As donor organs fly across state lines, could it tackle illegal trade?
A single donor’s organs saved 4 lives across 3 states, Indore, Delhi and Haryana, in a feat that should be replicated to stem the illegal organ trade that preys on people’s desperationUpdated: Jun 14, 2016 19:25 IST
On April 28, a heart retrieved from 18-year-old Deepak Dhaketa began beating inside Delhi resident Anita Verma, 47, within 4 hours and 3 minutes of Deepak being declared brain dead, at the Sri Aurobindo Institute of Medical Sciences, Indore.
The entire procedure was undertaken within the optimal ischemic time — usually four to six hours, after which the muscles of the heart, if not beating or supplied with oxygen, deteriorate.
What made this transplant possible was a massive effort to transport the heart to Madhya Pradesh, Delhi and Haryana, creating green corridors on the ground and in the air. Apart from the doctors involved, city and hospital administrations, air-traffic control, the police, traffic police and Central Reserve Police Force worked together closely. The transplant was performed by Dr Anil Bhan, director of cardiothoracic and vascular surgery at Medanta.
“The aorta, the main artery supplying oxygenated blood to the body, was clamped to help retrieve the heart, at 10.53 am in Indore. At 3.56 pm the transplantation surgery in Delhi was complete,” says Dr Naresh Trehan, chairman of Medanta. Transporting the heart from Indore to Delhi took 1 hour and 46 minutes.
Speed is key
Organs are only harvested from people declared brain dead, usually after an accident, while the patient is on a breathing machine. When a person dies naturally, the heart stops beating, cutting off the oxygen supply and damaging the cells. The damage, called ischemia, progresses rapidly at body temperature. Hence retrieved hearts and other organs are first cooled inside the body, then stopped, removed, and shipped at 4 degrees Celsius, which lowers the tissue’s metabolic rate by 90%, creating a window in which it can be implanted.
How Dhaketa’s heart reached an operation theatre in Haryana from Indore within two hours is a study in coordination and efficient management among different departments. “Air Traffic Control gave the necessary clearances and created a green corridor that ensured no flight was within the radius of 27 nautical of the chartered flight, which covered a distance of 670 km in 1 hour 20 minutes, the flight time of a commercial Boeing,” says Dr Trehan.
The plane was allotted a priority bay, where an ambulance was waiting at the tarmac with CRPF escort to move the retrieved heart out through the service gate within 3 minutes. “The ambulance ride from the airport to the hospital, 18 km away, took 20 minutes and 29 seconds because of the green corridor and escort provided by the Delhi and Haryana traffic police in their respective states,” says Dr Sunil Dubey, head, emergency services, Medanta.
Indore, close to 600 km away from Mumbai and 700 km from Delhi, has emerged as India’s leading centre for organ harvesting, from where harvested organs have been sent to Delhi and Mumbai nine times over the past seven months. In Dhaketa’s case, for example, his organs saved four lives — the heart was transplanted at Medanta in Gurgaon, the liver at the Institute of Liver and Biliary Sciences in Delhi, and the kidneys in Aurobindo Hospital in Indore. Unlike the heart, the retrieved liver has a shelf life of up to 12 hours, so window for transplantation is higher.
Recipe for success
What transformed Indore’s transplantation scenario this year were efforts of the Indore Organ Donation Society, established in February 2014, and close coordination between MGM Medical College and the city administration. “The Human Organs Act 1994 needed multiple permissions for a single organ donation when a single-window clearance is what is required to actively harvest organs in a short time frame,” says Dr Sanjay Dixit, joint secretary, Indore Organ Donation Society.
This was made possible with the Madhya Pradesh government appointing the dean of medical colleges as the appropriate authority for permissions and Additional Director General (ADG) of Police Vipin Maheshwari. They together fast-tracked permissions needed for medico-legal cases. Divisional commissioner Sanjay Dubey further fine-tuned the process by clearing bottlenecks, often handing over relevant documents to airport authorities for inter-city transport of donated organs. Dhaketa’s organs saved four lives, just like Durgesh Malviya’s (see box) did a month before him. Such efforts will help end the illegal sale of organs that preys of people’s desperation.
‘After 3 years, I can cook again’
Anita Verma, 47, recipient of a donor heart
Anita Verma received Durgesh Malviya’s heart just a few days ago and now she can do simple things like cooking, after three years spent in bed. Verma suffered from dilated cardiomyopathy, where the heart muscles lose their ability to pump blood. Her heart was functioning just at 15% to 20% capacity before the transplant.
“Every morning, I would see my 97-year-old mother-in-law do yoga and go on her morning walk and I would sit in my bed and cry. For three years, I could hardly move. Six months ago my condition worsened. I found it difficult to even talk,” Anita says.
Only a heart transplant could save her. She was registered at the All India Institute of Medical Sciences and Medanta.
“I had given up hope. I got three calls from Medanta, but each time either my weight or my age was not right, and the heart went to someone else. When we finally received a call on April 27, my sons packed my bag and we reached the hospital within half an hour, hoping that this time I would get the heart,” says Anita, who worked with the National Commission for Women as a research assistant before she took ill.
Her husband, got cold feet at the last moment. “Dad was unsure of outcome. But my brother and I explained that not all get this opportunity,” says Dipanshu, 18, Anita’s younger son.
- Anonna Dutt
‘A part of my son still lives’
Prem Lal Malviya, father of a heart donor
It was a heart-wrenching call for Prem Lal Malviya, a small farmer from Madhya Pradesh, to donate his son Durgesh’s organs after he was declared brain dead following a road accident on March 3. The decision to finally agree to give away his son’s heart, eyes, liver, kidneys and skin was made possible by the simple thought that his son had always wanted to serve the society.
“He was the youngest in the family but would always talk about big issues concerning the nation. Welfare of society being one of them. He also often coached children in taekwondo without charging money,” says a teary-eyed Malviya.
The youngest of four children, Durgesh was a gold medallist in taekwondo and wanted to join the IAS. His organs found recipients in three states — the heart and liver saved lives in Delhi, the kidneys in Indore, while the rest of the organs and tissues were banked.
Meeting one of the recipients to whom one of Durgesh’s kidneys was donated was a heart-warming moment for his bereaved parents and three sisters.
“The woman thanked me, saying we had given her a new lease of life. I only ensured a part of my son’s body continues to be of use to somebody. He left this earth too quickly. If he had been able to choose, he would have wanted the same,” says Malviya, wiping away tears.
- Nida Khan