A rare cadaver hand and larynx (voice box) transplant facility has come up at Amrita Institute of Medical Sciences (AIMS) in Kochi, Kerala. The facility has received statutory clearance by the state medical authorities.

World over around 110 hands have been transplanted from cadavers on 85 patients with less than 5 per cent rejection rate. In the case of larynx, only three-four cases have been reported globally so far.  So far, no documented transplant has taken place in India for limb or larynx.

Unlike re-plantation, where a dismembered limb is surgically restored, in the case of transplant, the limb or larynx of a brain-dead person is transplanted on a recipient. Transplant of hand and upper limb has been accepted as one of the best forms of rehabilitation in patients with loss of hands. They are superior in many respects to prosthetic rehabilitation.

Larynx transplant has been beyond surgery so far, since it was difficult to restore complicated nerve and muscle functions. But with improved technology these challenges have now been overcome and Amrita Hospital has the expertise and technological support for management of such a complicated surgical restoration.  

“Two patients have registered with Amrita Hospital for hand transplant. We are now waiting for donors,” said Dr Subramania Iyer, who heads the plastic and reconstructive surgery department at Amrita Institute of Medical Sciences and Hospital, Kochi.

Dr Iyer said, like kidney, heart, liver or cornea of a brain-dead person limbs and larynx can be transplanted to a recipient, who had lost one or both limbs or larynx.

“Unlike kidney or liver transplant, since this donation disfigures the body, we give a prosthetic hand, so that it appears as if the hand is there for a brain-dead person,” said Dr. Iyer. “However, it requires a lot of counselling for a family of a brain-dead person to convince them donate his/her limbs to someone who requires it.”

Dr Iyer said, the success of limb transplant is high, since it is on an exterior part of the body and if there is any indication of rejection, corrective medication can be done, unlike any interior organ.

Hand transplant is followed by post-operative rehabilitation by physiotherapist and occupational therapist. In about one year of such a transplant, the limb becomes 90 per cent normal, but some small muscles might not become totally functional. But with regular rehabilitation, in the course of time, the transplanted limb becomes normal like a natural limb.  

Transplant of hand and upper limb has been accepted as one of the best forms of rehabilitation in patients with loss of hands. They are superior in many respects to prosthetic rehabilitation. AIMS has been approved by the government of Kerala and medical directorate to perform hand transplants after inspection of the facilities and ascertaining the expertise. The department is backed by a large and experienced transplant team, social workers and psychologists.

AIMS has a high turnover of microvascular surgical cases and is one of the pioneers in the field in India. AIMS has been recognized with several awards for its innovative approaches to plastic surgery problems. It partners with Smile Train organization for offering cleft lip related surgeries. There is a dedicated craniofacial wing to take care of these problems. The hospital attracts patients from all over the world for correction of the mutilated faces.