With little public attention but considerable surgical precision, India has emerged as a global leader in hand transplantation—one of the most complex frontiers in reconstructive surgery.
As of September 2024, the country has performed 73 upper extremity transplants, including 33 bilateral procedures—the highest numbers recorded worldwide. Though no doubt the number is very small when compared to the demand, as there have been few cadaveric donors for other organs.
Experts assert that the achievement in the hand transplantation area reflects not only surgical skill but also institutional coordination, donor management systems, and sustained post-transplant rehabilitation.
Dr. Dinesh Kadam, Department of Plastic and Reconstructive Surgery, A. J. Institute of Medical Sciences and Research Centre, Mangalore, Karnataka, recalled the journey began at Amrita Hospital in 2015, when a team led by Dr. Subramania Iyer and Dr. Mohit Sharma performed the first double hand transplant in the Indian subcontinent.
Nearly nine years later, the recipient continues to lead an active life. The institution has since completed the highest number of hand transplants at a single center globally and has mentored other hospitals, said Dr. Kadam in an editorial, "Indian Plastic Surgery Teams Lead with the World's Highest Number of Hand Transplants," published in the Indian Journal of Plastic Surgery in 2024.
He pointed out that in 2017, the Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) became the first government institution in India to offer hand transplant services and conducted the country’s first cross-gender transplant. The same year, Stanley Medical College performed a double hand transplant, reinforcing Tamil Nadu’s leadership in deceased organ donation.
Since 2020, programs have expanded to Mumbai, Kolkata, and Delhi. Centers such as Gleneagles Hospitals, AIIMS Delhi, IPGMER-SSKM Hospital, KEM Hospital, and Sir Ganga Ram Hospital have contributed to the national tally, he said.
Dr. V. K. Tiwari, Plastic Surgeon and Dean at Bara Hindu Rao Hospital, Delhi, said, “Practically speaking, the feasibility of hand transplant has increased significantly. Also, hand transplantation is not done for aesthetic reasons—it is performed mainly to restore function. The primary goal is to help the patient regain the ability to perform daily activities, not cosmetic improvement.”
He emphasized that replantation—reattaching a patient’s own amputated hand—remains the first preference. “Hand transplantation is considered when replantation is not possible. Earlier, we mainly performed replantation. However, in cases such as blast injuries where the hand is severely damaged and cannot be salvaged, a hand transplant is considered later.”
Dr. Tiwari attributed India’s high numbers to expertise. “The reason is largely due to expertise. We have many skilled microsurgeons in India who are capable of performing hand transplants. In India, those who are doing other organ transplants have skilled hand transplants also. In some other countries, either the expertise is limited or centers are not actively taking up such cases.”
However, he lamented that cadaveric donor numbers remain low. “If awareness improves, hand transplantation can benefit many patients… Besides publicly honoring, which is being done presently, incentives can be provided in other meaningful ways. For example, donor families can be offered some job or some additional points or preferences in government schemes.”
Dr. Nikhil Mehta, Consultant in Plastic Surgery at Yatharth Hospital, described the procedure as transformative. “Hand transplantation is a composite tissue transplantation. It is a surgery in which a hand from a cadaveric donor, along with its muscle, nerves, and blood vessels, are attached to a person with the absence of either one or both hands.”
“It is a life-changing surgery as it gives back the functionality to the patient and helps him to become self-dependent,” he said, adding that advances in post-transplant medication have improved success rates.
Dr. Mehta noted, “India has superseded the world in hand transplantation procedures, owing this distinction to the vast number of trained plastic surgeons, especially encompassing fine microsurgical skills and the skill of managing hand trauma patients. Also, the level of expertise matches international standards and exceeds it at times. The standard of care in Indian healthcare setups comes at an affordable cost, making it even a financially viable choice for patients.”
Yet challenges persist. “The biggest challenge is organ donation from brain-stem-dead donors. The relatives need to be counseled more… as the duration of time is crucial for harvest,” he said.
Dr. Swapna Athavale, Consultant in Plastic Surgery at Jupiter Hospital, explained the technical complexity. “A hand transplant is not just attaching a hand. It means reconnecting the bone, tendons, arteries, veins, nerves, muscles, and skin in such a precise way that the new hand becomes living tissue in the patient’s body.”
She detailed the process—bone fixation with plates and screws, microscopic repair of radial and ulnar arteries, connection of multiple veins to ensure drainage, and meticulous nerve repair. “Nerves grow very slowly, about one millimeter per day. That means sensation and muscle control return gradually over months. Without nerve regeneration, the hand may survive but will not function properly—it would only be a ‘living prosthesis'.”
The first 72 hours after surgery are critical, requiring close monitoring for vascular compromise. Lifelong immunosuppression is mandatory to prevent rejection, though early episodes are often reversible, Dr. Athavale added.
The experts noted that India’s inclusion of hand transplants in the national registry in July 2024 is expected to strengthen transparency and allocation systems. With over a thousand deceased organ donors annually and an estimated 110 upper extremity amputations per million population, the potential remains significant.
However, scaling up will require stronger donor awareness, faster logistics, improved preservation techniques, robust immunosuppression protocols, and long-term rehabilitation support, they said.
As Dr. Tiwari observed, “Overall, the idea is to promote organ donation through awareness, honor, social recognition, and carefully designed non-monetary incentives—while ensuring the system remains ethical and free from misuse.”
