No helping hand

Chennai: The first hand transplantation programme was launched in the state at Stanley Medical College and Hospital more than seven years ago and it was considered a major relief to trauma victims.

But there has been only one hand transplant performed till now and around 200 patients remain on the waiting list due to lack of donors and taboo related to hand transplantation.  

As per the data available with State Health and Family Welfare Department under Deceased Organ Transplant Programme, a total of 6,481 organ donations has been undertaken in Tamil Nadu from October 2008 to May 2018, of which only two of them were hand transplants.

Though the Transplant Authority of Tamil Nadu (Transtan) boasts of topping the list of highest number of organ transplants in the country, it does not sufficiently support hand transplants. The donor card mentions all volunteer donations of organs such as liver, kidney, cornea, lungs and heart but not hands.

“After government doctors at plastic surgery departments at government hospitals insisted on mentioning hand donation in the volunteer donor card, Transtan authorities offered choice to mention it under ‘others’ category,” said a plastic surgeon at government general hospital in the city on condition of anonymity.

Though fear of disfigurement and amputation of the body of the deceased person is the major reason behind poor donor rate for hand transplants, government authorities do not seem to pay attention on initiating awareness programmes for the same.

The Director of Medical and Rural Health Services issues registration certificates under the Transplantation of Human Organ Act, 1994 to applying hospitals to allow for conducting transplants.

Around 130 hospitals have registered for performing liver, heart, lungs, renal and heart valve transplantations.

However, only three hospitals are registered to perform hand transplants in Tamil Nadu Stanley Government Medical College and Hospital, Global Health City in Perumbakkam and SRM Institute of Medical Sciences in Vadapalani apart from medical superintendent at Stanley Medical College.

 The first hand transplantation in India took place in 2015 at Amrita Institute of Medical Sciences in Kochi. With 11 licensed centers for conducting hand transplants all over the country, only three hand transplants have been conducted at Amrita Institute of Medical Science in Kochi till date apart from the one conducted in Tamil Nadu.  

“It has been more than five years since Global Health City registered for performing hand transplants, but not even one donor has been registered. We have four patients in the waiting list, three from India and one from abroad.  but no surgeries could be performed due to lack of donors,” said Dr Selva Setharaman, hand transplant and plastic surgeon at Global Health City.

Similarly, patients are in queue for a hand transplant at SRM Institute of Medical Sciences also, but no donors have registered yet, said hospital authorities. While unwillingness of donation of limbs by the family members remains a major factor for the small number of donors, the Transplantation of Human Organs and Tissues Act medically allows transplantation of a hand, or cadaver, only from patients who have suffered a brain-stem death, i.e. irreversible damage to brain turning it non-functional.

 “Ever since the hand transplant has been performed at the hospital, we have patients lining up from various parts of the city and other neighbouring states. Though waiting list is on an increasing trend, not even one donor has been registered at the hand transplantation programme centre at Stanely Medical College and Hospital after the successful surgery,” said Dr V. Ramadevi, head of department and professor, plastic surgery, at Stanley Medical College and Hospital.

Surprisingly, in a period of 10 years there were only two donors and only one successful transplant that was performed in February this year. The first dual transplant was attempted in December 2017, which turned unsuccessful. Not many people are aware of a hand transplantation procedure. “After the first successful hand transplant, we hope that more people will become aware of the procedure and its success. People did not know because they have not heard of or seen a hand transplant case.” says Dr Ramadevi. Cost is also considered to be relatively high, however, in Tamil Nadu the cost is covered under Chief Minister’s Comprehensive Health Insurance Scheme, which otherwise costs around Rs 20 lakh in other hospitals.

Religious beliefs work against hand transplant

The family of 37-year-old Venkatesan donated his arms after he succumbed to injuries in an accident to 29-year-old Narayanaswamy against religious and spiritual beliefs.

Family volunteered to donate the hands to benefit others. However similar perception on arm donation does not prevail in society.

A mason by profession in Dindigul, Narayanaswamy lost both hands due to electrocution in 2015. M. Venkatesan, a resident of Manali,  who was declared brain dead after a severe brain injury dead was the donor of limbs for Narayanaswamy. Venkatesan tripped from the stairs at his house in Manali and was declared dead as he could not recover even after an emergency surgery.

Kin of Venkatesan say that they agreed to donate the organs including the hands thinking that it could benefit others and would help an individual have hands like of his own.

Religious beliefs are a major setback to the families of eligible donors as they do not want the visible organ of the deceased to be amputated. With traditional beliefs being a dominating factor in the country, burying or cremating a body with a missing part is considered unacceptable.

“After transplantation of other organs, one cannot visibly see that the organs have been removed, however, in case of hands, it is clear that the hands have been amputated and prosthetic hands replace it, which is psychologically difficult to accept by the family members of the deceased. A series of counseling has to be undertaken to convince them to donate hands,” says consultant plastic surgeon at Sri Ramachandra University, Dr M Jyotsna.

Plastic surgeons say that kin of deceased person may get angry if hospital authorities ask for hand donation due to emotional reasons. Some families see that organ donation is of financial benefits to the hospitals and therefore do not agree to donate organs.

It is not only the donor family that needs to be convinced but also the recipient has to undergo a series of counseling procedures to accept the hands of another person. There have been instances when the recipient wanted their hands removed few months after the surgery, as they were not ready to accept someone else’s hands, say doctors.