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 [...]]]>

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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.

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Bushra Baseerat | TNN

For the last many years, Andhra Pradesh ranked highest in the number of organ transplantations. However, the state has now lost its envious position to Tamil Nadu, not because the awareness levels among organ donors in AP has dipped but because of government apathy.

Statistics in city hospitals throws up an ironical situation. About [...]]]>

From

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Bushra Baseerat | TNN

For the last many years, Andhra Pradesh ranked highest in the number of organ transplantations. However, the state has now lost its envious position to Tamil Nadu, not because the awareness levels among organ donors in AP has dipped but because of government apathy.

Statistics in city hospitals throws up an ironical situation. About 10-12 people are dying daily in various hospitals awaiting organs that can be sourced from brain dead patients. And at any given point of time there are 8-10 brain dead patients in different ICUs of city hospitals but only a small per cent of them become organ donors.

It was the same scenario in every state until two years ago when AP was dethroned from its number one slot by Tamil Nadu, whose government took a progressive step, making it mandatory for hospitals to list out its brain dead patients and aggressively started promoting cadaver transplantations. The result? The number of organ donations in the state has doubled ever since the government took this initiative in October, 2008, say experts.

In stark contrast, AP is moving backwards. For two consecutive years — 2008 and 2009 — the city saw only 17 families coming forward to donate organs of brain dead patients. While this year, there has been a slight rise with 16 donors donating 112 organs and tissues. Experts say the numbers are a drop in the ocean.

In 2009, the state had planned to promote cadaver transplantations by easing the organ retrieval norms and by appointing a centralised agency to streamline the organ allocations on a priority basis with Nizam’s Institute of Medical Sciences (NIMS) as the nodal agency.

Till date, this exercise has remained on paper. Experts say that there is a need to use the huge pool of brain dead donors. “Hundreds of fatal road accidents are reported each month but just about 5% of the transplants are cadaveric. Rest of the donations involve living donors,” says Dr S Saharia, former president, Indian Society for Organ Transplants.

The number of waitlisted patients runs into hundreds in each hospital. Those who do not have a suitable donor in the family enrol themselves for a cadaver transplant and join the scores waiting for for months.

CHENNAI: For grief counsellors at the Government General Hospital (GH), the noble deed of an uneducated, homeless migrant family showed them the power of the human spirit. Hailing from Andhra Pradesh and surviving against the odds by eking out a living working on construction sites, relatives of Ramesh, a 23-year-old labourer, moved doctors with their [...]]]>

From http://timesofindia.indiatimes.com/City/Chennai/Brain-dead-migrant-workers-family-come-forward-to-donate-his-organs-/articleshow/6169101.cms

CHENNAI: For grief counsellors at the Government General Hospital (GH), the noble deed of an uneducated, homeless migrant family showed them the power of the human spirit. Hailing from Andhra Pradesh and surviving against the odds by eking out a living working on construction sites, relatives of Ramesh, a 23-year-old labourer, moved doctors with their decision to donate his organs follwoing his death in an accident.

Ramesh was rushed to GH for treatment after sustained injuries in an accident at a construction site. Doctors declared him brain dead on Tuesday. Since it is imperative to have family members present in a situation like this, GH authorities tracked down Ramesh’s family and asked them to reach the hospital immediately.

When they arrived, hospital authorities found that none of the members could speak Tamil, they were all illiterate and that Ramesh’s wife was a minor. The young bride’s tragedy was compounded by the fact that she had known her husband for only a year since the couple got married only recently. As migrant workers in an alien city, the family did not even have an address to put on the forms and entered their address as Retteri platform’ instead.

Though in a state of shock and bewilderment, the family listened patiently to grief counsellors (persons designated to talk to relatives of a patient about the uses of organ donation if an individual has been declared brain-dead) as they told them about organ donation and its formalities.

With the help of translators, the counsellors told Ramesh’s family how donating his organs will help give life to others. The family took some time to discuss the issue among themselves and came back to tell doctors that they were willing to donate Ramesh’s organs.

According to Dr J Amalorpavanathan, coordinator, state organ registry, “One kidney was used for another patient at the GH, one was sent to Stanley Medical College, his heart valve was sent to Madras Medical Mission, liver to Christian Medical College, Vellore, and eyes were sent to the Eye Bank of Government Ophtalmic Hospital, Egmore.”

While organ donation in Tamil Nadu has progressed swiftly with the state organ registry having facilitated more than 100 cases, doctors said the situation in India was rather dismal. “We found it very moving that this family who are living in the most dire straits and have nothing going for them, came forward and agreed to sign the papers agreeing to donate his organs. They have set an example for us all by salvaging their boy’s death to help give life to others,” Dr Amalorpavanathan added.

100th regulated cadaver transplant performed Ramya Kannan

CHENNAI: The 100th regulated cadaver organ transplantation was concluded on Sunday morning at the Government General Hospital.

The organ donor, B. Ravikumar, a young tea shop hand from Trisulam, was declared brain dead at the GH on Thursday after he was run over by a [...]]]>

From http://www.hindu.com/2010/07/05/stories/2010070559950500.htm

100th regulated cadaver transplant performed Ramya Kannan

CHENNAI: The 100th regulated cadaver organ transplantation was concluded on Sunday morning at the Government General Hospital.

The organ donor, B. Ravikumar, a young tea shop hand from Trisulam, was declared brain dead at the GH on Thursday after he was run over by a vehicle.

R. Veena, transplant co-ordinator of Mohan Foundation at the GH, said Ravikumar’s mother and wife agreed to donate the organs. The couple have two children aged six and four years.

On Sunday morning, doctors operated on Ravikumar to remove his heart valves (which went to Frontier Lifeline), both kidneys (one each went to the GH and Government Stanley Hospital), liver (Global Hospitals) and corneas (Government Eye Hospital).

The liver could not be used as it was found to be damaged subsequently.

Meanwhile, the organs of another young donor Natraj (39), who was injured in a road accident, were harvested after consent was received from the family at K.G. Hospital, Coimbatore.

The kidneys and eyes went to K.G. Hospital and liver to Madras Medical Mission.

CHENNAI: Should an alcoholic with a damaged liver receive the same priority as a non-alcoholic patient for cadaver liver transplants?

Votes seem to be rolling in for those who prefer to remain sober. A team of transplant surgeons has asked state cadaver transplant registry to give priority to patients with non-alcoholic liver cirrhosis. Surgeons fear [...]]]>

From http://timesofindia.indiatimes.com/articleshow/6042592.cms?frm=mailtofriend

CHENNAI: Should an alcoholic with a damaged liver receive the same priority as a non-alcoholic patient for cadaver liver transplants?

Votes seem to be rolling in for those who prefer to remain sober. A team of transplant surgeons has asked state cadaver transplant registry to give priority to patients with non-alcoholic liver cirrhosis. Surgeons fear alcoholics, who undergo liver transplant, are likely to strain at the leash to break the no-alcohol vow, bringing fresh damage to the liver.

‘‘Organs are hard to come by. It should therefore be used judiciously,’’ says Dr R Surendran, who heads the department of surgical gastroenterology at the Stanley Government Hospital in Chennai. Transplant is the only option for patients with end-stage liver disease. ‘‘Today, the topmost cause for liver diseases in the country is hepatitis A followed by Hepatitis C. One in five persons coming to the hospital with an end-state liver disease has alcoholic cirrhosis. If this person is given a liver, many alcoholics get back to drinking and reach a point of no return,’’ Dr Surendran says.

In many cases, patients do not find a suitable liver among their parents, siblings or spouse. They are wait-listed for cadaver organs. ‘‘Only a very few patients find one,’’ says Dr Anand K Khakhar, consultant transplant surgeon, Apollo Hospitals.

Both the hospitals maintain a wait-list of patients seeking organs. They say alcoholic liver failure patients are first sent to de-addiction programmes and counselling even before they are put on the list. ‘‘The patient needs to be certified by a doctor,’’ says, a psychiatrist, ‘‘that h/she has been sober for at least six months. It’s then that we give them a chance.’’

‘‘We advise them that liver disease will accelerate if they start drinking again,’’ Dr Khakhar says.
But there are several others who say time is important. Senior hepatic surgeon Dr Mohammed Rela says, ‘‘In general, the rule sounds logical and is being followed internationally. But in some cases, the patient might not be left with enough time to prove that he is sober. So why be judgmental or why play god? A better way is to help them reform after the surgery.’’.

Alcoholic liver failure patients pick a hole in the liver-for-sober logic. ‘‘Going by the logic that alcoholics should not be given liver, diabetics should also not be given a kidney. Because like alcohol, diabetes will make the new kidney dysfunctional. It’s denial of the fundamental right to live. We will go to court,’’ says 41-year-old Mahesh Kumar (name changed), who has been wait-listed for organ transplant. ‘‘Liver transplant is in itself a punishment. We would not go back to drinking,’’ he says.

But some feel, the debate on liver transplants fuels ambivalence, just like the one on mercy killing. Dr Thomas George, editor of Indian Journal of Medical Ethics, says it is a very difficult decision for doctors or patients to make. ‘‘Since organs are scarce, we must leave the debate to society. Let it decide whether it’s science or fundamental right,’’ he says. Cadaver organ registry co-ordinator Dr J Amalorpavanathan says the advisory committee of the registry will decided on it. The registry has so far facilitated transplant of 513 vital organs, including 79 livers from brain-dead patients.

Special Correspondent

— Photo: S.R. Raghunathan Changing scenario:K. Ravindranath, chairman, Global Hospitals (left), and Mohamed Rela, Liver Transplant specialist, at a conference in Chennai on Sunday.

CHENNAI: The liver transplantation scene in India that started with low success rates a few decades ago has [...]]]>

http://www.hindu.com/2010/05/31/stories/2010053160550500.htm

Special Correspondent

— Photo: S.R. Raghunathan

Changing scenario:K. Ravindranath, chairman, Global Hospitals (left), and Mohamed Rela, Liver Transplant specialist, at a conference in Chennai on Sunday.

CHENNAI: The liver transplantation scene in India that started with low success rates a few decades ago has evolved into a specialty that boasts success and survival rates comparable with the best centres in the world, liver transplantation pioneer Mohamed Rela said on Sunday.

Addressing a press conference, Dr. Rela, who heads the liver transplant programme of Global Hospitals and Health City here, said good liver transplants were able to provide a one-year survival in 90 per cent of cases (75 per cent of cases with acute liver failure), a five-year survival rate for 85 per cent of patients and a 10-year survival rate in about 70 per cent of cases.

Apart from medical expertise and technological advances, the enormous changes in the transplantation scenario were also due to the raised awareness leading to more cadaver and living donor transplants, Dr. Rela said. Tamil Nadu, especially Chennai, was the forerunner for altruistic cadaver liver donation, and the mobilisation of the organised sector of the government was now a model for other States, he said.

“In terms of long-term survival of ten years or longer, results with liver transplantation are better than that with renal transplants,” Dr. Rela said.

While liver transplants now cost about Rs.22 lakh for adults and half that amount for children, the usage of immuno-suppresants could be tapered down, leading to lesser post-transplant costs, he said.

Pointing to liver cancers as among the most common causes of liver disease, Dr. Rela said the lack of screening was leading to patients presenting with fairly advanced cancers.

Later, addressing a scientific session, Dr. Rela said transplants could be offered for benign liver tumours, which if left unattended could be lethal through “mass effect than metastasis.”

In a condition like hepatoblastoma — an important liver tumour in children — the worldwide experience has been that any tumour that does well with chemotherapy did well with resection. However, pre-operative chemotherapy is an important intervention prior to resection procedure.

On hepatocellular carcinoma, which was one of the most common cancers, Dr. Rela said it was important to appreciate the condition as two diseases rolled into one with both having different prognosis.

While resection, chemo-embolisation, radio frequency ablation and liver transplantation were among the available options to treat liver cancers, one of the problems in India was that each centre offered the treatment modality that they had, Dr. Rela said.

He suggested that it was best for patients to report to a centre that had all these facilities and could thus provide multi-disciplinary treatment.

“Though in many cases, liver transplant could be a better option than resection, liver resection will remain a major modality in India because of the lesser costs involved,” Dr. Rela said.

Global Hospitals Chairman K. Ravindranath said the group would soon be opening centres in Delhi, Mumbai and Kolkata in the next couple of years when it would have the largest number of liver intensive care beds.

Chennai/Margao: A cadaveric liver, 250 units of blood components and a dedicated team of doctors and paramedical staff working roundthe-clock at the intensive care unit of Apollo Hospitals in Chennai could not save 27-year-old Joelle Nadia Torrado from Loutolim in Goa, who was admitted to the hospital last week. [...]]]>

Pushpa Narayan | TNN

Chennai/Margao: A cadaveric liver, 250 units of blood components and a dedicated team of doctors and paramedical staff working roundthe-clock at the intensive care unit of Apollo Hospitals in Chennai could not save 27-year-old Joelle Nadia Torrado from Loutolim in Goa, who was admitted to the hospital last week.
Torrado was known to be “close” to a prominent politician from South Goa, and both had reportedly returned from a trip overseas a few days before she tried to commit suicide on May 15.
Doctors at Chennai’s Apollo Hospitals said Torrado developed end-stage liver failure after she consumed rat poison along with the anti-depressant pill Alprozolam. She died on Saturday following severe blood poisoning that led to cardiac and respiratory arrest.
She was first admitted to Apollo Hospital, Margao (Goa), after she consuming Ratol (rat poison). She was subsequently rushed to Jupiter Hospital in Thane, near Mumbai, where a special executive magistrate recorded her statement. She said she accidentally consumed Ratol “mistaking it for a toothpaste”.
However, as medical records at Apollo Hospital, Margao revealed that she had consumed an entire tube of Ratol, the police were of the view that it was a deliberate attempt at suicide and booked her under Section 309 of the IPC.
Sources said Torrado was shifted to Thane from Margao after the politician took it upon himself the risks involved in airlifting her to Mumbai in a critical condition.
Torrado was taken to Chennai by a chartered flight last week. “When she was wheeled in she had already developed liver and kidney failure. She was on active dialysis and on life support,” said a senior doctor at the Apollo Hospitals.
Investigations revealed that the combination of rat poison and anti-depressants had caused “severe and uncontrollable” bleeding of the liver. Zinc phosphate, the main ingredient of rodent poison, had also severely damaged the liver. Her name was forwarded to the state organ transplant registry. “We moved her up the waiting list, by-passing several patients due to her age and medical condition,” said Chennai organ transplant co-ordinator Dr J Amalorpavanathan. Luckily, the registry received a call from KG Hospitals in Coimbatore about the brain death of a 32-year-old man after an accident. The liver transplant team from Apollo Hospitals harvested the liver and airlifted it to the Chennai hospital for a 13-hour liver transplant surgery.
However, following the transplant she did not recover well. “She developed blood poisoning and died of cardiac respiratory arrest,” he said.
Margao deputy superintendent of police Mahesh Gaonkar, when contacted, said the police investigations would continue and all aspects pertaining to the suicide attempt, including the role of the South Goa politician, probed.
Late on Sunday, the police recorded the statements of the deceased’s mother and brother, for the first time since the case was registered. Goa’s leader of Opposition Manohar Parrikar said it was the job of the investigating agencies to find out the truth behind the death.