Is Chennai one of the best locations in the world for heart transplants?

From http://epaper.timesofindia.com/Default/Client.asp?skin=pastissues2&enter=LowLevel&AW=1280137624234

Part of “Special Report” that came with TOI

Gifting life : Is Chennai one of the best locations in the world for heart transplants? SHIVANI BAIL speaks to doctors and patients across the city to know more…

Asecond chance at life is the biggest gift a person could possibly give a fellow human being. Doctors have the opportunity to provide this gift to critically ill patients, everyday, by performing complex transplant surgeries. Of all such surgeries performed on people, a heart transplant is one of the most complex.

The city of Chennai is fast emerging as an important hub for patients suffering from end-stage heart failure.

“We performed 22 heart transplants last year,” says Dr KM Cherian, Founder of the KM Cherian Frontier Lifeline Hospital; the first surgeon in the country to conduct a heart and lung transplant and the second to conduct a heart transplant. Hospitals such as Apollo Hospitals and Dr KM Cherian’s Frontier Lifeline have pioneered advancements in the field of cardiothoracic medicine. In fact, today, even the Government General Hospital performs heart, liver and kidney transplants on a daily basis!

So, when does a person need a heart transplant? “There are several reasons why a person’s heart fails. Complications arise due to arterial blocks, malfunctioning valves or as the result of a congenital defect,” says Dr Paul Ramesh, a leading cardiothoracic surgeon from Apollo Hospitals. “Heart failure occurs in people who have had repeated heart attacks and it can occur in people for no apparent reason (idiopathic cardiomyopathy). It can occur in young people as the result of a viral infection (viral myocarditis) and it even affects women post-delivery (postpartum cardiomyopathy),” says Dr KM Cherian. “Heart transplants are useful for a small percentage of patients with heart failure. We decide to put a patient on the transplant list only after carefully weighing associated risks and benefits. It is only when the benefits outweigh the risks that we recommend and go ahead with surgery. This is why it is very important for patients to reach us when their condition is stable, when they can be involved in the decision-making process.” Most people find this potentially life-threatening operation extremely scary and blanche at having to decide whether or not to opt for the surgery.

However, ask the patients themselves and they tell you that more than the thought of being operated on, it is the wait for a donor that is extremely difficult. “I had almost given up hope of ever receiving a heart,” says Sheela P (name changed), a patient from Mumbai, who suffered from Sarcoidosis of the heart and was operated on at Frontier Lifeline. “I missed three opportunities to undergo a transplant! Every time I missed an opportunity, my husband would calm me down and say that even though we missed this opportunity, we had to realise that for me to live, someone had to die; we couldn’t get impatient.”

Even after the surgery, a patient’s life is in danger. They have to take immunosuppressant drugs for the rest of their life, so that their new organ isn’t rejected by the body. However, this makes them vulnerable to other illnesses.

“A good transplant programme must have a multi-disciplinary approach with good coordination between the various departments of a hospital, as well as between different hospitals and the Government. In addition, post-operative care is extremely important,” says Dr Paul.

One of the reasons why Chennai is a popular medical tourism destination for people suffering from heart failure is because the Government machinery here is highly efficient. The Tamil Nadu Government has the most streamlined transplant programme in the country. By making the organ donation process transparent and by setting stringent rules for private hospitals, it has drastically brought down the instances of organ trafficking in the State.

“There was a time when Chennai was famous all over the world for organ trafficking,” says Dr J Amalorpavanathan, Convenor, Cadaver Transplant Co-ordinator, Tamil Nadu and Consultant Vascular Surgeon, Government General Hospital. “With the current system, it is difficult to breach our protocol. We work in coordination with almost every hospital in the State. It is impossible to bypass our system. Every patient’s life is important to us.”

So how does the system work? “Recipient lists are created based on a patient’s blood group. Each list is uploaded on the internet and constantly updated. As soon as the Government receives information about a donor, they first contact patients from within the same hospital. If a recipient is not available there, we allocate the organ to another hospital in our database,” says Dr Amalorpavanathan.  “There is no competition when it comes to transplants. Every hospital has to work with every other hospital in the State,” adds Dr Paul.

When did the Government begin implementing a central system for organ coordination?
“In October 2008, a young boy named AP Hithendran died in an accident. His heart was donated by his parents, who were both doctors, to a young girl named Abirami. This attracted a lot of publicity, prompting the government to put the present system into place. However, despite the positive outcome of that incident, I believe that both donors and recipients should not receive any media attention. There are times when donor families feel the need to contact recipients and this creates a lot of problems for both families,” says Dr Amalorpavanathan.