Four-hour window to transport organ
The average rate of survival for patients with a donor heart is 20 years and onethird survive for at least 30 years, said Dr K.R. Balakrishnan, a heart transplant surgeon from Fortis Hospital Chennai.
Throwing light on the actual cadaver organ transplant bill and the challenges, he said: “The cadaver organ transplant bill was passed in 1994 in India and by 1996 we were able to carry out only four transplants.
“However, it was only in 2009, after the setting up of the first statewide organ registry for distribution of donor organs, that we were able to work out the logistics of transporting the organs.”
Once that was streamlined, there was a rise in number of cadaver heart transplants with 20 taking place in 2014, 40 in 2015, 76 in 2016 and until going to press, about 65 in 2017.
Transportation issues
One of the biggest challenges of cadaver organs is the logistics of transportation and the ability of the organisers to be able to get it to the recipient quickly enough, said Dr Balakirshnan. “We have a large number of donors registered but the challenge is the availability and usability of the donor organ. There is an established system of grief counsellors who are in touch with the donor patient’s relatives and counsel them in cases of brain death to quickly donate the organs.
“These grief counsellors liaise with the transplant coordinators who follow the protocol of reaching out to the first recipient on the waiting list. Our first choice is a patient within the same city, followed by the same state, then the country and if that is ruled out, the next is a foreign patient.
“The elimination process is based on the blood group and if that matches between a donor and the recipient. For instance, if there is a AB +ve blood group donor, his or her organ can only be donated to a recipient matching the blood group. Currently, we have a waiting list of two months for Indian recipients and three months for foreign recipients.
“There is only a four-hour window to transport the organ from donor to recipient. Be it intercity or interstate, we have to organise the logistics in a manner where minimum time is lost in traffic or airlift of the organ. We have created traffic corridors within the city to transport donor organs where a cordoned-off lane on the main highways is used to transport the organ without delay. Nearly 70-75 per cent of organs are airlifted,” he added.
Once the recipient receives a donor heart, he is put on powerful immune suppressant drugs and so has to be protected from infections to avoid rejection. The patient therefore needs a strong and professional follow up programme, said Dr Balakrishnan, who has almost had a 100 per cent success rate in the transplants he has carried out.
“My patients feel an emotional connect to our hospital and the city of Chennai and I have had some patients returning to a much better quality of life.”