
21-year-old student from Pune and the curious case of her changing hands - rchaudhary
https://indianexpress.com/article/cities/mumbai/21-yr-old-student-from-pune-and-the-curious-case-of-her-changing-hands-6301734/
======
bilekas
Wow.. Wow wow wow. I had no idea this was even remotely possible...

I would never have imagine that the nervous system alone would be able to
adjust. This is incredible.

I'm really curious now if there have been other transplants like this before
with similar results?

> The nerve begins to send signals, it is called reinnervation, and the
> muscles function according to body needs.

Also, is this just letting the body 're-connect' or is this some specific
medical process to achieve ?

Either way this is incredible!

~~~
hinkley
Are you talking about the general case of attaching nerves or the specific
case of the physiological changes here?

From the article they seemed to be describing well known phenomena regarding
peripheral nerves. The myelin sheath can survive detachment, the nerve does
not. With finger re-attachment, a very talented surgeon reattaches the
sheathes, and new nerves grow down the channel, at a rate of about an inch a
month (mentioned in passing in the article). So for a finger, with some luck
you should be able to feel your fingertips in a few months. The arms would
have taken a year or more. (I can't imagine what that feels like,
emotionally).

There's also a lot of plasticity in the brain. I'd heard of cases where a
badly seared finger has a patch of skin grafted from the side of another
finger to restore tactile function. They move the skin patch with the nerves
still attached, and at first your brain tells you that the side of your finger
is being touched. With rehab your brain eventually believes that the sensation
now happening to your thumb actually occured on your thumb.

But she would have had to do this for the whole lower arm, twice.

~~~
tempestn
Does this same process not work for a severed spinal cord? Or would it just
take a prohibitively long time? Or.. _can_ severed spinal cords be repaired
now?

~~~
hinkley
I never quite understood this. I mostly remember that it was important to some
people to distinguish between the peripheral and central nervous system when
discussing how it behaves

[https://en.m.wikipedia.org/wiki/Neuroregeneration](https://en.m.wikipedia.org/wiki/Neuroregeneration)
has a bit, about the central nervous system being actively hostile to
regrowth.

It also says I was off about the myelin sheath - it’s the next layer of tissue
that surrounds the myelin sheath that survives. The sheath itself also begins
to break down post-trauma, apparently.

------
mkl
> Hand donations are rare, because few families are willing to donate limbs
> fearing disfiguration of the body even though a prosthetic limb is fitted to
> the donor’s body.

Can someone explain this? Is it an Indian thing?

If I died and donated my hands, I would be proud for them to be missing in the
casket. I can only see because two people donated their corneas.

~~~
vsskanth
There is a stigma because some people believe your body needs to be whole
during your last rites (Even though you cremate the body in the end if you're
Hindu). This is pure superstition.

This is gradually changing with increasing education and awareness among
people, making organ donations socially acceptable and something to be proud
of.

~~~
pmarreck
> some people believe your body needs to be whole during your last rites (Even
> though you cremate the body in the end if you're Hindu). This is pure
> superstition

It's not just superstition, it's easily defeated with reason: If this were
true, then every innocent person who has to suffer an amputation due to an
accident would be unjustly disadvantaged.

It's similar to people who argue against gay marriage since kids aren't
produced: This implies every heterosexual marriage without children is
worthless

~~~
thaumasiotes
> it's easily defeated with reason: If this were true, then every innocent
> person who has to suffer an amputation due to an accident would be unjustly
> disadvantaged

How's that a defeat? Terrible things happen unjustly all the time.

Every innocent person who has to suffer an amputation due to an accident
_already is_ unjustly disadvantaged; it's not like this is an impossible state
of affairs. (Just ask them whether they'd prefer to have their appendages
back!)

------
DoreenMichele
When I was younger, I used to routinely joke on the internet that "I have
three shades: White, off-white and lobster red." I didn't really tan. I mostly
went from cadaverous white to badly sunburned.

I've taken a long strange journey of healing and one of the side effects is
that I am now capable of tanning. So based on my experience, I will suggest
that gut biome may be a factor here. It's less obvious than "female hormones"
in a cross-gender transplant, but it more closely fits my experience of
changes in skin function and color.

For background info to help you understand the context:

I have a form of cystic fibrosis, not diagnosed until my mid thirties. My
maiden name is Irish in origin and discussion on CF lists years ago suggested
that people with CF are "typically" very pale skinned with blonde hair. Irish
families are the most likely to have more than one member with a diagnosis of
CF and Irish people tend to be very pale and often don't tan well.

------
JPLeRouzic
Thanks for sharing this story. I really like it. The change of color is one
thing but it would be interesting to know how the brain rewrites its motor
cortex to connect to the right peripheral nerves and to the muscles they
connect to.

~~~
dole
Change of color was one thing but the change of shape was very surprising.
tl;dr: changes in color and shape may have been due to hormones being the
first(?) male-to-female hand transplant, hand shape became more female.

~~~
gibolt
They mentioned her losing 12kg after an infection. There could be more to it,
but that is a significant loss that could explain much of it

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natch
Site is currently hosting UI-hijacking ads that kick in after 15 seconds or
so. Flagged.

~~~
pmarreck
Agree. The story is good but this source is absolute trash.

This is why people use devices like PiHoles and adblock.

------
codezero
Wow I didn’t realize so few people had hand transplants. For numbers that low
in the human experience, I like to compare with the number of people who’ve
been to space.

At 200 transplants, that is twice as rare as going to space!

~~~
Someone
The technical part of hand transplants is hard; there’s a lot of nerves and
muscles to connect.
[https://en.wikipedia.org/wiki/Hand_transplantation](https://en.wikipedia.org/wiki/Hand_transplantation):

 _”The operation is quite extensive and typically lasts from 8 to 12 hours. By
comparison, a typical heart transplant operation lasts 6 to 8 hours”_.

Apart from that, there’s the psychological aspect. Recipients must accept
their new hand as theirs. That can require extensive psychological support.

Then, there’s the ethical aspect. Unlike heart transplants, a hand transplant
isn’t life-saving, but like it, it condemns patients to the life-long use of
immunosuppressants, with the side effect of a weaker immune system.
Prosthetics may be the better choice. It also is a lot cheaper.
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3499956/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3499956/)
claims

 _”The lifetime cost of a single hand transplantation is approximately
$528,293; on average 62% of this total is due to expensive immunosuppressive
therapy and postoperative management.18 The lifetime cost for a single
prosthetic adaptation is approximately $20,653

[…]

The quality-adjusted life years (QALYs) of prosthetic adaptation exceed those
for hand transplantation, due to the complications of immunosuppression.”_

~~~
notRobot
Most of your comment makes sense to me, except this bit:

> Then, there’s the ethical aspect. Unlike heart transplants, a hand
> transplant isn’t life-saving, but like it, it condemns patients to the life-
> long use of immunosuppressants, with the side effect of a weaker immune
> system. Prosthetics may be the better choice.

Surely it's up to the transplant recipient to decide what will be best for
them? I'm sure there are many people to whom the trade off will be worth it.
How exactly do "ethics" come into play here?

~~~
Someone
It can be (and in his case has been) argued that (some) patients do not know
what will be best for them.

Patients typically are fairly shortly after traumatic injury, and don’t really
know what either option entails.

Combine that with the Hippocratic oath or its modern equivalent, which
requires doctors to do what’s in the best interest of the patient, and there’s
a clear conflict.

(Couldn’t find an example directly related to this, but the general problem is
[https://en.wikipedia.org/wiki/Medical_ethics#Between_autonom...](https://en.wikipedia.org/wiki/Medical_ethics#Between_autonomy_and_beneficence/non-
maleficence))

------
jfengel
The photo shows her holding a pen. It's amazing that you can transplant
something as complex as a hand and use it to manipulate something as
delicately as writing.

The photo doesn't show her wrists very clearly, but not only has the color
matched, but I don't see any scarring. I'm sure it's there, but even so...
it's just stunning how good this is.

~~~
usddddd
It looks like the transplant attached the hands and forearms to the upper part
of the recipients arm. She lost basically just below the elbow in the accident
it seems.

------
iandanforth
Can any trans folk comment on if they've noticed significant changes in their
hands in response to hormone treatment?

~~~
AprilArcus
I've been on hormones for nine years. None of the reported changes strike me
as implausible. My skin became gradually softer, and my hairs finer and less
pigmented over the first couple years of hormone therapy, and by about six and
a half years in, some skeletal changes became evident.

I've noticed that folks' skin tone tends to darken and lighten about a shade
on testosterone and estrogen, respectively. I did not personally notice
pigmentation changes, but my skin was very light to begin with.

As for my hands, I can't make interesting specific comments; all these things
seem to be systemic. I'm sure that the ratio of the lengths of my ring and
index finger (a sexually dimorphic trait) did not change.

I have a vivid memory of looking at the back of my hands while driving and
feeling intensely uncomfortable with my "man hands", just around the time I
started hormones. That thought never crossed my mind again, though, after a
short time I felt fine with them and haven't been bothered by them since. I
suppose they must have changed enough to relieve my anxiety while I was
distracted by other more dramatic effects.

------
forkexec
So I assume she has to take immunosuppressants more/less for life, but then
that leads to immunodeficiency too?

~~~
robotnikman
I would assume so. If we ever find a way to prevent our immune systems from
attacking transplants it would be a major breakthrough, and organ transplants
would last far longer for the recipient.

~~~
forkexec
I wonder then how it works that some people are able to stop
immunosuppressants and not experience rejection? Perhaps finding the
fundamental basis for this and whether it's replicable just after transplant
would have the potential to save an enormous amount of money, hassles and
risks.

------
happy-go-lucky
Here's a video from the Institute where she underwent the transplantation.

[https://m.youtube.com/watch?v=RjakQiWPDMk](https://m.youtube.com/watch?v=RjakQiWPDMk)

------
r00f
Not sure why that should be surprise. Skin does not go light or dark randomly,
it depends on the amount of melanin and other things body produces. If her
natural skin is light, the skin of new hands lost all additional pigmentation
over time and went to the body average levels.

------
sxv
The analyses and speculation in the article place too much emphasis on sex /
gender and too little on general diversity of physical characteristics. But
perhaps I am jumping to that conclusion because I regard India as having
archaic, sexist modalities.

~~~
macewindu
> I regard India as having archaic, sexist modalities.

Unlike USA?

------
stared
> Hand donations are rare, because few families are willing to donate limbs
> fearing disfiguration of the body even though a prosthetic limb is fitted to
> the donor’s body.

In my opinion, this state of things is a strong argument for utilitarianism
for organ transplantation[1].

For me, it is hard to find a measure in which an additional discomfort during
a funeral[2] outweighs the discomfort of living with a life-altering
disability (e.g. no hands) or well, dying (which affects their family members,
friends, etc).

[1] I support an option that people may personally opt-out of the system,
meaning that they don't agree for their own body to be donated (and agree they
won't be a recipient).

[2] In many places closed-coffin funerals are a standard, regardless of the
state of the deceased.

~~~
BrandoElFollito
Opting out of the system would require to spend some time with the people
these incredibly selfish people deny from a hope of a better life.

That would need to be a strict oup out system, no questions asked to anyone if
no opt out.

Finally, the opt out system should be designed by the people who designed some
gov sites (crazy captchas, scrollbar behaving erraticaly, confusing questions,
pale on pale colors, internet explorer 6 required)

------
scarejunba
Genuinely blows my mind that hand transplants are possible.

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steeve
The article is impossible to read on mobile because of ads. After a few
seconds it redirects to some shady website.

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justplay
wow. I feels like I should also donate my body. I am really proud of those
doctor and wishing alot of happiness to that family who donated there child
body. As an indian and hindu, I can feel how big this means.

------
robocat
Flagged: redirects to lottery won advert after a timeout on Android.

~~~
perilunar
I got that too on Mac/Safari. Disabled JS and went back.

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autonoshitbox
This is one of the coolest things I've seen in my entire life.

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zupreme
After reading, I feel the need to know how, when, and why he died.

~~~
happy-go-lucky
"She came to know later that Sachin, a B.Com student from Ernakulam’s Rajagiri
College, had been declared brain dead that day after being involved in a bike
accident — and that his family had agreed to donate his hands and other
organs."

------
connectsnk
I didnt know such surgeries could be performed in India. I didnt even know
such surgeries were possible in the first place let alone being done in India

~~~
scarejunba
Interestingly, not only can such surgeries be performed in India but some
kinds of surgeries have better outcomes in India for cheaper prices than in
America. I believe it's some kinds of heart surgeries that I saw the stats
for.

~~~
jessaustin
Surgeons who do lots of surgery are better than other surgeons who don't. This
advantage dominates those of training, resources, years of experience, etc.
It's no surprise that inexpensive surgeons in a populous nation would be the
best.

~~~
ferzul
practice makes perfect

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aaron695
No one suspicious there is no footage of her gripping things?

This is amazing, totally amazing, but you are not in a Sci-Fi movie. Her hands
are quite limited.

> Today, her handwriting almost matches her original

Here is footage of her writing, but you don't see her initially gripping the
pen. Certainly her hand writing will have changed.

[https://www.youtube.com/watch?v=SE1scH3riEc](https://www.youtube.com/watch?v=SE1scH3riEc)

I get in India life is tough for many people so the media does all these great
glossy stories that border on lies, it seems built into the system, individual
facts are not as important as the story. But it's not that simple.

