Worldwide, more than 100 hand-arm transplantations have been performed since 1998. However, in the Netherlands an upper limb transplant has not yet been performed. Following the presentation of a feasible recipient candidate in 2015, a platform has been created in the Radboud University Medical Centre in Nijmegen, the Netherlands, to be ready for the first upper limb transplantation. The patient in question lost both her legs below the knee and both hands due to severe sepsis in 2014 and is highly motivated and psychologically strong, making her an ideal candidate for a bilateral forearm transplant. The aim of this paper is to describe the history of limb transplantation and the ethical and medical aspects of initiating a vascularised composite allotransplant program. Recipient screening and donor selection are highlighted, the surgical procedure is portrayed and postoperative protocols including immunosuppressive therapy and rehabilitation are presented. © 2019, Netherlands Society of Intensive Care. All rights reserved.