Thiruvananthapuram, Jan. 24: Kerala?s first heart transplant patient, P.A. Abraham, died this morning after leading a normal life for 20 months.

The 35-year-old Abraham, who had come back from the Gulf, fainted after having tea with friends at a joint. He died on the way to hospital.

The death has come as a shock to his surgeon Jose Periyapuram, who hoped Abraham would surpass the 24-year record of the longest surviving heart recipient.

Periyapuram told The Telegraph the cause of death would be clear only from an autopsy, which required the consent of relatives. ?I talked to him on the phone last night but there was no clue to the imminent death,? he said.

Abraham had been suffering from cardiomyopathy (heart?s inability to contract) when the private Medical Trust Hospital at Kochi identified him for the transplant at a free camp. After the successful transplant, he had said: ?Doctors told me I required a heart transplant. My financial condition made the surgery out of reach. Moreover, who would donate a heart? All I wanted was to live.?

Abraham, a bachelor who lived with his father in Alappuzha district, owed his extended life to the Kochi hospital which bore all the expenses, and the family of accident victim . Sukumaran which donated the heart.

Abraham, who had a sturdy built, was planning to be a taxi driver and the hospital management had fixed the second anniversary of the transplant on May 13 to buy him the cab.

Kerala?s only other heart recipient, Vipin, who was operated on four months ago, ?is doing fine?.

According to statistics, of the less than 50 successful heart transplants in the country, only six have survived. The first transplant was at the All-India Institute of Medical Sciences, New Delhi, in 1996.

Periyapuram said 20 per cent of those who undergo heart transplant surgery die on the table and only 35 per cent of the rest live up to 10 years. ?While serious heart problems are found among people above the age of 60 in most European countries, we have people even below 40 with end-stage failures,? he said.

Cardiologists also point out that not all patients with acute heart problems are lucky enough to find a donor.

Periyapuram, however, said Abraham?s death would not deter him from doing more transplants. The success of the surgery had raised hopes of many heart patients and helped create awareness about the need for organ donation, he said. ?Close relatives of accident victims call us, expressing their willingness to donate organs so that others may live.?

Over the last 10 years, there has been an increase in the number of patients with cardiovascular disease in Kerala. The overall figure for the country is five to 10 per 1,000.

Heart disease and strokes kill 17 million people every year around the world and the World Health Organisation predicts the figure will rise to more than 20 million by 2020 and 24 million by 2030.