Youth who lost two limbs to gangrene to undergo hand transplant

At 92, Mumbai's biggest civic hospital is all set to create a national record by becoming the first state government-run medical institution to perform a hand transplant on a patient. After a wait of two years, the hospital has finally registered a 25-year-old, who lost both hands to gangrene, for the surgery this month-end.

In 2016, the plastic surgery department of KEM Hospital was granted the certificate to carry out hand transplants. However, the hospital didn't get any recipients despite conducting several awareness programmes. Now, finally, a 25-year-old patient, who refused to reveal his name, is ready for it, becoming the first in India to undergo such a surgery in a civic hospital.

In India, only Kochi's Amrita Institute of Medical Sciences, a private hospital, has performed three hand transplants so far.

Donor search soon
Talking to mid-day, Dr Vinita Puri, head, Department of Plastic Surgery at KEM Hospital, said, "The patient is a case of post-infective gangrene in both limbs. Due to the infection, his hands had to be amputated to save his life. Later, when he got to know about the hand transplant procedure at our hospital, he approached us. "He'd come to us months back, but we registered him only recently, as it took us a long time to carry out the diagnosis and complete the formalities."

She refused to divulge any more information about him citing doctor-patient confidentiality. Currently, the operation theatre of the plastic surgery department has been closed for repairs. Once those are completed, search for a donor will be initiated.

Dr Hemant Deshmukh, dean, said, "A successful hand transplant will give a ray of hope to thousands of people who lose their hands. As it will be done at a civic hospital, the surgery will be free of cost, so even the poor can benefit."

About the procedure
Hand transplantation is an extremely complex procedure. The surgery can last up to 16 hours, as compared with eight hours for a heart transplant and 12 hours for a liver transplant. Only a brain-dead person's hand/s can be considered after securing the family's consent.

The goal of the procedure is to give the patient functional limb(s) with the transplanted hand(s). The patient has to undergo clinical evaluations - a physical examination, X-rays, psychosocial evaluation, nerve conduction studies, tissue studies and laboratory studies.

Hand transplant patients have to be on immunosuppressive therapy - drugs that must be taken daily for life. This therapy is similar to the one kidney transplant patients are kept on.

Donor selection criteria

• Total and irreversible damage to the brain
• Family's consent to donation
• Matching limb size and blood type (mandatory requirements)
• Matching gender, skin tone, race and age (individual preferences, not mandatory)

Patient criteria

• Aged between 18 and 60
• Amputated just above the wrist
• Bilateral or dominant hand amputation
• Understands advantages and risks involved in this surgical technique
• Is otherwise healthy, physically and mentally
• Is able to give informed consent
• Indian resident
• Willing to live in Mumbai for a year for follow-up

Unsuccessful for Monica
In 2014, Monica More, then 19, lost her hands after falling on the railway tracks through the gap between the train and platform at Ghatkopar station. She, too, was supposed to undergo a hand transplant, but her case didn't proceed further. She, currently, has been fitted with prosthetic hands.

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