At 8:30 am on most days, as you walk into Global Hospitals at Parel, you can see Dr Nilesh G. Satbhai giving pre hand transplantation sessions to his patients. Dr Satbhai is a Consultant Plastic, Aesthetic, Hand and Reconstructive Microsurgeon at Global Hospitals, Parel. Global Hospitals is one of the two hospitals in the city with a licence to perform hand transplant, it got the license about 8 months ago
Hand transplantation in India is a rare treatment option. Rather most people, who come to ask for it in the beginning, want to give it a second thought after understanding the entire process. While explaining to his patients, he repeatedly says, “Hand Transplantation is the best possible reconstruction and rehabilitation for a bilateral and also most of the unilateral hand amputees. But it is a complex procedure with life-long commitment from the patient in terms of care, physiotherapy, medications, etc. I may sound over-cautious or negative at times, but I am giving you the real picture.”
The real picture however, seems like one which is dimly lit. For many, hand transplantation in India is unheard of. The first hand transplantation in India took place in 2015. Post which only three hand transplants have taken place in the country, all of which have been at Amrita Institute of Medical Sciences (AIMS), Kerala. However in India, 11 hospitals have licences to conduct hand transplants.
“I got about two consultations on hand transplant last month. But both of these are still under the process of receiving consent,” said Dr Vinita Puri, professor and head of the plastic surgery department at KEM hospital. Both of these consultations were from outside Mumbai, from the states of Punjab and Madhya Pradesh.
In Mumbai, two hospitals (namely KEM Hospital and Global Hospitals) have got the licenses to perform hand transplants, yet no transplantation has taken place in the city.
“Every month, at least three patients come to me enquiring about hand transplantations. But as I sit down with them and explain it in detail about post-surgery care. We need to understand that a hand transplant is a life enhancing treatment which requires care post-surgery like physiotherapy, medications, most of which will last for a lifetime. This is a huge logistical exercise and hence it may not be feasible for several hospitals to get the license,” explained Dr Satbhai.
Hand transplant is followed by post-operative treatment by physiotherapist and occupational therapist. In about one year of a transplant, the limb becomes 90 per cent normal, but some small muscles might not become totally functional or total blood circulation might not be normal. But with regular rehabilitation, in course of time, the transplanted limb becomes normal like a natural limb. “When a patient comes to us, we have to counsel them and tell them about the pros and cons associated with this procedure. Till now, we have not had any registrations for transplants,” said Dr Puri.
Doctors say that the reason for this is due to the misconception about costing. “Hand transplant is a costly surgery, but the recurring costs are much lesser than any artificial hand prosthesis. hence in the long term, it is a cost effective treatment. One time cost for a single hand transplant will be about Rs 15 lakh. A double hand transplant will likewise cost about Rs 20 Lakhs. The recurring cost of medicines etc. will be exclusive of this,” said Dr Satbhai.
“At KEM, the cost would be about a lakh and a half and later monthly immune suppression will be as per other transplants. This also can be reduced considerably with help from social workers and organizations helping the economically weaker families,” said Dr Puri.
Globally around 110 cases of cadaver hand transplant have been documented so far, with less than three per cent rejection to a new foreign body, say experts.
Immunosuppression medication also plays an important role in this treatment. These are also known by the name of anti-rejection drugs. Most people with organ transplants take these drugs for a lifetime. “Basically, these drugs suppress immunity and reduce your body’s reaction to foreign bodies and organisms. In the case of a hand transplant these medications will go on for a lifetime, like any other organ transplant. This is another important reason that patients need to keep in mind,” added Dr. Satbhai.
“People must also be able to accept that until now, they must have led a healthy life but the attachment of a foreign limb may require a different kind of lifestyle and mindset,” explained Dr Puri.
Awareness is a major hurdle in this process too. “The problem is poor awareness. People barely know about this procedure. There is a lot of counselling required for this treatment,” she added.