It’s all about timing and some teamwork
“We have found a donor for you and can transplant a healthy heart into your body today. Can you come for surgery immediately?” Pravin Singh got this phone call on April 3 as he was stepping out of AIIMS after a routine check-up.Updated: May 17, 2008, 23:30 IST
“We have found a donor for you and can transplant a healthy heart into your body today. Can you come for surgery immediately?” Pravin Singh got this phone call on April 3 as he was stepping out of AIIMS after a routine check-up.
He promptly said yes and went back right in. “I wasn’t worried, just relieved that my problem was about to be over,” said Pravin, who is married with two children. Singh has to stay in Delhi for the next three months before he is declared fit to go home.
Singh’s heart failure had been caused by cardiomyopathy — the most common reason for heart failure in India — in which the heart muscles thicken and cannot pump blood properly.
“A month ago, doctors at AIIMS had told me a heart transplant was the only cure, but I may have to wait for years to get a healthy heart. The call came within a month of my diagnosis,” said Singh, a security officer from Jabalpur.
“He is fit and has recovered very well after surgery. We insist on the patient staying in Delhi for three months for follow-ups to ensure the implanted heart is not rejected,” said Dr Airan. People with transplanted hearts need to take medicines to suppress their immunity so that the body does not label the implanted heart as a foreign body and reject it.
“Since patients need to take steroids for a few years along with strong immunosuppressants, the risk of infections is high, which is what most of them finally succumb to,” he said.
The actual transplant was the culmination of a long process initiated by Dr Sumit Sinha, a neuro-surgeon at AIIMS Jai Prakash Narayan Apex Trauma Centre, declaring an accident victim brain dead and contacting the Organ Retrieval and Banking Organisation (ORBO) immediately.
“The anonymous people who work behind the scene — such as the treating physician who declares brain death — also play a critical role in successful transplants. If there was no donor, Pravin would still walking around with a diseased heart,” said Dr Aarti Vij, director, ORBO.
In this case, the donor’s family readily agreed to donate his organs, but that is not always the case.
“Of the four brain deaths at AIIMS, two families agreed for donation. Resistance to donation usually comes from the elders. In one case, the family agreed but the mother said no and we had to tear up a filled form. In the another case, the son wanted to donate but the donor’s father said no,” said Dr Vij. “We go ahead only when we have consensus from the whole family,” she said.
Quick retrieval and implantation is preferred so that the body can be given back too the grieving family as soon as possible. “There are no scars, only one midline incision down the chest. If the long bones are retrieved, we replace the cavity with artificial bones so that the body is not disfigured,” said Dr Vij.
ORBO has the unenviable job of coordinating with surgeons from eight different streams of medicine, the police, forensic experts and the donor’s families to ensure retrieval happens as quickly as possible.
“It’s all about teamwork with surgeons from eight different specialities working together to retrieve the donated organs for transplantation,” said Dr Airan.
Once a heart is retrieved, it has to implanted within six hours. “Another setback is the distance patients have to travel to reach Delhi,” said Dr Vij.