A Helping Hand

Dr. Warren Breidenbach and Dr. Vijay Gorantla, the leaders in hand-transplant surgery, talk about their work and the first hand transplant in India which took place recently at the Amrita Institute of Medical Sciences, Kochi

By Shevlin Sebastian

Photos: (From left): Dr. Vijay Gorantla,  Dr. Subramaniam Iyer and Dr. Warren Breidenbach. Photo by Mithun Vinod. Mathew Scott using his transplanted left hand. A cross-section of the transplanted hand 

On December 23, 1985, Mathew Scott lost his left hand because of a firecracker blast at his home in New Jersey, USA. On January 24, 1999, at the Jewish Hospital at Louisville, Kentucky, a hand was grafted by a team led by Dr. Warren Breidenbach, who is now the Chief, Division of Reconstructive and Plastic Surgery, at the University of Arizona.

But it was a difficult operation that lasted 14 ½ hours. “The hand has a very complex structure,” says Dr. Breidenbach. “It has multiple tendons, nerves, arteries and blood vessels. The complexities are different when you are transplanting from the arm or above the elbow.”

However, this operation has become an epoch-making moment. Because, today, after 16 years, Scott's hand is still functional. “This is the longest surviving hand transplant in the history of man,” says Dr. Breidenbach, while on a visit to Kochi. “Scott still needs to take anti-rejection drugs for the rest of his life, because the body never totally accepts the hand.”

As for the efficiency of an attached hand, Dr Breidenbach says, “A transplanted hand is never as good as the original. The hand is weaker and has less sensation.” Nevertheless, three months after the operation Scott was able to throw a baseball with his left hand. He can now write, turn the pages of a newspaper and tie his shoelaces, apart from carrying his two children. Before losing his hand, Scott was a paramedic. And, after the transplant, he was able to go back to his job.

Today, Scott has to go for follow-up visits every two months and have annual check-ups. “He has to be monitored all the time, because of the anti-rejection drugs that he is taking,” says Dr. Breidenbach. “Sometimes, there can be side-effects like tumours, diabetes and hypertension.” Incidentally, the cost is steep. Apart from the surgery, the lifetime buying of the anti-rejection drugs will work out to more than $1 million.

Sitting next to Dr. Breidenbach is Dr. Vijay Gorantla. The Administrative Medical Director of the Pittsburgh Reconstructive Transplant Programme at the University of Pittsburgh, he has done five hand transplants.

As to the oft-repeated theory that something of the personality of the donor gets into the recipient, both doctors debunked the notion. “There is no scientific proof,” says Dr. Gorantla.

Asked at what time the hand is taken from the donor, Dr. Gorantla says, “When a person is brain-dead, he becomes eligible for organ donation. But the timeline starts after the retrieval of the heart. Thereafter, the other organs, like the lungs and kidneys, are taken. The hand is usually procured simultaneously with the abdominal organs. And it takes less than 30 minutes.”

Incidentally, both the doctors had come to Kochi to review the results of the history-making hand transplant surgery which took place at the Amrita Institute of Medical Sciences on January 13, 2015.

The transplant team was led by Dr. Subramaniam Iyer, Professor and Chairman of Plastic and Reconstructive Surgery. The other members included Drs. Mohit Sharma, Sundeep Vijayaraghavan, Kishore P. and Jimmy Mathew.

“What has happened in Kochi is a big deal,” says Dr. Breidenbach. “There are not many hand transplants that have been done worldwide. Thus far, the total is about 100. So we wanted to see first-hand what has been done here. And I have been extremely impressed with the depth of the understanding of the problems and the methods used to do this successful transplant.”

Both the doctors commended the team put together by Dr. Iyer. “You need a top-quality multi-disciplinary team for a successful transplant,” says Dr. Breidenbach. “That means, there should be somebody who is good at immunology, physio-therapy, post-operative cure, ethical aspects, anaesthesia and the psychological valuation of the patient. It is heartening to see Indian medicine doing so well.” 

(The New Indian Express, Kochi and Thiruvananthapuram)