Recipient list (for heart transplants) is ever increasing while donor numbers are dwindling

Recently, Fortis Hospital, Mulund conducted two successful heart transplants following concentrated and speedy coordination between airport authorities, hospitals, government officials and traffic constables to create green corridors. Dr Anvay Mulay, Chief Cardiac Surgeon, Fortis Hospital, Mulund narrates the sucessful events and talks about the challenges involved in heart donation in India, in an interaction with Raelene Kambli

Why is heart the least donated organ? Reasons behind the dismal number of heart donations in India?

Heart donation is only possible after brain death of a patient – a living person cannot donate his heart, making heart donation very scarce. In India, people are declared dead once their heart stops functioning, then their heart is not good enough to be transplanted. Only a small segment of those dying patients who have been declared ‘neurologically critical’ and are brain dead, can donate organs. Among those who are suitable for heart donation, not many patients and their families are ready to progress with organ donation – further building scarcity.

What is the rate of heart donation in India vs the West?

It’s not comparable. The heart donation numbers were very high in US and UK, but the numbers are now on the decline, not because people don’t want to donate but for the following two reasons – increased life longevity and drop in the percentage of road traffic accidents, whereas the list of recipients is on a sharp incline. In India, the donation rate in itself is so meagre that donation rate comparison cannot be made.

What transformation have you seen in the field of heart transplants in India and world over?

In India, heart transplant programme is now gaining momentum but there is a long way to go; abroad, heart transplant statistics are on the decline or are rather static. Reiterating what I said previously, the recipient list is ever increasing while the donor numbers are dwindling. As informed earlier, increased life longevity and drop in the percentage of road traffic accidents are key reasons for the decline of heart transplants abroad. Brain dead patients are getting lesser and lesser whereas the recipient list is ever increasing.

Tell us about the green corridor which was laid out for two consecutive heart transplant surgeries?

Green corridor means a VVIP corridor created when there is need for a heart to be transported from point A to point B in record breaking time. Unlike liver and kidney transplants, which allow a little more ischemic time, green corridor is an absolute must for heart transplant, which has to be conducted in a stipulated time. Primarily, a green corridor is created to avoid any lapse in the ischemic time of the organ.

What are the basic parameters required for an heart transplant; for donation and for the hospital to conduct the surgery?

Parameters for the recipient are:

• Should be less than 70 years of age
• Should not have cancer that has spread all over the body
• Should not have diabetes, which would have caused damage to the kidneys or gangrene of the foot
• Should not have lung pressure issues

Patient having intractable angina (chest pain) inspite of angioplasty; patient who has got intractable arrhythmia (irregular heartbeats) requiring multiple shocks repeatedly and patients who suffer from severe heart failure are suitable candidates for a heart transplant.

Parameters for the donor are:

• Should be less than 65 years of age
• While determining the cause of death we have to ensure that the heart is not damaged or the patient doesn’t have a previous history of heart damage. An echocardiography is done, blood grouping and cross matching of the recipient and the donor is done. Body surface area, weight and height of the donor is also mapped against the recipients stats
• If the donor is over 50 years old, coronary angiography is done to understand if the patient has any coronary artery disease and if the heart is good enough to be transplanted into a recipient, or not. Once this detailed study is done, then the decision of going ahead with the transplant or not, is made

Parameters for the hospital:

• Zonal Transplant Coordination Centre (ZTCC) has authorised some hospitals where heart transplants can be done, these are called transplant hospitals or recipient transplant hospitals. Other hospitals where there are no such facilities, liver and kidney transplants can be conducted and a donor heart can be retrieved. If a donor patient is critically ill in any such facility, which is equipped with ICU and operation theatres but there is no set up for heart surgery/ transplant – such facilities are also recognised by ZTCC for retrieval of the heart. In such scenario, our team of expert doctors go to such facilities and retrieve the heart
• Nursing homes/ smaller facilities, where ICU and operation theatre facilities are not available, the patient has to be moved to a suitable facility that is recognised by ZTCC and the heart is retrieved

Any special permissions required to conduct such procedures?

Yes, the ZTCC panel interviews the recipient, ensures that the facility is equipped and available for the transplant, only then is the recognition and license to conduct a heart transplant given.

What were the challenges you faced in organising the entire heart transplant exercise in both the cases?

I and my team are very passionate towards the cause of organ transplantation hence we faced no challenges.

Were these two cases treated differently? How different?

There is no difference in treatment or management of both the patients – both have steadily recuperated and have come out of the ICU.

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