Giving details about the case, Prof.Suresh Patankar, chairman of Ace hospital, Erandwane, Pune, said that a 41-year-old man came to the hospital with abdominal pain and was found to have a kidney located in the pelvis, instead of its normal position. Along with multiple kidney stones, there was a blockage at the Junction, between the kidney and the joining ureter. Traditionally, such cases are extremely difficult to treat due to abnormal anatomy and the higher risk of complications.

An ectopic kidney is a very rare birth condition that is often linked with ureter obstruction and rarely with kidney stones. Treating such cases can be difficult due to the unusual position and structure of the kidney, short ureter, complex blood vessels, and the vicinity of intestines makes the procedure challenging during surgery. While laparoscopic surgery is safer and offers faster recovery compared to open surgery, it can be technically demanding and time-consuming for surgeons.  Patients with long-standing kidney stones can cause inflammation, scarring, and make tissues friable; hence, any attempt at suturing for repair produces tearing of tissues, making surgery even more difficult and increasing the risk of bleeding, infection, and other complications. Earlier, medical guidelines recommended performing such operations in 2 stages. However, with robotic technology, complex surgeries have become safe, more efficient, and less stressful for patients and surgeons.

Therefore, the Ace robotic team decided to go with a robotic surgery, added Prof. Patankar. Using a robotic surgical system, we were able to precisely remove the stones and repair the kidney in the same procedure. But this procedure was not simple and straightforward because of the multiple stones, and there was significant damage to the ureter. Hence, the challenge was how to overcome this problem, and there are no guidelines as such to repair this problem. So on the operating table, we decided to remove the stone laparoscopically and endoscopically, and simultaneously, using a buccal mucosa, that is, the skin inside the cheek, to repair the block.

This patient recovered smoothly and was discharged on the 4 day after surgery. Follow-up showed a good result and no further blockage. A detailed review of existing medical literature confirmed that this is the first reported case where both procedures, stone removal and a graft repair, were done simultaneously on an ectopic pelvic kidney with robotic assistance. Our claim has been confirmed by a peer review of the prestigious “Journal of Robotic Surgery,” which stands amongst the top 25% of World databases.

Dr.Patankar further added that hospitals have performed a large number of robotic procedures mostly for the kidney, prostate, including cancers, and reconstructions. But this procedure was a milestone and highlights how robotic surgery is revolutionizing urology, making even the most challenging procedures safer, precise, and more comfortable for both surgeons and patients. With greater flexibility of movement, enhanced 3D vision, improved ergonomics, and the wise thinking of the surgeons, it allows surgeons to perform complex operations with more precision and comfort. This gives a safe and better outcome for the patients.

The team of doctors included, along with Prof. Dr.Suresh Patankar, senior urologist Dr.Gururaj Padalsalagi, Dr.Sachin Bhuiyal, Fellow-Dr. Saurabh Uplenchwar,  Anesthetist team, Dr.Suchita Hardikar, Dr.Sonali Vaste, Dr.Neha Banwat.

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Despite the unimaginable grief, his wife made the courageous and selfless decision to donate all his organs, duly supported by her family and counseling team. The liver and both kidneys were retrieved and allocated by NOTTO (National Organ and Tissue Transplant Organization), while the heart and lungs were deemed unfit for transplant. The liver was transplanted into a 61-year-old male, and one kidney into a 52-year-old male, both at HCMCT Manipal Hospital, Dwarka. The second kidney was transplanted into a 59-year-old female at another private hospital in Delhi.

Dr. Shrikanth Srinivasan, Chairman, Manipal Institute of Critical Care Medicine, “Despite the best efforts of the treating team, the patient’s condition did not improve and was declared brain dead on 12^th May 2025. Despite the profound loss, the family made the courageous decision to donate his organs, offering a gift of life to those in need. Their strength and compassion in such a difficult time is truly inspiring and serve as a powerful reminder of the impact one life can have on many.”

Dr. (Col) Avnish Seth VSM, Head, Manipal Organ Sharing & Transplant (MOST), said, “Organ donation should be an essential component of end-of-life care. Only if the family is fully convinced that their loved one succumbed despite the best possible treatment, will they consider doing something for others. Trust is an important component. Transparency in the allocation of organs as per the waiting list, like it is being done in our country by NOTTO, gives a lot of confidence to the family to arrive at the correct decision. This altruistic gesture by the family has saved three lives, and this is the true spirit of humanity. He will live on.”

There remains a wide gap between patients who need transplants and the organs that are available in India. Around 1.8 lakh people suffer from kidney failure every year, however, only 13,426 kidney transplants were performed in 2023. An estimated 25,000 to 30,000 liver transplants are needed annually in India, but only 4491 were performed in 2023. Similarly, out of several thousand people suffering from heart failure, only 221 received a heart transplant. In the case of corneas, about 25,000 transplants are performed annually against a requirement of 1 lakh.

This noble act of organ donation highlights the pressing need for organ donations in India, as there is a significant disparity between patients awaiting transplants and the availability of organs. Increasing awareness and participation in organ donation can bridge this gap and offer hope to countless lives in need. 

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PUNE: Despite challenges of different blood groups and multiple arteries, a 40-year-old female resident of Pune who suffered kidney failure was successfully treated by the doctors of Manipal Hospital, Baner.

Aarti Mashale, a homemaker, has been facing a series of severe health issues since 2015. Her struggles began with a diagnosis of SLE (Systemic Lupus Erythematosus) and lupus nephritis, a debilitating autoimmune disease. Despite trying five different forms of medications, her severe hypertension remained uncontrolled. In 2020, her health further deteriorated with the onset of herpes zoster and diabetes. By April 2021, she had developed early signs of kidney failure, which rapidly progressed, culminating in the need for dialysis by 2023.

As Aarti’s condition continued to deteriorate, she required an urgent kidney transplant. Her husband, Rahul Mashale (43) decided to donate one of his kidneys. However, the transplant was challenging due to ABO incompatibility (mismatched blood group), with Rahul having AB+ blood and Aarti having A+ blood. Further evaluation revealed an additional challenge that Rahul had triple renal arteries, a rare anatomy occurring in only 10% of the population. Defying all odds, Dr. Tarun Jeloka and Dr. Anand Dharaskar along with their team, successfully performed the kidney transplant on 18^th July 2024. 

Speaking on the case, Dr. Anand Dharasakar, Consultant Urology said, “This was a challenging case for us. Performing a transplant was complicated as the donor had three renal arteries, while the recipient had only one. Suturing the three arteries was difficult in the donor’s case, therefore, we performed a laparoscopic surgery to harvest the kidney, which is less invasive, quicker to heal, and more cosmetically preferred for the donor. However, transplanting the kidney into the recipient with only one artery was equally daunting, requiring precise vascular reconstruction to ensure proper blood flow.”

Overcoming the challenge of mismatched blood groups, Dr. Tarun Jeloka, Consultant of Nephrology and Transplant said, “We performed the transplant using a special protocol for incompatible blood types. To reduce the risk of rejection, we gave the patient a monoclonal antibody medication two weeks before the transplant, followed by additional medications a week before. We also did a procedure called plasma exchange to remove harmful antibodies from the blood until they reached a safe level. Despite the higher risks, the transplant was successful, just like a matched transplant. The patient’s kidney function became normal within two days, and was able to go home without any complications.”

The donor was discharged within 7 days, while the recipient was discharged within 9 days of the procedure. The recovery period for both will be the same as for matched transplants: 2-4 weeks for donors and 6-12 weeks for recipients. Both donor and recipient can expect to live normal lives, with the recipient required to take transplant medications lifelong.

The transplant team involved Dr. Tarun Jeloka, Dr. Anand Dharaskar, Dr. Saurabh Khiste, Dr. Shrirang Ranade, Dr. Nilesh Warwantkar, Dr. Ranjeet Maheshgauri. Anesthesia support was provided by a team headed by Dr. Ashish Pathak. 

In India, as reported in 2022, 71% are female donors, and among spousal transplants, 90% are wives. Males are considered bread-earning members and hence have a concern toward non-donation. However, we want to emphasize that kidney donation does not compromise health in any way and this and similar cases should become examples for male donors.

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FARIDABAD: Two male patients, one of them 64 years old and the other 19 years of age, have successfully undergone hand transplantation at Amrita Hospital, Faridabad. This is the very first time that such a procedure has been conducted in North India. Significantly, this is also the first time in India (and only the second such case in the world) that a kidney transplant recipient has received a hand transplant. The two complex hand transplantation surgeries lasted for around 17 hours and were conducted in the last week of December 2023.

Gautam Tayal, the 64-year-old patient hailing from Delhi had undergone a kidney transplant 10 years ago, due to which he was already on immunosuppressants. About two years ago, he lost his left hand just above the wrist in an industrial accident in a factory. The hand that he received in the transplant belonged to a 40-year-old man who was declared brain dead following a head injury. The deceased man’s family generously agreed to donate his various organs, including his hands, immediately following his death. The donated hand was flown from Thane, near Mumbai, to Faridabad, where the doctors immediately started the procedure to transplant the hand.

Said Dr. Mohit Sharma, Professor & Head, Centre for Plastic & Reconstructive Surgery, Amrita Hospital, Faridabad: “This is not only North India’s first-ever hand transplantation, but also the first one in the country conducted on a kidney transplant patient. This is a very rare and exciting feat in medical science. To achieve the union of the two hands, we had to join two bones, two arteries, 25 tendons, and 5 nerves. The patient is doing well in the post-operative period and his hand movements are in recovery. He will be discharged within a week.”

Patient Gautam Tayal said, “I was devastated at losing my limb at this age. However, seeing Amrita Hospital’s stellar record of conducting hand transplants gave me hope for the future. This hand transplant has gifted me a new lease of life. I am so happy and grateful that God, and Amrita doctors, have given me a second chance to live my life to the full.”

The second-hand transplantation at Amrita Hospital Faridabad was conducted on a 19-year-old youth, Devansh Gupta, hailing from Delhi. He lost both upper limbs (hands) and the right lower limb above the knee in a train accident three years ago. The two hands he received in transplantation belonged to a 33-year-old man from Surat who was declared brain dead due to a chronic and fatal lung condition. His family readily agreed to donate his various organs, including his hands, immediately following his death, and that is when Devansh’s prayers for a new pair of hands were answered.  The hands were flown to Faridabad from Surat in a complex logistical operation.

Said Dr. Anil Murarka, Senior Consultant, Centre for Plastic & Reconstructive Surgery, Amrita Hospital Faridabad: “The patient’s right limb was transplanted at the upper arm level and the left limb just above the elbow level. The higher the level of amputation, the more challenging the hand transplant becomes, and there are profound technical issues in upper-arm-level hand transplants. So far, the patient’s progress has been excellent. He needs to take immunosuppression lifelong so that the new hands are not rejected by his body. It will take him anywhere between 6 to 18 months to regain enough function in his new hands to do day-to-day activities. He also needs to undergo intensive physiotherapy including muscle stretching for another year.”

Said the patient Devansh Gupta: “When I lost both my hands at such a young age, I couldn’t come to terms with reality. It was a devastating loss from which it was impossible to recover. My life as I knew it came crashing down. Getting a new pair of hands seems like a dream come true to me. God has finally answered my prayers. I eagerly look forward to the day when I will feel the first sensation in my hands and be able to move my fingers. I thank the doctors of Amrita Hospital for giving me a new life and a new hope.”

Said Swami Nijamritananda Puri, Administrative Director, Amrita Hospital, Faridabad: “I extend my heartfelt congratulations to the Amrita doctors for achieving such a remarkable medical feat, particularly in successfully conducting a hand transplant on a kidney transplant recipient, which is India’s first. This accomplishment is a testament to the world-class infrastructure of our hospital and the exceptional skills of our surgeons. In a brief period, Amrita Hospital has emerged as one of the world’s leading institutions for hand transplants.”

Said Dr. Sanjeev Singh, Medical Director, Amrita Hospital, Faridabad: “My congratulations to Amrita doctors and everyone involved for the two successful hand transplants in Faridabad. This is a major medical feat. The hand transplant surgery posed a risk of kidney failure to the 64-year-old patient, but thanks to the entire team at Amrita, the surgery was a success. We now look forward to both the patients leading normal lives, like anyone else.”

The success of this complex operation was attributed to the concerted efforts of a multidisciplinary team. Key contributors include consultants in Plastic and Reconstructive Surgery, such as Dr. Shikha Gupta, Dr. Devajyoti Guin, Dr. Srilekha Reddy, Dr. Vasundhra Jain, and Dr. Arun Sharma. The Department of Anesthesiology, led by Dr. Mukul Kapoor and supported by Dr. Shaloo Garg, Dr. Niti Gulati, and Dr. Ketan Kulkarni, played a pivotal role in managing the patient throughout the procedure and the post-operative period. Orthopaedic surgeons, Dr. Mrinal Sharma and Dr. Priyadarshi Amit, along with their team, ensured the quick union of bones for limb stability.

In Nephrology, Dr. Zacharia Paul, Dr. Urmila Anand, and Dr. Kunal Gandhi managed crucial immunosuppression to prevent limb rejection. The Pathology Department, under the leadership of Dr. Gaurav and Dr. Arruparrna Sen Gupta, handled limb rejection diagnoses. Dr. Ansar Ul Haq and the Physical Medicine Department oversaw the patient’s rehabilitation post-transplantation, while Dr. Charu Dua looked nutrition of the patients. Silent contributors included nursing staff and OT technicians, including Ms. Shakti Khati, Ms. Rari Chandran, Ms. Sonia, Joginder, Rohitash, Virender, Neeraj, Akash, and ICU nurses Dharamender, Pradeep, Pawan, Megha, Pritika, Abbas, Nitika, Pramod, Swarnima, Nidhi, and Priyanka. Medical administration, represented by Dr. Danish, Mr. Ashwini Sarin, Ms. Nivedita, transplant manager Mr. Arjun, and Smt. Vani played a crucial role in logistical coordination, including the transportation of doctors and organs. Dr. Mohit Sharma also acknowledged the divine blessing of Amma, the institute’s founder, as the backbone of this surgical achievement.

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