A young woman in India received arms from a darker-skinned male donor after losing both of her hands in a bus accident. Her transplanted hands' skin has faded with time.
Shreya Siddanagowder, had her arms amputated below the elbow after an accident in 2016. According to The Indian Express, she underwent a 13-hour transplant operation in 2017 by a team of 20 doctors and 16 anesthesiologists.
Her new hands were donated by a 21-year-old guy who died in a bicycle accident. Physical treatment improved Siddanagowder's motor control of her arms and hands over the next year and a half, and they gradually became slimmer than they were before the transplant. According to The Indian Express, there was another unexpected change: the skin on her new limbs, which had been darker since the donor had a darker complexion, became lighter in color, more nearly matching Siddanagowder's skin tone.
Siddanagowder's physicians believe her body generates less melanin than her donor's, which could explain why her new arms are lighter (melanin is a pigment that lends skin its color). Dr. Uday Khopkar, head of dermatology at King Edward Memorial Hospital in Mumbai, told The Indian Express that more research is needed to determine the cause.
According to the Mayo Clinic, candidates for hand transplants go through months of evaluations and discussions. Experts examine the patient's overall health, including blood tests, X-rays, and nerve function in amputated limbs. According to the Mayo Clinic, eligible applicants are placed on a waiting list and matched with hand donors based on variables such as skin color, hand size, and blood type.
Siddanagowder's visit to the Manipal Institute of Technology's transplant department in Karnataka, India, to register for a transplant coincided with a matching blood type hand donation. According to The Indian Express, her surgery was Asia's first double hand transplant as well as the continent's first intergender limb transplant.
"I am the first female in the world to have male hands," Siddanagowder claimed in a video posted on Facebook by the MOHAN Foundation in June 2019, a charity nongovernmental organization that promotes pioneering research in transplantation and organ donation in India.
However, her hands "have feminine features now," Siddanagowder added.
Slimmer and lighter
According to physiotherapist Ketaki Doke, who worked with Siddanagowder in her hometown of Pune, one explanation for her hands taking on a more "feminine" form could be the muscles adapting to their new host.
"The nerve starts sending messages — this is called reinnervation — and the muscles respond to the body's needs," Doke explained. "Her hand muscles may have begun to adapt to a feminine physique."
Siddanagowder rolled up her left sleeve in the video to show where the transplanted forearm joined her arm, remarking that the forearm's formerly darker tone had lightened since the transplant in 2017.
"Now it matches my own skin color," she said.
According to Johns Hopkins Medicine in Baltimore, just about 100 people have had their hands transplanted worldwide. According to Dr. Subramania Iyer, head of plastic and reconstructive surgery at the Amrita Institute of Medical Sciences in Kerala, India, Siddanagowder's doctors are monitoring the changes in her hands' skin color and shape, and they plan to publish the details of her transplant and recovery in a case report.
Iyer told The Indian Express that further evidence is needed to figure out what is causing these changes in her transplanted hands.