NEW DELHI // Every day, Abdul Rahim, a captain in the Afghanistan army, makes his way to his physiotherapy appointment at the Amrita Institute of Medical Sciences in Kochi, where he tries to remember how he once used his hands.
Even to think of them as “his hands” is a challenge. He does control them, if a little clumsily, but he has only had them since last April, when they were transplanted on to his forearms in a marathon 15-hour surgery.
Mr Rahim’s hands still look like foreign objects, their darker brown colour a sharp contrast to the pale tone of his forearms. “But I can eat by myself now, and I can drink water, and I can dress myself, and I can write,” he told The National. He can also ride a bicycle and even steer a car.
“All of this is remarkable,” he said. “A year ago, I had no hands at all.”
Mr Rahim’s case was only the second double-hand transplant ever carried out in India, following the first – also performed at the Amrita Institute – four months earlier.
“The world’s first double-hand transplant was done 17 years ago, and around 80 have been done around the world since then,” said Subramania Iyer, the head of the hospital’s department of plastic and reconstructive surgery. “But they’ve all been in Europe and the US, and a couple in China.”
Dr Iyer’s department had been planning to venture into hand transplants for many months before taking on its first case, he said. “Prosthetics are not very good. They’re expensive and not always effective.”
At the same time, grafting a new hand onto a patient is tricky business. “You have to reattach a lot of small structures like nerves and blood vessels,” Dr Iyer said. “And the chances of a hand being rejected by a body is high, because skin is the part of the body that has the most potential to be rejected.”
Rehabilitation is also crucial. “A liver or a kidney, once transplanted, will begin working right away,” Dr Iyer said. “For a hand, you need to work for at least a year to get full function back. Abdul has 80 to 85 per cent of his hand function back. It’s almost as if he has his own hands again.”
For Mr Rahim, now 31 years old, the prospect of getting a new pair of hands once seemed impossible.
In April 2012, in his native province of Kandahar, Mr Rahim’s unit was clearing a road of ordnance, when an unexploded bomb went off. He lost both hands but suffered no other injuries.
Afghanistan did not possess the medical infrastructure to conduct hand transplants, so Mr Rahim looked overseas. His government helped him explore the possibilities of transplants in several countries, including Iran, but Mr Rahim found that the procedure was rare if not non-existent.
It was in Delhi, in late 2014, that Mr Rahim heard of the Amrita Institute and contacted Dr Iyer’s department. He was the second person on the hospital’s registry. Now he needed to wait for a donor.
One morning last April, TG Joseph, a 52-year-old construction worker in Kochi, left home to go to work. Hours later, his daughter Aleesha learnt that his motorcycle had been hit by another vehicle on the way, and that he had been declared brain-dead as soon as he arrived at hospital.
“When we were there, the doctors asked us if we wished to donate his organs,” Ms Joseph told The National. Her uncle, TG Cletus, had pledged his own organs already, so he persuaded the family to donate Mr Joseph’s cornea and liver.
“Then the doctors told us about Abdul Rahim,” Ms Joseph said. “They said: ‘We have a patient who has lost his hands,’ and they asked if we wished to donate those also. As a family, we made the decision to do it.”
The surgery cost 1.5 million rupees (Dh80,000) and was paid for by the Afghanistan government.
Dr Iyer described the complexities of the surgery: the connection of two bones, two arteries, four veins, 14 tendons, and numerous nerves and smaller blood vessels in each arm. Twenty surgeons and eight anaesthetists were in the theatre at various points through the 15-hour surgery.
The hands would look markedly different, Dr Iyer had already warned Mr Rahim. “When we were going into the theatre and he was being wheeled in for the surgery, I told him that TG Joseph was darker than him,” Dr Iyer said. “We had to tell him that. It’s our duty.”
“But he wasn’t bothered about it at all,” he added. “He was just worried about having functioning hands again, and being able to live on his own rather than depending on someone else all the time.”
Ms Joseph recalls the first time she met Mr Rahim once the transplant was finished. “I looked at him, and I was so sad at first, because I was reminded of how I had lost my father,” she said. “But then, when I touched his hands, I was happy.”
“I felt like some part of my father was still alive.”
After the surgery, Dr Iyer advised Mr Rahim to stay on in Kochi for at least a year, to work on rehabilitation. Mr Rahim found a flat for himself, his wife and his 12-year-old son, from where he could commute easily to the hospital for his exercises.
“Earlier, there was a language problem. Since he’s from Afghanistan, it was very difficult to communicate with him, and we had to use Google Translate to get through to him,” Dr Iyer recalled with a laugh. “But in all this time, he has managed to pick up English as well as Hindi, and he can understand us to some extent.”
In two months, Mr Rahim said, his physiotherapy will come to an end.
“I can finally go back home, to Afghanistan,” he said. “I am looking forward so much to beginning life again. For a long time, I thought I would remain without hands for the rest of my life. This still feels like a miracle every day.”
Even Dr Iyer, a veteran reconstructive surgeon, talks about the operation in an amazed tone.
“I remember when Abdul met Joseph’s wife and daughter,” he said. “It was an emotional moment, and he was so grateful to them.”
People have remarked to Dr Iyer, in the months following the transplant, about how this was a case in which a Hindu surgeon took a Christian man’s hands and put them on a Muslim man, he said.
“But religion, in this case, was so superficial,” Dr Iyer said. “When someone interprets it like that, you’re surprised. Of course it’s a good message. But I can tell you that, when it was all happening, no one gave it a thought. Everyone just did what they felt was right.”