Hand in hand
In any transplant, serious surgical complications are a possibility and the immunosuppressive drugs that are needed have side-effects and can predispose to deadly infections. So, when the transplant is not for a life-threatening condition, the benefits need to outweigh the risks.
Sanjay Nagral
Sept 4, 2020, Mumbai Mirror
Last week in Chennai, a young man’s family donated his organs after he was pronounced brain dead. This no longer makes news as such donations have become common. But there was something extraordinary about this one. The kidneys, liver and heart are now commonly donated and transplanted. In this case, lungs and hands were also donated. The lungs were transplanted into a man from Gurugram with extensive lung damage due to Covid. The hands were flown to Mumbai for a young woman who had lost both her hands in a railway accident six years ago.
Lung transplants are rare but not new. However, transplants for lungs ravaged by infections is not the usual indication. In Covid, however, there is a subset of patients whose infection resolves but the lung gets irretrievably damaged. The first few lung transplants for post-Covid damage have been performed across the world, including the one in Chennai. Given its enormity, even thinking about its wide use for Covid is currently a preposterous idea. Nevertheless, it’s an achievement and a life saver for the recipient.
In the later part of the 20th century, after initial success with the kidney, transplants of the liver, heart and lung became a reality and are now performed in thousands. These are lifesaving. Spurred by this success, surgeons turned their attention to what may be simplistically termed ‘non-essential’ organs for sustaining life. Thus, organs like the tongue, larynx and hands have been successfully transplanted, mainly to enhance quality of life. Hand transplants, though still very rare, have been performed mainly for those who lose both hands in accidents. A Kochi surgeon, Dr Subramania Iyer was the first to perform it in India.
It may be worth remembering that any transplant potentially poses a danger to the recipient. Serious surgical complications are always a possibility and the immunosuppressive drugs that are always needed have side- effects and can predispose to deadly infections. So, when the transplant is not for a life-threatening condition,
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the benefits need to outweigh the risks.
For example, a deeply problematic transplant is that of the uterus. Last year, a hospital in Pune performed a few procedures and were projected as some kind of a breakthrough. Uterus transplants are performed for women with absent or a diseased uterus and cannot harbour a pregnancy. There are viable alternatives like surrogacy or even adoption. The argument that the woman is desperate to have her own child in a transplanted uterus in her body is disingenuous. The woman can potentially die of the transplant, besides suffering sideeffects of the surgery and immunosuppression. Even limited familiarity with Indian society is enough to appreciate that it is not always the women’s free decision to experience motherhood but that this is often subject to intense family and social pressures. I doubt whether a woman would agree to risk death for bearing a child in her own uterus.
Abdul Rahim, a bomb disposal expert in the Afghan Army, lost both his hands while defusing a mine in 2012 in Kandahar. Keen to overcome his handicap, he heard about the hand transplant programme in Kochi. He travelled and waited for a donation. His patience was rewarded when a 54-year-road accident victim TG Joseph’s hands were donated. Abdul was the second successful hand transplant in Kochi in 2015. He regained a significant part of his hands’ functions. He re-joined the Afghan army and returned to defuse bombs. Abdul would visit Kochi every year to meet Joseph’s family. On the 19th of February this year, Abdul was caught in a deadly blast while trying to defuse another bomb in Kabul. He died at the hands of the Taliban. The act of donating organs after death in a moment of intense grief is the kind of extraordinary act that reaffirms faith in the good of humanity. However, simultaneously we seem capable of terrible acts of destruction against our fellow humans.
Monika More is courageous and lucky. She survived a terrible accident on Mumbai’s suburban railway, had moral and financial support for a transplant despite being a girl and finally managed to get one. Not many in this country are so lucky.
The human will to live longer is formidable. One way is by conquering infections. Another is by replacing diseased organs, though the demand will always outnumber availability. When I see organs and patients flying across our country’s skies for urgent transplantation in the times of Covid, there are multiple thoughts that cross my mind. One is elation at this amazing orchestra of generosity, coordination and technical skills, something I saw in Europe 20 years ago but never thought we could achieve. And then there’s this feeling of despair that while this is happening in the skies, on the ground gasping patients continue to die for want of an ambulance or oxygen or a hospital bed. And even worse, the worry that we may be normalising this duality as our collective fate.
The writer is a surgeon who, when not wielding a scalpel, wields a pen.