what you need to know

What is hand transplantation?

It is a surgical procedure to transfer hands from deceased person to a patient who has lost one or both hands. It greatly improves the quality of life, providing better mobility and greater independence to the patient.

How is hand transplant different from other transplants?

It is a composite tissue transplant. Unlike other solid organ transplants like liver, kidney and heart, the hand transplant involves several tissues like skin, fats, muscles, tendons, cartilages, blood vessels, nerves and bones. The solid organ transplant starts working immediately but the transplanted hand takes 3month to 1 year, depending on the level of transplant. Transplants at lower level will start functioning early.

Who is a good candidate for the surgery?

The patients who had above or below the elbow amputation resulting from injury, trauma or medical conditions which cannot be successfully restored using currently available standard reconstructive procedures.

How is the recipient prepared for hand transplant surgery?

Patient undergoes an extensive screening process that can take several months. He will receive medical and psychiatric evaluations to assess health, social support, and the ability for self-reliance and compliance with physician-directed care. Only those candidates who meet specific selection criteria are placed on the waiting list for the transplant.

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 accidentally touched live high-tension wires and lost their hand at the forearm level.

Can patients start using their hands normally after transplant?

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 per cent. 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?

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 are currently doing only double hand transplants. Once we collect enough data on the response of the patients with a double hand transplant, we can think of single hand transplants too, weighing carefully the risk-benefit ratio for patients.

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 set-up 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 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 not in India). The other long-term problem is the side-effects of medications, but again, these are not life-threatening.

Can children also get hands transplant?

At present, hand transplants for children are not being carried. The ill effects of immunosuppressants when started at a young age, are not considered ethically and medically justifiable.

What is the role of immunosuppression in hand transplantation?

The recipient immune system treats the transplanted hand as a foreign body causing rejection. Immunosuppressants are anti-rejection medicines which prevent the rejection by reducing the immunity of recipient’s body. These medications affect all the systems and organs in the body. Rehabilitation is critical in improving the functional outcome after hand transplant’. The risks of long term immunosuppression include hypertension, diabetes, increasing risk of infections, liver and kidney dysfunction and increase the risk of developing cancer. Because these drugs have to be taken for lifelong, the risk of immunosuppression is a concern.