India has the capability and skills required to emerge as a center of excellence in hand transplants, but there is an acute shortage of donors due to lack of awareness and reluctance of families of potential donors
India’s top hand-transplant surgeons from Kochi’s Amrita Institute of Medical Sciences – a center of excellence in hand transplants – have urged the Government and the healthcare industry to come together to launch a national campaign for hand donation. There is an urgent need to create awareness about hand transplants in India, and encourage people to sign up for hand donation, they said at a workshop on hand transplants here by the hospital.
Said Dr. Subramania Iyer, HOD, Plastic & Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, who led the team of surgeons which successfully conducted India’s first-ever hand transplant in 2015: “Very few countries in the world have the capability to conduct hand transplants more so in Asia. India is now one of them. However, neither the potential recipients nor the donors or their families are much aware that hand transplants are now possible in the country. Thousands of hand amputees continue to lead the life of a cripple without realizing that with hand transplants, they can get as much as 95 percent of hand functionality back and lead a normal, productive life. It is not the shortage of skills but the shortage of donors that are the main challenge in hand transplants in the country.”
Despite hundreds of people losing their hands every year due to various causes, there have only been a total of five hand transplants in India till now in India, four of them conducted at the Amrita Institute of Medical Sciences. In 2015, 29-year-old Manu TR, who lost both his hands when thrown out of a moving train by goons, became India’s first hand transplant recipient.
Three more hand transplant surgeries were thereafter conducted at Amrita Institute of Medical sciences, the last one in October 2017 when Shreya Siddanagowda, a 19-year old engineering girl student studying at Manipal University, got the gift of a new pair of hands from a male brain-dead donor. She is now undergoing post-operative therapy sessions. The first three recipients – Manu TR, an Afghan soldier who lost both his hands in a landmine blast, and a young man from Kerala working as an electrician – have already returned to their jobs and are leading an independent, productive life.
Explains Dr. Mohit Sharma, Professor, Plastic & Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, who is a part of the hospital’s hand transplant team: “Hand transplants are not life-saving but life-altering. They are entirely different from other transplants – the age, color, size, sex and even skin color of the recipient and donor need carefully matching. The complex surgery is conducted by a team of 25 surgeons and 12 anesthetists across 14 to 16 hours. There is only an 18-hour window in which the donor’s hands must be transplanted. The surgery today costs about Rs 20 lakhs, and the patient needs to stay in the hospital for a month.”
Arms are harvested from a brain-dead donor. Each tendon, artery, nerve and vein is identified and tagged. The bones are then connected with metal plates to the body of the recipient, and a total of 25 tendons, 2 arteries, 6 nerves and 5 veins are carefully reattached.
Said Dr. Subramania Iyer: “India is emerging as a center of excellence in organ transplants. While there is lot of awareness about donation of organs like cornea, liver and kidneys, not many people know that hands can be donated too. Hand transplants is an evolving field less than 20 years old, yet it has the potential to contribute significantly to medical tourism. For example, we have successfully conducted double hand transplant surgery on an Afghan soldier who has now gone back to Afghanistan and got his job back. But for hand transplants to be more common, we need adequate number of donors. We have received more than 1,000 enquiries for hand transplants from across the country and even abroad, and dozens of patients are actively waiting for donors, yet only four or five hand transplants have been conducted in India since 2015, compared to kidney or liver transplants which are routinely conducted every week.”
Dr. Subramania Iyer added: “Hands can be procured only from brain-dead donors. While traumatized relatives of the deceased readily agree to cornea donation and even of internal organs like kidneys and liver, there is marked reluctance in case of hand donation due to visible mutilation of the donor’s body. As awareness about hand transplants increase, the reluctance of the families to donate hands will come down. The media has a very important role to play in creating this awareness in the society. The Government too needs to provide financial aid to double hand amputees for hand transplants, as majority of the patients cannot afford the surgery. Organ donations will also get a boost by creating more awareness among doctors about the phenomenon of brain death. Unfortunately, the current MBBS curriculum doesn’t teach about brain death or organ donation at all.”