operation itself, and three months of post-operative care.

After working on adult hand transplants at Brigham and Women’s and Massachusetts General Hospitals, Dr. Taghini says he was always thinking of his younger patients. “Over the years, I worked with many children who had hand conditions that could not be helped with traditional surgery,” he said in a blog post on the Boston Children’s Hospital website.

With a transplant, Dr. Taghinia hopes children can become more independent and perform many of the daily tasks—feeding themselves or going to the bathroom–we take for granted. Even more than their functionality, however, Dr. Taghinia says hands “help define us. Whether expressing emotion through hand gestures, or touching a loved one, our hands are usually deeply involved in our interactions.”