The initial trial period of experimental human hand transplantation has proved successful far beyond expectations. The early and unexpected success of hand transplants has resulted in a 95% allograft survival in 22 hands transplanted onto 17 patients worldwide with an over-all early record of high-quality functional results, exceptional patient satisfaction, no mortality, and acceptably low morbidity. The 1- and 2- year graft and patient survival rate is 100%. These results beat the initial success rate of any organ previously transplanted. Our first patient, at 53 months post-transplant, is the longest surviving hand transplant recipient in the world. We expect more programs will follow the course of this new hand era and new hand transplant programs will be developed. The purpose of this abstract is to define donor-recipient selection criteria in hand transplantation. Hand Transplant Donor Criteria: 1) Age matched as closely as possible 2) Optimal skin color and sex matching with recipient is needed 3) Matching of bone length and diameter is mandatory 4) Living-related donors are not accepted at this time 5) A history of any malignancy (recent/remote or treated) is an absolute exclusion criterion 6) At organ procurement, the donor hand is dissected last but harvested first 7) The donor family consent process includes a discussion of cosmetic prosthesis for open casket funerals. Hand Transplant Recipient Criteria: 1) Must be in good state of health 2) Must be between 18 and 65 years of age 3) Congenital hand defects are currently not candidates 4) Blindness is currently an absolute exclusion criterion 5) Thorough pre-transplant psychological work up is mandatory for all hand transplant candidates 6) Use of or attempted use of prostheses prior to transplant is required 7) Ability to undergo rigorous rehabilitation to achieve good functional results 8) Level of amputation is important in recipient selection. In conclusion, hand transplant programs should consider these criteria during the donor-recipient selection in order to standardize their selection protocol.