Dr. Subramania Iyer is The only surgeon in India to do a hand transplant
Dr. Subramania Iyer, Head, Plastic and Reconstructive Surgery, at the Amrita Institute of Medical Sciences, Kochi (Kerala), and his team in 2015 conducted the first-ever successful double hand transplant in India on a young man. Since then, he has done two more hand transplants – the only surgeon in the country to do such a surgery. He spoke to Punjab Kesari about how people missing both hands can now get new hands and a new life.
- What are the main causes in India of people losing hands?
The main causes of loss of hands in India are accidents, cracker blasts and electric shock. I have seen many patients who accidently touched live high-tension wires and lost their hand at the forearm level.
- What is the process of getting a hand transplant in India?
Hand transplants in India are currently carried out only at the Amrita Institute of Medical Sciences in Kochi, Kerala, which conducted the country’s first hand transplant in 2015. Hand transplants are done under the supervision of the Kerala Network of Organ Sharing, an organisation run by the state government. All recipients need to be listed in this registry. Hand transplants can be done only when suitable matching hands are available for a patient.
- What are the issues you face in getting donors for hand transplants?
The hands can be procured only from brain-dead individuals whose family agrees to hand donation. There is often reluctance from the family due to the visible mutilation caused by donation of the hands. To overcome this, we fit the body with prosthetic hands after the donation. We at Amrita Hospital had to counsel several families requesting for hands for our first-ever transplant in 2015. But with increasing awareness, this reluctance is coming down, as is evident from the donation that happened for our subsequent double-hand transplants.
- How much does hand transplant surgery cost in India?
The current cost at the Amrita Institute of Medical Sciences ranges from Rs 15 to 20 lakhs for a double hand transplant.
- What is the success rate in hand transplant surgery?
The immediate success in survival of the transplanted limbs is 100 percent. However, some of these hands may get rejected due to immune system related problems, especially if the patient fails to take regular medications. The failure rate due to such reasons is about 2-3%.
- Can patients start using their hands normally after transplant? How much hand function can they regain?
It depends on the level of amputation. The nearer the amputation is to the wrist, the quicker is the return of the hand function. In these hand transplants, the return of the function is more than 95%. But when the hand transplant is done for elbow or higher level, the return of function might not be as good.
- Can those with a single hand missing also go for a hand transplant?
All hand transplant patients need to take medications to prevent rejection of their transplanted hands. These have some side-effects. The functional deficit associated with loss of both hands is much more severe than with only one hand. When the risk-benefit ratio is considered, hand transplant is fully justified for patients who have lost both hands, but not so in case of those with only one hand missing. Even though single-hand transplant is much easier to do, we at Amrita Hospital are currently doing only double hand transplants. Once we collect enough data on the response of the patients with double hand transplant, we can think of single hand transplants too, weighing carefully the risk-benefit ratio for patients.
- What kind of patients are ineligible for hand transplant surgery?
People who don’t have hands since birth are not suitable, as they may have poor development of the brain function responsible for moving hands. This may prevent the adequate return of function in the transplanted hands. People with hands missing from the upper arm onwards also do not qualify, as there may not be enough bone and nerve length available for attaching the transplanted hand. Severely mutilated arms are also not suitable, as they lack structures to connect to the transplanted hands.
- How complex is the hand-transplant surgery?
It is large-scale surgery, requiring about 30 medical and 20 paramedical experts. Apart from a good surgical team, a large setup involving immunologists, hand therapists, social workers, psychologists and pathologists is needed.
- What are the risks in hand transplant surgery?
The challenges with hand transplants are the long duration of surgery and the problems associated with immunosuppression medications. The period immediately after the surgery has to be very carefully managed to prevent life-threatening infections. But no untoward incident has ever been reported with any hand-transplant patient at Amrita Hospital or anywhere else in the world. Later on in life, if the transplanted hand gets rejected by the patient’s body, it can be salvaged by giving medications. However, there have been some instances where this was not successful and the transplanted hand had to be removed. But the life of the patient is not in danger in these situations. The other long-term problem is the side-effects of medications, but again, these are not life-threatening.
- Does one have to take medication lifelong after hand transplant?
Immunosuppressant medications have to be taken lifelong by patients and they have to lead a very strict, hygienic way of life to avoid getting infections. They also have to undergo physiotherapy and occupational therapy for the return of hand function.
- Can children also get hands transplant?
At present, hand transplants for children are not being carried out anywhere in the world. The ill effects of immunosuppressants when started at a young age are not considered ethically and medically justifiable.