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Saturday, September 26, 2020

Behind India’s 10th double hand transplant, some fear and a lot of hope

On Friday, 15 hours later, Maharashtra recorded its first successful hand transplant after the hands of a 32-year-old man, who had been declared brain dead, were transported from Chennai and surgically affixed to 24-year-old Monika’s arms

Written by Tabassum Barnagarwala | Mumbai | Updated: September 2, 2020 5:27:35 pm
maharashtra first double hand transplant surgery, Maharashtra hand transplant, maharashtra double hand transplant, maharashtra hand transplant hospital, maharashtra news, indian express newsMonika More, 24, before surgery at Global Hospital in Mumbai

Before she entered the operation theatre Thursday midnight, Monika More called a transplant recipient in Pune for support and strength. After that short call, she smiled nervously and headed for her own double hand transplant surgery.

On Friday, 15 hours later, Maharashtra recorded its first successful hand transplant after the hands of a 32-year-old man, who had been declared brain dead, were transported from Chennai and surgically affixed to 24-year-old Monika’s arms. Until then, only nine other double hand transplants had been done in India.

“The hands are larger than her frame because they belonged to a man. But she finally has what we prayed for. We never lost hope,” Monika’s uncle Vishwas More said. Mother Kavita said her daughter would meet the donor’s family to thank them.

Monika will remain in intensive care for the next two weeks, and take about six months to develop movement in her hands. On Friday, the initial signs of a successful transplant were seen after doctors put a pulse oximeter on her finger and feet, and found the same reading of her oxygen saturation level, indicating that blood supply had begun.

Read| Transplants plummet in Maharashtra, only 3 live organ transplants recorded in April

Monika lost her hands in 2014 in a train mishap at Ghatkopar station, and has depended on prosthetic limbs. In 2018, after hearing about Pune-based Shreya Siddhagaonkar’s transplant, she registered herself on an organ waitlist. Her father Ashok More started collecting funds but three months later succumbed to a heart attack.

In 2019, Monika started working as a supervisor in a private nursing home in Kurla and supported her family until the pandemic began. But after the lockdown, the family was left with no source of income, and worried about paying the hospital bills until an NGO and hospital agreed to finance the procedure.

The Lalbaug Cha Raja trust donated Rs 1 lakh on Thursday for the surgery, while Global hospital, which undertook the transplant, paid for the chartered flight to bring the hands from Chennai.

The surgery has been billed at Rs 22 lakh. “The remaining amount will be funded by the hospital and NGO Yuva Pratishthan,” said former MP Kirit Somaiya who arranged for Rs 5 lakh.

It was on Thursday morning that Monika received a call from Global Hospital that a prospective hand donor had been found. “She immediately said yes. We had been waiting for this call for two years,” younger brother Kartik said. A technician drew her blood sample at home, and a doctor flew to Chennai for a compatibility test with the donor who had suffered a road accident.

Read| Coronavirus patient undergoes bilateral lung transplant in Chennai

The samples matched, and by evening Monika was in hospital for Covid-19, HIV, Hepatitis and other tests. “When I spoke with her, she was scared. It is overwhelming to receive hands after six years without them,” said Siddhagaonkar, who underwent a similar transplant in 2018 in Kerala and spoke to Monika minutes before Thursday’s surgery.

“Since then, she has been at home. We never lost hope that a donor will come one day. She used to call the doctor regularly to check,” uncle Vishwas said. “The entire family has not slept since Thursday,” said grandmother Parvati More.

According to doctors, the transplant started at 2 am and ended by 5.10 pm Friday. Twelve doctors, comprising six plastic surgeons, four anaesthetists, and two orthopaedic surgeons, fused two bones, one major artery, four veins, five nerves and a bundle of muscles in the procedure.

The lead surgeon Dr Nilesh Satbhai had made preparations through Thursday to pull together the team. Plastic surgeon Dr Mohit   Sharma, who flew in from Kochi and was part of India’s first hand transplant team, said the biggest challenge was to operate fast.

“Hands can be preserved in solution for 10 hours. But it is not wise to delay once they are retrieved. It took about 3-4 hours to transport it. So we had to operate quickly,” he said.

The doctors were divided into two teams and began transplanting both hands simultaneously. First, the bone in the donor’s hand was attached to More’s arm using a titanium plate, and then the surgeons began stitching the veins, artery and nerves. They took small breaks through the night, but none could afford a nap.

Sharma said that amid the Covid-19 pandemic, infection risk remains high in transplant recipients. “For two weeks, she will remain in ICU, and then two weeks of isolation is important,” he said.

“The rehabilitation component will continue for a year. Since the nerve endings lose ability to function in amputated limbs, it takes months for sensation and movement to return. It will also take her body time to adjust to the fresh weight of new hands,” he said.

In Siddhagaonkar’s case, where a man’s hands were transplanted, the limbs changed colour within two years to match her lighter skin tone and even turned feminine. Now, Monika’s family is “hoping to see a similar transformation”.

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