The Kochi-based Amrita Institute of Medical Sciences (Amrita Hospital) has conducted India’s first elbow-level double hand transplant on a 21-year-old youth, who lost both his hands from the elbow in 2013 due to electrical burns. This is the third double-hand transplant at the hospital, which claims that it is the only facility in India with the capability to conduct hand transplants.
The 1,300-bed tertiary referral and teaching hospital, serving over 800,000 outpatients and more than 50,000 inpatients annually also created medical history in January 2015 by carrying out India’s first hand transplant on a 30-year-old patient. This feat was followed by another hand transplant surgery in April 2015 on a young Afghan soldier, Abdul Rahim. These, along with that of Jith Kumar Saji now, are the only three hand transplants ever been done in India.
Jith, the son of a mason hailing from a small village in Kannur, used to work as a light-and-sound assistant with a local event management group. While at work in August 2013, he fell on live high-tension electric wires when the tent under which he was working suddenly collapsed. He sustained severe burns on both him arms. He was rushed to the hospital unconscious, but his hands couldn’t be saved and had to be amputated at the elbow.
For Jith’s double-forearm transplant, Dr. Subramania Iyer, HOD, Plastic and Reconstructive Surgery, Amrita Hospital, led a team of 25 surgeons and a 12-member anesthetic team in a marathon surgery that lasted 14 hours.
“This surgery was technically much more complicated than the previous two hand transplants at Amrita Hospital. For hand transplants above the wrist, the tendons are still connected to each other. But in an elbow-level transplant, these connections have to be made to the muscle mass. Identification, tagging and connecting the nerves, tendons and arteries are very challenging. That is why forearm transplants have been attempted only a few times in the world,” explained Dr Iyer.
The donor was a 24-year-old Raison Sunny who was declared brain dead after a road accident. The harvested hands were brought to Amrita Hospital from 30 km away in Angamaly, in a highly coordinated effort.
“It was essential not to lose any time. Since the transplant involved large quantity of muscles, rejoining them to the recipient’s body and reestablishing blood supply had to be much quicker, compared to the earlier two hand transplants done by us. The hands after harvesting from the donor were covered in ice-containing wrappers several times to reduce their metabolism, and rushed to Amrita Hospital in an ambulance,” said Dr. Subramania Iyer.
The recipient patient spent three weeks in the transplant ICU after the surgery and is now fit to be discharged. He has been undergoing physiotherapy and can use both his elbows. He is even able to eat with the support of special splints and would need to undergo intensive physiotherapy and rehabilitation exercises for at least the next two years for his hand function to return fully. In addition, he will have to take life-long immuno-suppressant medications to prevent rejection of the transplanted hands, stated the hospital.
Since the youth is from an economically disadvantaged, several individuals and philanthropists from Kerala pooled in resources to fund his surgery.
The hospital’s extensive infrastructure offers facilities comprising 25 modern operating theatres, 240 intensive-care beds, a fully computerized and networked Hospital Information System (HIS), a fully digital radiology department, NABL accredited clinical laboratories and 24/7 telemedicine service.