Transplantation of kidneys, liver, heart, lungs, pancreas, intestine etc is now reasonably well established. These are organs. Tissues like cornea, skin and bone can also be transplanted. The decision of the near ones to donate these from their dear one who has just died is one of the noblest gestures of them all. Some organs like kidney and part of liver can be donated by a living person.
There are some newer developments. Composite tissue transplants sometimes called reconstructive transplants are one. Composite tissues are parts of the body that contain multiple tissues like skin, bone, muscle, nerve and more.
Till now, more than hundred hands have been transplanted across the world. Most have been done on patients who have lost their hand or hands to trauma. The first one was done on 1998 at Lyons, France. The second one was done on Louisville, USA, one year later. The second one is still surviving and patient is doing well. The success rate is quite good.
Faces have been transplanted, over thirty in number. These have been done on patients so disfigured that many cannot eat and some have to breathe through a tracheostomy.
The first both hands transplant in South Asia was done at Amrita Institute of Medical Sciences at Kochi on 2015, January. Two more double hands transplants were done after that, in the same centre.
The ethics of transplantation has been extensively discussed. It is clear that Life-saving transplants are ok. Liver, heart and sometimes others come in this category. Kidneys also can be tentatively included. Dialysis can replace kidney function, though it is now accepted to be inferior to a transplant.
Hands and face are different. They are not life-saving transplants. They are highly visible parts of the body, and closely related to the identity of the individual. They are technically difficult.
There is consensus that transplants should be done only for treatment. It should not be done for vanity reasons or for marginal benefit. Hands can be done from only brain-dead persons. No hand can be taken from a living person, even with consent.
What is the state of hands and face transplants?
Our experience is not complete. The oldest surviving hand is only seventeen years old. Only posterity can judge us. There is no doubt that some of these transplants are, essential.
But the fact remains that we are replacing a disability with a disease. The disease of immune suppression. It cannot be taken lightly. That is why for the present, some say that one should do double hands only for patients who have lost both their hands. But most hand transplants done till now have been single ones. The three done in India so far are double hands. We have tentatively decided to keep them like that for the time being.
In addition to hands and face- larynx, knee, uterus, and even a penis has been transplanted. The benefits have not been widely accepted.
The debates are on. The tragedy is that all these cadaver transplants are dependent on another tragedy- a valuable person becoming brain dead. Immune suppression is a major impediment. We can wait for the day when organs- and parts of bodies- can be grown in the lab from one’s stem cells. We will then move from repairing-medicine to replacement-medicine.
