In September 1998 the world's first hand transplant was performed in Lyon, France. A new era in reconstructive surgery had begun. This case highlighted the potential for composite tissue allotransplantation (CTA). While CTA is not a new technique, it unifies the principles of reconstructive microsurgery and transplant surgery, achieving the goals of absolute correction of a defect with anatomically and physiologically identical tissue with none of the issues of donor site morbidity associated with autologous tissue transfer. The adoption of this technique for non-life threatening conditions to improve quality of life has generated a number of new ethical considerations. Additionally, the prominence of transplanted hands has led to much discussion around the issue of body identity and psychological assessment of potential recipients. This is fundamental to any hand transplantation programme. With the advent of hand transplantation dawning in the UK, we review the many ethical considerations that contribute to this new frontier.