When Shriya Sidanagodar was amputated and had two new ends transplanted, the Indian student did not hesitate to agree, even though they were helping a man. But their looks naturally altered to the point of identifying with her body and skin color.

The forearms were covered in hair and large, but today they became smooth and skinny, and they also adapted to the color of her skin, which surprised the doctors who performed this rare 13-hour transplant.

"The donor was a tall man with his hands wide," Soma Danagoder's mother Soma told AFP on the phone from her home in Pune, western India.

"Now nobody can tell that they are the hands of a man ... Even Shreya started wearing jewelry and nail polish," she added.

Shreya's life was turned upside down in 2016 when, at the age of 18, she suffered a bus accident that crushed her forearms.

The delay in obtaining first aid resulted in amputation of her hands from below the elbows.

Only 200 successful hand transplants have been performed worldwide, including nine in India, since the first similar transplant was performed in the United States in 1999 for a man whose left hand was blown off by fireworks.

Find a giver

The first hand transplant was performed in India in 2015 at the Amrita Institute of Medical Sciences in Kerala state in the south of the country where the Sedanagoder family accompanied her daughter. The biggest problem was finding a donor, as Indian families often hesitate, culturally, to give their loved ones a hand after their death.

"People usually have to wait a long time," said Subramania Eyre, a member of the team of doctors who performed the operation.

"As a result, those looking for a transplant are so desperate that they don't mind if the hands are back to the opposite sex," explained the specialist in reconstructive surgery.

Ultimately, the hospital received the hands of a man in August 2017. Shreya and her family agreed to get them.

The two forearms were first attached to the bone before "stitching" the tendons, blood vessels and skin.

After the transplant was completed, Shreya had to undergo more than a year of physical and psychological physical therapy to adapt to the presence of the new hands, and to be able to move and feel them.

Birthday gift

Eyre said the color of the sedanagoder's hand began to change a lot and quickly, but it was difficult to determine the reason behind it. "It could be because of MSH, which is a hormone controlled by the brain responsible for stimulating melanin production," she explained.

Melanin is a natural pigment that gives skin, hair, and eyes their colors.

While Dr. Shehla Agarwal, a dermatologist in New Delhi, noted that the absence of testosterone explains why the hands are getting smoother. Iyer agreed with the opinion that other hormonal changes may explain the change in color. However, she pointed out that there are other additional factors that contributed to this major change.

"The male donor may have been exposed to more sunlight and physical activity compared to the recipient," Agarwal reported.

Shreya is very happy with this transformation, and she even took her last exam using her new hand.

"We are very happy for her," said Eire. It was the most beautiful moment when I received a letter that I wrote in her handwriting on my birthday. "There is nothing better than this gift."