An expert committee set up by the Regional Organ and Tissue Transplant Organisation – and State Organ and Tissue Transplant Organisation (ROTTO-SOTTO) has chalked out new guildelines for hand transplants. According to the new guidelines, artificial limbs will be attached to the bodies of donors, whose hands have been removed for transplant.
“It may not be a life and death situation, but a hand transplant is crucial for the patient whose limbs have been amputated in accidents. The guidelines have specified that the there should be no prior injury to the donor’s hands or any nerve affectation. The expert hand committee will decide whether the donor hand is good enough to be used for the transplant. Once the hand is removed from the donor, an artificial limb will be attached so that when the body is given back to the donor’s relatives, they will not find any mutilation,” Dr Vinita Puri, chairperson of the expert committee told The Indian Express.
Maharashtra has three authorised hand transplant units — two in Mumbai and one in Pune. Command hospital in Pune was the first to attempt a hand transplant last year, which, however, did not yield the desired result. Dr Astrid Lobo Gajiwala, director, ROTTO-SOTTO Maharashtra, said a team of experts have finalised the guidelines, which have been submitted to the Directorate of Health Services.
“Unlike solid organs like kidney, liver and heart, hand transplants are not life saving but they dramatically improve the quality of life of patients, particularly those who have lost both hands. The alternative is prosthetic rehabilitation, which has its own drawbacks. Currently in Maharashtra, we have five patients on the waiting list for hand transplants,” said Gajiwala.
“Hand transplant is a life-long commitment to treatment. The patient has to take special medications (immunosuppressant drugs). Patients who want to undergo a unilateral hand transplant also have to be counselled that they will be on lifetime immunosuppressant drugs,” said Dr Puri, who also heads the Department of Plastic, Reconstructive Surgery and Burns at Seth G S Medical College and KEM hospital, Mumbai.
Hand transplantation is an extremely complex procedure. The surgery can last from 12 to 16 hours. In comparison, a typical heart transplant takes six to eight hours and a liver transplant, eight to 12 hours.
According to the new guidelines, a recipient has to be a patient with amputated upper limb unilateral or bilateral at levels distal to mid arm. Patients can be listed for hand transplant through only one centre within the State Organ and Tissue Transplant Organisation area. Experts said there should be no implant inside the limb and have ruled out a deformed hand for transplant. “It is also important that appropriate consent is taken from the relatives of the donors before the limb can be used for transplant,” Puri said, adding that donors’ families have to be encouraged and counselled.
25 years of THOTA Act
‘At least a million for a billion’ is a campaign being conducted by the National Organ and Tissue Transplant Organisation (NOTTO) to collect the maximum number of pledges to donate organs and tissue on the occasion of 25 years of Transplantation of Human Organs and Tissues Act (THOTA) on Monday. The Act was passed by the Parliament on July 8, 1994 and then amended in 2011. It paved the way for deceased organ donations by recognising brain stem death.