“When you lose your sight after being able to see, the world suddenly goes dark. In the same way, when you lose your hands after having them for many years, the world changes and feels nearly impossible to navigate,” says Dr S Selva Seetharaman, Director & Senior Consultant, Institute of Plastic, Aesthetic and Reconstructive Surgery at Gleneagles Global Health City.
Dr Selva could see these difficulties first-hand in patients such as 24-year-old Sadashivan (name changed to protect privacy). Sadashivan’s life shrank beyond imagination one awful day in 2018 when he accidentally suffered a high voltage electrocution and lost both his hands. Suddenly, he needed the support of his mother for even the simplest of chores.
Despite his losses, Sadashivan refused to give up hope of a more functional life, and those hopes were rewarded in May when a hand donor was found for him. Donated by a woman in Ahmedabad, the hand was airlifted to Chennai and transplanted onto Sadashivan in a 16 -hour marathon procedure. With this remarkable procedure, Sadashivan joins an exclusive group of just over 200 patients around the world who have received successful hand and arm transplants.
“We have seen many inspiring cases where people learn to be able to do remarkable things without their hands. But such feats are forced out of them because of necessity. And it is never an easy thing,” observes Dr Selva. Though accidents causing hand or arm amputations are not life-threatening in many cases, they rob patients of so much functionality and independence that many fall into despair.
In many such cases, one available option is a prosthetic limb. Prosthetics do offer some distinct advantages over hand transplants. There is no major surgery involved, no risk of rejection, readily available and no need to be on immunosuppressants for life.
However, there are significant limitations to a prosthetic arm. The basic ones simply provide the aesthetic appearance of an arm, while some of the more complex prosthetics even allow a limited range of mobility and use. “But that arm lacks sensation and you can’t touch or feel anything. Though such patients can do some tasks with their prosthetic arm, patients can get fed up with the regular fitting and the wear & tear of the prosthesis,” explains Dr Selva.
This is why the restored functionality of a transplanted arm has such a great impact on quality of life. Suddenly, patients can touch and feel with the fingers of the transplanted hand. With sufficient physiotherapy and learning, they can start to feel like that hand is their own again, the doctor says.
To be sure, hand transplants are highly complex procedures not to be undertaken without a lot of thought and effort. Patients have to undergo a comprehensive counselling process before they are registered for a transplant, says Dr Selva. Patients are registered only if they are highly motivated to follow through on the transplant.
The surgery itself is very complicated, as the human hand consists of 3 major nerves, 2 major arteries, multiple veins, tendons, bones, muscles, and soft tissue. Transplant surgery requires doctors to fix bones together, reattach multiple arteries and veins and repair muscles, tendons and nerves. All these procedures are done with greatest precision which is required for the functional recovery. In Sadashivan’s case, this required the expertise of 8 plastic surgeons, 4 orthopedicians, a vascular surgeon, 4 anaesthetists, a nephrologist (transplant immunology), and 30 paramedical personnel, led by Dr Selva.
Importantly, there are limits to which patients can receive a hand transplant. Doctors can only perform transplants in cases of accident, and the surgery cannot be done for patients with birth deformities. This is because a hand transplant relies on existing nerves, muscles, bones and other tissue to connect the transplanted limb. In patients with birth deformities, such tissues are not likely to have properly developed, explains Dr Selva.
Despite the revolutionary and lifechanging impact of hand transplants, says Dr Selva, just over two hundred patients have benefited across the world and only a handful in India. One of the major reasons for this is a lack of sufficient donors.
Donors must fulfil certain conditions for the donated hands and arms to be viable. They must have suffered brain death but with activity in other parts of the body. While such situations occur with certain kinds of death, particularly from road accidents, patients families are often much more unwilling to donate hands than other organs.
“People are much more willing to donate internal organs, but not hands, because that feels more to them like mutilating the body. While we understand this feeling, they should consider the benefit they can give to others. Donors’ body will be fitted with a prosthetic hand so that the physical appearance of the donor is not altered. Hence their families need not worry on that aspect,” says Dr Selva.
While Sadashivan had a three-year wait to regain a hand, some other patients have been waiting much longer and this can only change if more awareness is created about hand transplants and the stigma around hand donation is removed.
Sixty days after his surgery, Sadashivan showed all signs of a successful recovery from the transplant. Despite the intensive physiotherapy he is undergoing, he is all smiles at the gift of a second chance at life without need of constant support.
Dr S Selva SeethaRaman
HOD & Senior Consultant
MS, DNB(Sur), MCh (Plastic), DNB (Plastic), MRCS, Fellow (TMH), PGDHHM, PGDMLS
Institute of Plastic, Aesthetic & Reconstructive Surgery
This article was published in association with Gleneagles Global Health City, Chennai.