From death to life, the miracle of heart transplantation

BILKULONLINE

By Dr. Dhiren Shah

Ahmedabad, Aug 13: A change of Heart, Changes everything, and let me tell you it’s not just philosophically true, but medically also. I am talking about Heart Transplantation. 

“Heart transplantation is no longer an experimental procedure (or a non-imp topic for exam). It is now the therapy of choice for selective patients with end-stage heart disease. It does change the quality of life dramatically for the bed ridden and terminally ill heart failure patients. And in the 40 heart Transplants that I have performed, I have seen this and had first-hand experience,” said Dr Dhiren Shah, Director and consultant, Cardio Thoracic and Vascular Surgery Department, Director Heart and Lung Transplant Program, Director Mechanical Circulatory Support Program, Marengo CIMS Hospital.

My favorite patient is a 17 year old very chulbuli girl from Amreli who suffered from COVID viral myocarditis and then had suffered from heart failure with heart functioning of only 15%. She was in the hospital for almost 5 months and was not recovering with any modalities of medical treatment. She was practically on death Bed.  Heart Transplantation was the only option possible and after the procedure she got discharged from the hospital on 14th day and now, after one and half year, she is dancing, playing and has started going to school and enjoying life like any other teenager. Most satisfying ‘Change of the Heart’ for any doctor.

But this was possible because one brain dead patient family decided to donate organs of their loved one. On that day 21 year old young boy who had met with a road traffic accident had injured his brain severely and was not recoverable. He was on ventilator and his other organ systems were in good condition. By his heart, lungs, 2 kidneys, liver, 2 eyes and pair of hands were donated through which 8 patients got new lease of life. Normally apart from the above organs even pancreas, small intestine and skin can also be donated. Anyone from the age of just a few days old to 100 years of age can donate organs based on his organ condition.

Brain dead is an irreversible condition, which results from severe injury to the brain and the most common reason is either accidental injury or Brain haemorrhage or stroke. All these patients are usually on ventilator and they cannot breathe without support system. Their body vital functions will be maintained by an artificial support system.  Such patients can donate organs.

This is a different condition from coma, where coma is a state of deep unconsciousness because of brain injury. Brain is still functioning and person is still able to breathe on his own without ventilator. There are chances of Brain Recovery.  Such patients cannot donate organs. Patient with Cancers and having critical condition because of any infections also cannot donate organs.

Once we identify that the patient seems like a brain dead, then doctors either Neurosurgeon or Physician will carry out various tests and lastly one Apnea test is performed to stamp patient as brain dead. After this panel of 4 doctors which can be neurosurgeon/physician, intensivist, anaesthetist, medical officer and/or  registered Medical officer can certify person as brain dead after performing 2 Apnea Test on patient . After this, the hospital has to inform SOTTO about this potential organ donor. Now SOTTO, Government organization, will allocate the organs as per the waiting list on government listing. Once patient is declared brain dead, the organs need to be retrieved within  24-48 hours .

Other way of organ donation is through living donor, which is common in India, where any of the living close relatives can donate one of their kidneys or part of Liver to their blood relatives.

Organs are harvested in the operation theatre just like any other operation. There is no disfigurement of the body after the organ harvesting. After organ are harvested from the donor, the time period within which you can use organs for recipients is within 4 hours for heart,  5-6 hours for lungs, 12 hours for liver pancreas and small intestine, 24 hours for Kidney.

By the gift of organ donation, person can give a decade or even more years of normal and fruitful life to a person who was suffering from heart failure, kidney failure or liver failure who would not have lived even for 3-5 years otherwise.

It is infinitely better to transplant a heart than to burn or Bury a heart to be devoured by worms –Dr Christian Bernard

(Dr Dhiren Shah is Director and consultant, Cardio Thoracic and Vascular Surgery Department, Director Heart and Lung Transplant Program, Director Mechanical Circulatory Support Program,  Marengo CIMS Hospital, Ahmedabad)