The Telegraph
Since 1st March, 1999
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Ahead, heart transplant on Bypass
- Main hurdle to Rs 2-lakh procedure will be finding donors, warn surgeons

Calcuttans, take heart. Apollo Gleneagles Hospitals, on the Eastern Metropolitan Bypass, is planning to set up a heart-transplant clinic to combat cardiomyopathy, or end-stage heart failure.

The transplant centre — the fourth in India after AIIMS, Apollo Chennai and Madras Medical Mission — will address the condition when the heart becomes enlarged, the muscle fibres are stretched beyond capacity and the patient is deemed ‘beyond salvage’.

“All coronary and valve diseases, and even some congenital heart conditions, if not treated properly, can lead to end-stage heart failure. And at that point, no surgery or intervention can give the patient long-term relief or return his/her past quality of life. The only answer then is a heart transplant,” observes Ramesh Sheshadhri, director, department of cardiovascular surgery at the Apollo Group’s multiple-speciality hospital.

“Contrary to common belief, a heart transplant is not a frightfully expensive proposition. The main costly component is the anti-rejection drugs to prevent negative response to the new organ. Even then, a complete transplant procedure should not cost over Rs 2 lakh,” says Sheshadhri, working on the blueprint for the transplant clinic.

A team of specialised personnel from St Thomas’ Hospital in Tennessee, USA, is likely to be flown down to help with start-up knowhow in the first one or two procedures, once the clinic rolls out in a few months’ time. “They are among the best in the business and have achieved a 95 per cent first-year survival rate in heart-transplant procedures,” explains the cardio-thoracic surgeon, who has performed more than 10,000 cardiac surgeries till date.

Finding donors and convincing people could be the principal roadblock. Heart for transplantation can only be extracted from a donor who has been certified brain-dead by a group of at least three neurologists. “That is the most difficult part in our country, with complex social, cultural and ethical issues involved. Not many next of kin of brain-dead patients are ready to give the nod, even if they know their consent can save another life,” laments Sheshadhri.

The donor for transplant is identified through matching blood groups, tissue and size of heart. All acute intensive-care units and trauma centres within a two-to-three-hour radius of the transplant clinic could be tied up for prospective donors, since a heart has to be transplanted within four hours of the organ being extracted from the donor. Once the donor is identified, the recipient is opened up, put on a heart-lung machine, and the donor’s heart is implanted.

A certain degree of isolation and relative barrier nursing in the most extreme of hygienic environment is necessary during the post-op period.

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