On 7th February 2018, history was created in the Government Stanley Medical College and Hospital, Chennai where the first double hand transplant in the state of Tamil Nadu was performed by The Institute for Research and Rehabilitation of Hand & Department of Plastic Surgery. Talking about the experience, Dr. V. Ramadevi, Head of the Department (HOD) & Professor of Plastic Surgery said that the department had always played a pioneering role, starting with Prof. R. Venkataswami (HOD from 1971 to 1991) and the successes in reconstructive surgery. Initiating a hand transplant programme was the vision of Prof. R. Krishnamoorthy (HOD from 2009 to 2011) and when she took over as HOD in 2015 she was determined to make it come to fruition. The first step was to renew the hand transplant license which was given in 2010. In addition, all the department positions were filled so that a complete team was in place. The team was enthusiastic, energetic and raring to go.

Dr. Ramadevi said that, in fact, an opportunity first arose in December 2017 with a potential unilateral hand donation. But it did not materialise due to various issues with the waitlisted recipients. While the team felt frustrated at the time, it actually turned out to be a blessing in disguise as it was a mock drill for the actual hand transplant two months later. All the flaws were ironed out, a checklist made and roles allocated. In the meantime, a number of awareness programmes were also held in the hospital and potential recipients were educated and counselled.

And then on 6th February 2018 that all important call came to the team. As luck would have it they had all just returned from the Tamil Nadu and Pondicherry Association of Plastic Surgeons’ meeting in Ooty. The time had come for the team to make history. The recipient was Mr. R. Narayanaswamy, 29 years, a mason from Dindigul, Tamil Nadu who had lost both his hands in an electrocution accident. The surgery was a marathon effort that lasted 13 hours involving 35 doctors and 40 paramedical personnel. There were four teams involved – two on the donor side and two on the recipient side. Dr. Ramadevi said that the grief counsellors, Mr. S. Senthil Kumar and Mr. G. Santhosh played a key role in counselling the family of the deceased donor. The grief counsellors shared that they had six intensive sessions with the family. The uncle of the brain-dead patient was instrumental in helping the family make the decision to donate the hands, in addition to the kidneys, liver and corneas of their loved one. To the family’s obvious question of disfigurement once the hands were retrieved, the grief counsellors laid their fears to rest by explaining that a prosthesis would be fixed to maintain the integrity of the body. These prostheses were fashioned in-house in the Splint section of the department.

Dr. Ramadevi said that there were some tense moments both during and post transplant, but it was tided over with the unwavering support of the anaesthetists, the nephrologist (handling immunosuppression), her own team, and the Dean Dr. Ponnambalam Namasivayam. The recipient was doing well and was undergoing hand rehabilitation.

A Hand Clinic has now been established in the department where prospective recipients are evaluated and counselled along with their families regarding the benefits and risks of hand transplant. It was inaugurated by Dr. C. Vijaya Baskar, Minister for Health & Family Welfare, Government of Tamil Nadu. At present there are 158 patients listed with about 20 for double hand transplants. The Chief Minister of Tamil Nadu, Mr. Edappadi K. Palaniswami also expressed his appreciation to the team of doctors. Many new facilities in the department have been provided through the government with the help of Dr. J. Radhakrishnan, IAS, Principal Secretary, Health & Family Welfare Department.

Dr. Ramadevi’s interest is in the field of academia where she is focusing on training young plastic surgeons in techniques that will allow them to scale new frontiers in the field of plastic and reconstructive surgery. And give them the opportunity to make history once again.Editor’s note: The first hand transplant in India was performed at the Amrita Institute of Medical Sciences (AIMS), Kochi by Dr. Subramania Iyer in January 2015. Since then four more hand transplants have beenperformed – three in AIMS, Kochi and one in JIPMER, Puducherry.-

Dr. Ramadevi’s interest is in the field of academia where she is focusing on training young plastic surgeons in techniques that will allow them to scale new frontiers in the field of plastic and reconstructive surgery. And give them the opportunity to make history once again.

Editor’s note: The first hand transplant in India was performed at the Amrita Institute of Medical Sciences (AIMS), Kochi by Dr. Subramania Iyer in January 2015. Since then four more hand transplants have been performed – three in AIMS, Kochi and one in JIPMER, Puducherry.

- Dr. Sumana Navin