Hand transplantation still an evolving area

Warren C. Breidenbach (left) explains hand transplantation while on a visit to Ganga Hospital in Coimbatore. Hospital Director and Plastic Surgeon S. Rajasabapathy (centre) and Plastic Surgeon at the University of Manchester Duncan McGrouther (right) are in the picture.After the first hand was transplanted in Ecuador in the 1960s, the prospect of harvesting a visible organ from a brain-dead patient and fixing it on an amputee still remains an evolving area in medical science.

Reduced life span because of drugs and also their high cost are among the factors that have kept patients away from opting for it, compared to kidney and even heart transplantation.Bringing down the amount of drugs, especially the immuno suppressants and steroids, is a key area of focus now to prevent the reduction of the life span of the patient, according to transplant specialist and Assistant Clinical Professor of Surgery (Plastic and Reconstructive) at the University of Louisville, Warren C. Breidenbach.So far, 33 transplants have been done worldwide, with 26 in the U.S. and the U.K. The patient in the first surgery in Ecuador lasted two weeks. The next one was in September 1998 at Leone in France and the survival was for two years. The longest surviving is the case done at Louisville in the U.S. in 1999 - the patient is still alive.

Along with Dr. Breidenbach, Professor of Plastic Surgery at the University of Manchester in the U.K. Duncan McGrouther and plastic surgeon and Director of Ganga Hospital in Coimbatore S. Rajasabapathy explain the issues that surround hand transplant.“It is not as easy as a kidney transplant wherein we place the donor kidney, join the blood vessels and shut up the recipient,” points out Dr. McGrouther. Getting the hand from a brain dead patient involves a lot of persuading the relatives. And, the recipient-amputee should also be told clearly of the risks such as reduced life span. The surgeons say that the choice is between living shorter with a new hand and living longer without it.

“This is not like any other emergency case where an accident victim can be provided with a donor hand from a brain-dead patient in the same hospital,” says Dr. Breidenbach.“The amputee will have to be given six months to a year for psychotherapy and to use a prosthetic hand. And, most people do not want a transplant done because it does not in any way increase their number of years of life as in the case of a heart or kidney transplantation.” As for the hand, it is only “quality of life transplantation,” he says. Dr. Rajasabapathy says hand transplantation is an elective surgery. And, the patient can choose whether to undergo it. Not having a transplant will not reduce the number of years of life. Dr. Breidenbach, however, points out that people who have lost both their hands may be inclined to go in for it.

“We need to be transparent while explaining the risks, as we need the patients’ informed consent,” notes the surgeon.But, there are some hopes in hand transplantation, especially with the focus on reducing the amount of drugs and thereby their impact. “The last surgery was done on November 29, 2006. We had used a new drug that eliminates the need for steroids, which are a major cause of complications.” Steroids can cause avascular necrosis in the hip (lack of blood supply to the hip bone that causes death of cells and tissues).Dr. McGrouther says the emerging area of tissue regeneration may help in growing a part of a hand in the laboratory and then attach it to a person.“When frogs and salamanders can regenerate limbs or other organs, genetic engineering may be able to bring out this locked up ability in the human system,” he says.

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