The Del'Roh is the supreme leader of the True Black Hand and oversees the entire sect. Since the Treaty of Enoch that reunited the Eastern and Western halves of the Black Hand in the 1700s, the Del'Roh has been selected by the eldest and most powerful and wise of Black Hand Kindred. The current Del'Roh has held the position ever since, over 250 years.
Little is known of the current Del'Roh, although she is powerful, brilliant, crafty, and charismatic, as befits her role as the sect's leader. Rumors about her abound, particularly regarding what kind of blood she can drink, implying that she could be a Ventrue.
The Del'Roh lives in the city of Enoch in the Shadowlands and rarely returns to the Living World. This gives her 10 lieutenants, the Seraphim, considerable autonomy. The Del'Roh is served by the liches, three powerful Kindred who used to be Euthanatos mages. They act as judges and as the Del'Roh's representation. The seraphim and liches form the Del'Roh's council of thirteen, also known as the wazirs, who meet on special occasions to determine the sect's direction and long-term goals. (The Del'Roh also sometimes meets with a council known as the Diwan – this may be the same as the council of thirteen.) The Mummy Inauhaten is not technically a wazir, but he sits on the council as he pleases and may speak to the Del'Roh due to his high status.
All those who join the True Black Hand drink the blood of the Del'Roh, at least one Seraph, and several other Hand members, forming a Vinculum.
In 1984, the Del'Roh called for the extermination of all Souleaters (as the True Black Hand referred to beings who had been corrupted by Vicissitude) after a stronghold of over 100 Souleaters was discovered in Libya. This initiated a secret war called the Shadow Crusade, designed to eliminate Vicissitude, which the True Black Hand believed to be a sentient, alien parasite from the Deep Umbra. However, the Del'Roh's limited support for the Shadow Crusade has lead some members of the True Black Hand to suspect that either she or some of her advisors are Souleaters themselves, or that the Del'Roh is preparing for a more immediate threat.
In The Black Hand: A Guide to the Tal'Mahe'Ra, Anadja, the current Del'Roh, earned it by being the sole vampire capable of approaching the Basalt Throne since the rediscovery of Enoch in the lands of the dead. Her lack of need for rest, and evident immunity to the negative effects of the Underworld upon other Kindred, are attributed to mystical properties granted by the Throne.