On 12^th October 2020, MOHAN Foundation organized a webinar as part of the Synchrony Dialogues series. This session titled ‘Hand and Limb Transplant’ was held after Dr. Sunil Shroff, Founder & Managing Trustee, MOHAN Foundation who was featured in one of the special ‘Karamveer’ episodes of Kaun Banega Crorepati (KBC) on Sony Entertainment Television (SET) on 9th October 2020. After this broadcast, the public reach on the noble cause has been augmented and the Foundation received several queries, especially on hand and limb transplant. The discussions were live-streamed on MOHAN Foundation’s Facebook and YouTube platforms to reach out and benefit a wide range of the public. The session began with a short video clip about the current scenario and the emerging need for organ donation in India.

 

Ms. Jaya Jairam welcomed the audience and introduced the panelists. The panel discussion was moderated by Dr. Shroff. The panelists were – Dr. Subramania Iyer, Professor and Chairman of Plastic and Reconstructive Surgery / Head and Neck Surgery /Oncology and Craniomaxillofacial Surgery at the Amrita Institute of Medical Sciences, Dr. Nilesh G. Satbhai, Plastic Reconstruction Surgeon Global Hospitals, Parel, Mumbai, Dr. Dinesh Kumar S, Chief Reconstructive Transplant Surgeon, Department of Plastic Surgery, JIPMER, and Ms. Shreya Siddanagowder, Asia’s first upper arm double hand transplant recipient and patient of  Dr. Subramania Iyer.

 

Dr. Shroff began his talk by saying that after the KBC program, he looked forward to an increasing number of people and families who will know about the noble cause and will decide to sign up for organ donation. He conveyed his hearty thanks to all those who reached out to the Foundation and for supporting the cause. He also said that the live discussion with the experts as panelists was organised to address queries of the general public regarding hand and limb transplants.

 

Dr. Shroff informed the audience that throughout India there were only four surgeons who had so far done hand transplants and that out of the four, three transplant surgeons were available as panelists in today’s webinar. Dr. Iyer conveyed his appreciation for the tremendous amount of information on organ donation and transplantation that was conveyed through the KBC program. He added that this program was a boon to many out there who wanted to clarify their doubts about hand transplants. The panelists one by one answered the queries as Dr. Shroff facilitated it for them.

 

The key points from the discussion are as follows:

 

Indications for a hand transplant

 

Dr. Subramania Iyer said:

• In India, people who suffer from loss of bilateral hands are considered as the main disability and are given priority for transplant surgery
• Hand transplant recipients also face some risks along with the gift of life transformation
• For a bilateral amputee, the amount of benefit always wins over the number of risks faced after the transplant
• The second priority for hand transplant is given to those who have lost their dominant hand
• Congenital absence of hand is not an indication

 

Scope for lower limb transplant

 

Dr. Nilesh G. Satbhai said:

• Lower limb transplant has so far experimented with in two centres worldwide.
• For those who require a lower limb transplant, it is always good for them to assess if it is worth taking the risk of immunosuppressants.
• There is prosthesis available for lower limb that is quite advanced and successful.
• Leg transplant could be justified in case if the same patient had already been a recipient and is under immunosuppressants.

 

Dr. Dinesh Kumar said:

• Lower limb transplant will be poorer in contrast to the upper limb transplant in terms of neurological outcomes.
• Lower limb deficit could be solved through a device like blade prosthesis as it’s a simple one-direction movement.

 

Time duration to regain functionality after hand transplant surgery

 

Ms. Shreya Siddanagowder said that   

• It took more than a year to get significant functionality after transplant surgery and for the colour of her transplanted hands to match her skin colour.
• She would rate the functionality of her transplanted hands between 85% and 90%.
• The hand transplant recipient needs to diligently follow physiotherapy exercises for good results.

 

Size of the team performing the operation and duration of the surgery & success rate of hand transplantation

 

Dr. Iyer said:

• Approximately, it takes 14 to 16 hours to complete the hand transplant procedure
• The hand transplant team almost requires 40 members for efficient time management
• Cold Ischemia time, not more than 6 hours is acceptable as there are also logistic challenges 
• There are 90% success rates for hand transplants worldwide, the reason for 10% failure might be due to chronic rejections and surgical issues

 

Update on the advanced prosthesis

 

Dr. Nilesh said:

• There is advanced prosthesis available worldwide up to INR 30 lakhs
• Some major drawbacks of prosthesis include lack of sensory capabilities and inadequate adaptability to all situations.
• Hand transplant surgery is a cost-effective treatment compared to prosthetics

 

Shreya who once was a prosthesis user also shared her perspectives saying that she had spent almost INR 5 lakh and it was not worth it.

 

Cost of hand transplant surgery

 

Dr. Iyer said that the whole hand transplant procedure costs between INR 18 to 22 lakhs and including the medication for 10 years (mandatory) it costs up to INR 30 lakhs. All other panelists agreed with him. Shreya added that she spends up to INR 6000 every month on immunosuppressants

 

The session also involved a Q&A time. Some of the questions that were asked by the audience are mentioned below:

1. What are the options, in case of losing the right hand?
2. What could be done if both hands are lost?
3. What are the side effects of immunosuppressants?
4. Is there any progress with stem cells? Is a bionic hand a better option for a congenital deformity? And does bionic hand also need immunosuppressants?

 

In the end, all the panelists shared their views on how to intensify efforts to spread the cause of organ donation. The session was then concluded leaving positive thoughts for those who are waiting for a hand transplant.

 

Click here to watch the video.