Starting a hand transplant program poses tremendous challenges. Solid organ transplantation and hand replantation are time-tested procedures and are now standard of care. Hand transplantation is the amalgamation of the scientific principles of reconstructive surgery and the concepts of organ transplantation. Thus, for any hand transplant program to be successful, there must be collaboration within a multidisciplinary team comprising a core group of hand and transplant surgeons. Such a joint effort can overcome the challenges that are inherent in a complex therapeutic option that integrates different disciplines and organizations during the planning, procedural, and posttransplant phases.