07 December 2010
By Sumitra Deb Roy
Annually, it is estimated that more than 5,000 Indians require heart transplants but so far, only a handful of hospitals in Delhi, Chennai and Hyderabad have successfully performed the surgery; less than 80 every year.
Lack of donors and the high cost–anywhere between Rs 15–20 lakh–are the main reasons for why the number of heart transplants is low, not just in India but even abroad, say doctors.
Besides the actual cost of the operation, the patient has to spend another Rs 15,000 to Rs 20,000 per month on immunosuppressant drugs to ensure that the donor heart is not rejected.
"The expense is unaffordable to most patients. And due to logistical issues, most private hospitals, too, shy away from applying for a licence," said a senior cardiologist from government hospital.
The transplant is the last resort for patients suffering from end–stage heart failure where the heart pumping capacity is almost nil, or the patient has a history of recurrent heart attacks. If Jaslok or Fortis Hospitals get the necessary permission and manage to perform a transplant, they will be the first hospitals in Mumbai as well as the state to do so.
Preparations are still in the nascent stage, say both the hospitals, though the excitement is palpable. "We understand it requires a lot of team effort and we already in the process of drawing up protocols, creating team of psychologists and looking into the training of surgeons," said Dr Ali Behramwalla, consultant cardiac surgeon of Jaslok Hospital.
The state team is yet to pay a visit to the hospital, which is a mandatory procedure. A team from the Zonal Transplant Coordination Committee (ZTCC) also looks into the preparedness of the hospital before granting permission.
State officials, however, have already visited Fortis Hospital to assess the logistical details. "It could be another few months before we get the goahead," said cardiac surgeon of Fortis Hospital, Dr Ajay Chaughule. He added that getting suitable donors has been the most daunting part of a heart transplant and that the problem persists.
"In order to make it a success, we definitely need better counselling and coordination," he said. As the heart is usually always donated by a patient who has been declared brain dead, counselling the donor’s family is an important part of the procedure.
Interestingly, while new hospitals are trying to make a foray into heart transplantations, several big private hospitals such as P D Hinduja at Mahim, Asian Heart Institute and Lilavati Hospital at Bandra have acquired the requisite permission to carry out the transplant for quite a while now. Yet not a single transplant has taken place in any of these hospitals.
The reasons, they say range from feasibility, cost and coordination of doctors to want of donors. For instance, the P D Hinduja Hospital has had a license to carry out a heart and lung transplant for five years.
"But doctors have not managed to draw up a list of suitable recipients as is done in the case of kidney transplant patients," said medical director Dr Gustad Davar.
He added that apart from logistical issues, there had been a lack of interest even on the part of cardiac surgeons.
One also has to take into account the health of the donor heart. "Finding a healthy heart, less than 45 years and free from heart disease, is an task in this country," said Chaughule.
Heart of The Matter
A heart transplant involves three surgeries
Harvesting the donor’s heart
Here, a team of physicians, nurses and technicians remove the heart from the donor’s body, once the patient is determined brain dead. The donor’s heart is preserved in ice to keep it alive until it is implanted. The heart has to be transplanted within 3 hours
Removing the patient’s damaged heart
This surgery can be tricky and it depends on whether the patient undergone cardiac surgery in the past
Implanting the donor heart
The surgeon creates five lines of stitches that connect the large blood vessels entering and leaving the heart
Patients can go home within two weeks if there are no complications. They have to take immunosuppressant medication to ensure that the donor heart is not rejected by the body
The surgery costs up to Rs 20 lakh Logistical problems like transporting the donor heart within 3 hours Finding healthy donors who have no cardiac problems, diabetes or other health problems
Globally, only 3,000–4,000 heart transplants are performed every year In India, around 8 centres in Chennai, Hyderabad and Delhi perform heart transplants. These include Care Hospital (Hyderabad) and AIIMS at New Delhi