First in eastern India: 10-year-old undergoes donor bone transplant

KOLKATA: Doctors at the state-run IPGMER & SSKM Hospital have conducted a successful bone transplant on a 10-year-old boy from Murshidabad. This marks the first bone transplant using donor bone from the hospital's own bone bank, which is also the only one in eastern India, and among a couple of such banks across govt institutes in the country.

The boy, Wasem Reja, was suffering from swelling around the left shoulder, which caused pain and movement restriction. Doctors at IPGMER diagnosed him with a tumour in the proximal humerus bone, the bone that forms the upper arm and joins it to the shoulder and the forearm. Reja was operated on for the tumour in Jan this year. Clearing of such tumour tissues during such an operation leaves a cavity in the bone.

Doctors at the orthopaedic department decided to conduct the bone transplant to fill up the cavity using bone from the bone bank, which has now become functional. The doctors examined 29 pieces of bone and selected three pieces from the bank for the purpose, which underwent all relevant tests and strict protocol procedures like gamma sterilisation and microbiology to rule out any kind of infection. Doctors conducted the bone transplant using approximately 20 grams of bone on March 11. The boy was discharged after a week.

"The procedure of the allograft bone transplant took us around one-and-a-half years. Even as all went well, we kept the boy for a week under observation for close monitoring as this was our first such case. He came back for follow-up on Tuesday and we found the bone graft is incorporating well with the normal bone," said orthopaedic professor Tanmay Datta, dept head and also in charge of the bone bank.

Doctors found blood supply to the area normal, swelling gone, the boy relieved of the pain, and no infection so far.

"The tumour was benign but very aggressive. If left untreated, it could have flared up, increasing pain and swelling. And if the bone cavity was left without the transplant, it could have affected the boy's hand function, gradually making him to struggle even to carry out daily chores in the long run," added Datta.

"We first went to doctors in Berhampore, where there was no improvement in my son's hand condition. The pain and swelling kept aggravating. That compelled us to come all the way to SSKM Hospital. We had no idea about bone transplant and went according to what the doctors suggested. We are now seeing a miraculous outcome. My son is pain-free now. Doctors said there would be further improvement soon," said the boy's father, Mahibur Rehman, a civic volunteer for Rejinagar in Murshidabad.

The bone bank at SSKM was unveiled by Bengal CM Mamata Banerjee in Sept last year. This is not only eastern India's first bone bank but among the few countable bone banks in institutes in India that include AIIMS Delhi and Tata Memorial Hospital Mumbai. Though there are some private bone banks, patients needing bone transplant need to purchase it via the hospitals where the transplant is planned.

Right after the inauguration of the bank, hospital officials started the procedures of banking bones, starting with bones that are cut during procedures like total hip and knee replacement surgery. Such expendable bones are generally discarded as biomedical waste. But the bone bank is now collecting these bones after taking permission from the donor patient.

Doctors said that in the unavailability of a bone bank, they used commercially available synthetic grafts on patients needing bone graft transplant, while human bones are always a better option. While taking bone from a living donor is also possible, there is always the risk of donor morbidity.

"The natural human bones are always a better option with better healing, better graft outcome," added Datta.

Because of the growing demand for bone transplant, the bone bank is now planning to bank donated cadaver bones so that more patients benefit. Talks are on with ROTTO (East), SOTTO and state health officials for the purpose. The orthopaedic department currently has 15 patients listed for bone transplant.

"For now we will be utilising the bone bank for the requirement of our own patients. But we can expand the services for patients in other hospitals in case of requisition and permission from the health department," said an official at IPGMER & SSKM Hospital.