Heart transplants in India face many challenges. Right from finding a donor to arranging the logistics for the transplant, these roadblocks have taken many lives. However, in the past few years, experts see some winds of change. Dr Kewal Krishan, Program Incharge, Heart Transplant & Ventricular Assist Devices, Senior Consultant Cardiac Surgeon, Max Heart & Vascular Institute, Saket, New Delhi, explains the present scenario in the heart transplant field, to Raelene Kambli
When was the first heart transplant done in India?
The first successful heart transplant was done in August 1994 at AIIMS.
What kind of transitions have you witnessed in the field of organ donation, especially when it comes to heart donation?
Post the first heart transplant there was a lot of enthusiasm within the medical fraternity and a few heart transplants were conducted in next three to four years. However, after that the interest waned and almost nothing happened for more than a decade in this area. Other organs like liver and kidney continued to rise in number as live donors were a possibility. The limitation of heart transplant is that only a deceased donor can be used so no activity happened for almost 14 years. Then in Chennai, because of the kidney donor racket, rules were amended for deceased donation procedure to make it more simplified. This increased the donor pool in Tamil Nadu and heart transplants have started happening more frequently since 2012.
Approximately, how many people in India are awaiting a heart transplant? What are the reasons behind the dismal numbers of heart donation in India?
Though there are more than 10 lakh people suffering from end-stage organ failure, most of those who manage to make it to the list eventually don’t survive the wait. This scenario proves to be especially fatal for those who are battling with end-stage heart failure. The reason for this could be lack of awareness amongst the public to donate organs. Less interest of intensivists to declare brain dead to avoid hassles after that. Though Human Organ Act 1994 (HOTA) has been amended to simplify brain dead related procedures there are still many hiccups.
What is the difference between total artificial heart transplant and left ventricular assist device (LVAD) procedure? Which is a better option and when?
Total artificial heart is when you remove the native heart and put a total mechanical heart, i.e. both the left side and right side of heart are now mechanical. In LVAD, the native heart remains in place, a pump is put in the left ventricle and then connected to aorta. Only left side is now mechanical and right side is still native heart. Total artificial heart is used when both sides of the heart are severely damaged. LVAD is used only when left side is severely damaged and right side can still function which happens in most of the cases.
What is the longevity and survival with an artificial heart?
Longevity of LVADs is around 15 years. Survival with LVAD is around 67 per cent at many centres. As these long term devices have come for clinical use in 2002, time will tell how long they can make patients who are on these devices survive. Total artificial hearts are used as a bridge to transplant only when both ventricles are severely damaged and LVAD will not give them survival advantage.
How easy or difficult is it to conduct a heart transplant in India?
It used to be difficult to transport heart from one place to another but nowadays with green corridors it has been made easier to transport a heart. Procedure itself is not very cumbersome though one should know how to transplant smoothly and in a scientific manner for good outcome. Recently, we successfully conducted the first heart transplant at Max Super Speciality Hospital, Saket in the history of Max Hospitals. The transplant for free of cost for the EWS patient who was awaiting the heart for past seven months.
What are the legal and ethical laws governing heart transplant in India?
HOTA controls all the legalities and ethical issues related to transplant. Health is a state subject so every state has its own rules and regulations to control deceased organ donation. This is one the reasons why in one state donation rate is higher than in another.
What are the latest developments you see in the concept of heart transplants?
One is easing up in Human Organ Act. Other, communication is better through mobile phones and scientific meetings. Government and NGOs are playing vital roles to spread the word and help to make things happen where nobody from private or government existed and lag was there. Young generation is quite receptive to organ donation of their brain dead family members when convinced.
What has been the reaction of the masses, influencers, donor families, and recipients towards this concept of heart transplant?
Reactions of masses have changed with time. More awareness and advertisements related to organ donation have changed the whole perspective in the community so that people are coming forward and asking if they can donate organs of their loved ones when they are declared brain dead. Recipient families feel quite happy that their patient would get a new heart and a new lease of life. They are going to get relieved of the disease and thankful to the donor family even if they do not know any details of the donor.
What is your view on government policy and efforts towards organ donation in India?
Government is also making lot of efforts for organ donation to happen by encouraging government and NGO officials. There is a website for registry by every state. Government is also helping to train transplant coordinators who are the key persons.
What are the main challenges and issues in the private healthcare segment?
In private healthcare, internal infrastructure is not a problem but there is no common network to help each other if brain dead is declared at any centre. Moreover, logistics related to expenditures of harvesting and maintaining donor till organs are harvested is also a challenge.
How can the various stakeholders work together to improve the situation for organ donation in India?
Government has to make certain rules and specify the steps and logistics to simplify the donation as it’s happening in Tamilnadu. Government should make it mandatory to notify the braindead. Though it’s there in the rules it’s not happening in reality. NGOs, especially MOHAN Foundation, are making remarkable difference in increasing the donation rate by convincing the families of potential donors and coordinating with different hospitals where organs are required.