During a 2006 visit to Mount Sinai Medical Center in New York, I was sitting with transplant cardiologist Dr. Alan Gass discussing a young patient of mine who had a heart transplant in 2001 at Ames. When I mentioned the year, he immediately cut up a yellow newspaper. Medha, the young wife of bhajan singer Anup Jalota, also had a heart transplant in the Sinai mountains in the same year when I was ill – Medha was the only one who traveled from India to America. My illness hit too close to home.
Both Medha and my patient are success stories in the world of heart transplants. Medha started living happily for a decade after the brain transplant. My patient, who came to AIIMS with advanced heart failure but is still doing well 21 years after his transplant, was seen by a team led by Dr P Venugopal – the same person who performed India’s first successful heart transplant in 1994.
But the story of heart transplant in India is very old…
“After all these years I can still see it clearly. It was an unforgettable sight. We had taken an old heart and we had to move very quickly to fill that huge hole with a new heart. They weren’t afraid of us then. No wonder they thought That we are out of our minds.”
—–Adrian Kantrowitz (American transplant surgeon)
In 1967, the world was racing for a successful heart transplant: surgical teams in the US were led by Dr. Norman Sumway of Stanford, Dr. Richard Lower of Virginia, and Dr. Adrian Kantrowicz in New York. But the winner was a relatively unknown contender from another country entirely, South Africa’s Dr Christian Bernard, who performed the first successful human-to-human heart transplant on the night of 2/3 December 1967 at the Groote Schuur Hospital in Cape Town.
India was not far behind. Dr. PK Sen from Mumbai was preparing for a heart transplant by practicing dogs. In February 1968, he underwent a heart transplant, the first for India and the fourth in the world. Unfortunately, that patient died, and so did the next one, and India’s heart transplant program never took off.
But it was only after 26 years that the AIIMS team led by Dr P Venugopal performed the first successful heart transplant on 3 August 1994. The patient was Devi Ram, a 40-year-old heavy industry worker. The heart donor was a 35-year-old woman who died of brain hemorrhage in the corridor of the neurosurgery ward.
The tension in the team was palpable. Dr. Christian Bernard’s first transplant patient survived only 18 days. Both PK Sen’s patients had died. In the words of Dr. Venugopal, “We were confident and prepared. The surgery was well planned and well executed. But we also knew that a failed transplant would destroy the process for up to 20 years.
The surgery was successful, and the patient lived for more than a decade, later dying of a brain tumor.
AIIMS has done more than 80 heart transplants so far (highest in the government sector) and recently started a lung transplant program with two successful transplants.
The gift of life
“We think to ourselves that what we are doing is just a drop in the ocean. But if that drop were not in the ocean, I think the ocean would be less because of that missing drop.” – Mother Teresa
A heart transplant is an expensive treatment and not everyone gets a heart but every heart transplant story inspires us to do more.
engineer: Animesh (name changed for privacy) was a young boy when he suddenly suffered a heart attack. We could not manage him with medication and listed him for an immediate heart transplant. These were the years when many centers had only one or two transplants.
While waiting for the heart, he went into cardiac arrest and we performed cardiac massage and put him on a heart-lung machine. A nationwide alert was issued for the heart. His blood group was AB positive (a universal recipient blood group). The heart became available in Jaipur, our surgeon reached Jaipur overnight, cut the heart and came back and transplanted the heart. Animesh recovered and today is completing his fourth year in Mechanical Engineering.
A wedding: Ruksana (name changed) is another young woman, one of five girls in a family of three girls with heart attacks. He was listed for a heart transplant, but there was no money. In fact, he had to pay for the medicine by teaching at a local madrassa. He was given Rs 10 lakh support from the Ministry of Health and a heart transplant. Today, three years later, she has plans for marriage and a family.
Blue to Pink: Krishna (name changed) was born as a blue baby with a complex heart problem. After birth, he underwent several operations until the age of 20, when surgeons gave up and said no more operations were possible. He was sent for a heart transplant. He waited for more than a year and we can continue to encourage and support him with the hope that he will find a heart. Finally, after more than a year of waiting, and after a difficult surgery, he recovered and is now a successful executive in a travel company.
Step by step: How is a heart transplant done?
There are two sides to the story. ill Who needs a heart transplant donor family which gives heart. A patient is one with advanced heart failure who has exhausted all forms of therapy, and goes to a transplant center. There, he is thoroughly evaluated for any correct or treatable cause and finally enlisted no, which is the central government body that regulates heart transplants in India. A patient support team Cardiologists, cardiac surgeons, intensivists, nurses, transplant coordinators and social workers.
When another patient passes Declaration of brain death, often in a trauma hospital or neurosurgery ward, social workers or doctors talk to families and advise them about organ donation. If the family is willing, a coordinated teamwork begins.
All teams that can harvest healthy organs (heart, lung, liver, kidney, eye) are notified and the patient is evaluated and organ recipients are alerted. If the organs are acceptable, the recipient is called to the hospital.
Typically, one team begins harvesting the organ while another team prepares the recipient. If the organ harvester comes from another city, the local police, green corridor and air transport all work together to deliver the organ to the patient within four hours.
The moment the limb is reached recipient hospital, the surgery takes place and can take anywhere from 4 to 10 hours depending on the organ and complexity. The patient is usually in the ICU for 2-3 days and is discharged in about 2-3 weeks.
I have too many diseases to be an organ donor: Patients with diabetes, high blood pressure, hepatitis can also donate organs.
If organ donation is consented to, doctors will not work hard to save lives: Doctors are trained to save lives. They will never compromise on this. Organ donation is considered only after declaring brain death.
I am too old for organ donation: There is no age limit for organ donation.
It is against my religion: No religion is against organ donation. If in doubt, talk to your religious leader.
Inability to lead a normal life: Apart from the need for lifelong medication, patients can lead normal lives as depicted in some of the stories above.
Hearts don’t last long: The longest survivors have lived more than 33 years after transplant. There is always the option of a second transplant. Reena Raju, a famous national level hockey player in India, underwent a second heart transplant eight years after her first heart transplant failed.
India Today: The transplant story continues.
After the first successful heart transplant in 1994, several centers in India slowly started transplanting, but only 50 transplants were done in the next five years. This was mainly due to lack of organized organ donation programs, public reluctance to accept the concept of organ donation (especially during brain death) and lack of government priorities for this very expensive form of treatment. .
Gradually the program was picked up by the state and central governments recognizing and supporting it, and more organized organ donation programs were started in many states and awareness of the concept of organ donation increased. Today India has done more than 1500 heart transplants, now more than 200 are done annually.
the way forward
Heart failure patients can be saved only by heart transplant. Transplants are expensive – not only is the surgery expensive, but post-surgery medication costs up to Rs 60,000 per month for about three to six months before the cost comes down.
The surgery itself costs Rs 15 to 20 lakhs. Low cost in government hospitals (AIIMS does transplant at a cost of 15 lakhs which includes all medicines for a period of 2 years). Government support for transplant programs is slowly becoming available but more needs to be done. Organ donation awareness is also important.
Who can donate?
Anyone can pledge to become an organ donor. You can fill the pledge form online at https://notto.gov.in. This registration is only an expression of your intention to become an organ donor. You get a donor card and you have to share your wishes with your relatives because by law the relatives have to make the final decision on organ donation.