Tran Bang Nam, a 19-year-old Thai Nguyen resident, was fortunate to receive two donated arms from a 31-year-old brain-dead young man from Hai Duong. Nam is still astounded 7 months after the historic transplant at 108 Central Military Hospital because life appears to have turned a new chapter.

A doctor examines Nam's transplanted hand.

Nam had an accident with a chemical explosive four years ago that crushed his two forearms, which could not be saved and had to be amputated. At the age of 15, his future came to an end.

When Nam awoke from the surgery and saw that his arm had been amputated, he asked his mother, "Mom, where is my hand?" Nam's mother patted him on the back and said, "It is taken to be transplanted."

Nam officially stopped studying after he returned from the hospital. Everyone assisted him with all daily activities such as bathing, toilet, dressing, eating, and so on. He was still anxiously awaiting the day of the hand transplant, constantly asking his mother when he would be allowed to leave the hospital.

Nam's mother, knowing she couldn't hide, had to tell her son the truth: his two arms would have to be surgically removed for the rest of his life. When he heard the news, the 15-year-old boy saw everything collapsing in front of his eyes, teetering on the brink of collapse.

According to Nam, there was a period of psychological crisis during which he was quiet and irritable for no apparent reason. There were nights when Nam stayed awake, missing his friends and school, and worrying about his uncertain future.

Nam tried to find a way to revive himself after losing his balance for a few months, starting with using tape to stick a spoon on his hand to scoop rice, clamping his elbows to hold a toothbrush... Nam gradually grew accustomed to his body's flaws, but the inferiority complex grew stronger and infiltrated every fiber of his being.

Nam's family was overjoyed at the beginning of 2020, when the patient Pham Van Vuong, 31, of Thanh Tri, Hanoi, had his forearm successfully transplanted from the world's first living donor. Though the chances of receiving a transplant are extremely slim, Nam hoped and registered for one.

Nam's family received a call from Hospital 108 in mid-September 2020, informing them that someone had donated two forearms.

“The patient is upbeat and dedicated to his rehabilitation. If the treatment continues, the patient will look completely different in 6-12 months, when the hand will be able to recover at least 80-90 percent of its original strength. At the time, Nam could ride a motorcycle, drive a car, and live a normal life like many others," Professor Hoang explained.

Nam often fantasized about returning to school and having fun with his friends after the life-altering transplant. The Thai Nguyen young boy hopes to return to school soon to fulfill his dreams.

Exciting opportunities for millions of people with disabilities

Both hand transplants for patients Vuong and Nam were performed by doctors at 108 Hospital, which  had four years of preparation, according to Professor Hoang, who himself spent around ten years in Germany studying and researching, as a PhD student and then a medical doctor in plastic surgery and hand surgery, and then post-doctoral research.

The patient's before and after pictures of hand transplantation.

After eight hours of stress, the transplant was successful on September 16, which was the first case of two-arm transplantation in Vietnam as well as Southeast Asia. The two arms fused very well after transplantation, and now, seven months later, the graft scars are very small, and the arms have turned firm and flexible.

Nam's arm recovered faster than expected, according to Professor Nguyen The Hoang, Deputy Director of Military Hospital 108, who performed the hand transplant. The most delicate movement of the hand was writing, which Nam also did.

While working on a doctoral thesis in science, Professor Hoang was invited by his teacher to be one of five surgeons who performed a world-first operation at the Rechts der Surgical Hospital in Isar, a town in Germany in 2008, on a German citizen who had lost both arms in a workplace accident. The surgery went off without a hitch, and the two arms that were transplanted functioned normally, which however, took up to 16 hours to complete with the coordination of leading experts from Germany, the US, the UK, Australia, and France.

Currently, only a few limb transplants are performed worldwide each year for two reasons: limb transplantation is a far more complex and stressful technique than organ transplantation, and donors are exceedingly rare.

According to Professor Hoang, the most difficult allogeneic limb transplant is the wrist and forearm transplant because there are 43 muscles, eight large blood vessels, and countless complex nerves to control extremely delicate movements of the hand, whereas leg grafting is much simpler.

Even though only 3 of 6 of the factors in the case of patient Vuong were in sync, the transplant was still successful. The rate of immune compatibility for the male patient was even lower, but the doctors were still self - assured in doing it, and the patient is recovering excellently. Professor Hoang believes Nam's case will rebound faster than Vuong's because the forearm was not crushed and infected.

“For each patient, the hospital's board of directors and the surgical team must carefully discuss and prepare for the worst-case scenarios in order to prepare to deal with them with the goal of ensuring absolute safety for the patient," Prof. Hoang said.

He also stated that allogeneic limb transplantation is far superior to hand grafting and the use of prosthetic hands.

In terms of cost, prosthetic hands cost billions of VND, are difficult to obtain for the poor, and must be repaired or replaced if damaged. The prosthetic hand can be grasped flexibly, but the patient always wants to hide and is self-deprecating in communication. Meanwhile, using the hand grafting technique, it only takes a few tens of millions of VND.

Prof. Nguyen The Hoang and patient Tran Bang Nam at Military Hospital 108.

“Rehabilitation of the post-transplant limb takes time, but it is capable of limited function. Above all else, the new hands will restore confidence in the patient's ability to communicate and function, something no computer or equipment can ever replace. Hand transplantation is the most effective, most ideal, and least expensive therapy option for all individuals with hand disabilities,” said Professor Hoang.

The procedure has been perfected by the doctors at 108 Hospital, but finding donated limbs is proving to be a challenge.

Since Nam's transplant, there haven't been any more cases of brain-dead patients registered to donate arms or legs at Military Hospital 108. Prof. Hoang said there are hundreds of amputee patients waiting for a transplant, many of whom are very young girls who have permanently lost their hands in traffic accidents and fire.

Despite understanding the compassionate value of limb transplantation, few families agree to let their loved ones' bodies be incomplete after death, according to Prof. Hoang.

“We hope that through dissemination of many positive stories, in the coming time, more people will understand the importance of organ and limb donation to help many disabled patients recover and return to normal life. In the event of burial or cremation, a person's arm or other body part will decompose into ash.”

Thuy Hanh

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