Matters of the heart, and lungs

Tamil Nadu performs a record no. of cadaver organ transplants, but, heart and double lung transplants are uncommon.

March 18, 2015 08:04 am | Updated November 16, 2021 05:11 pm IST - CHENNAI

Monday was sort of his second birthday, said 68-year-old C.V. Hanif. Exactly a year ago, Mr. Hanif, a businessman from Kerala who had end-stage lung disease and cardiac failure, had undergone a heart and double lung transplant at Apollo Hospitals. Today, he walks 5 km a day.

For R. Asokan, a priest from Ooty, being able to speak continuously is important. This had become nearly impossible before he too underwent a similar transplant. Ten days after the surgery in October 2013, he was discharged, and soon after, was back to work.

From October 2008 to date, Tamil Nadu has performed 124 heart transplants and 56 lung transplants. Heart and double lung transplants, however, are still rare for a number of reasons — lack of awareness about the procedure being a major one.

Heart and double lung transplants are required in case of specific diseases such as pulmonary hypertension, but in a majority of cases, they become necessary when patients come with end-stage heart or lung failure, said T. Sunder, a senior consultant cardiothoracic and transplant surgeon at Apollo Hospitals.

“We have performed the largest number of heart and double lung transplants in India, and our outcomes are comparable to those anywhere in the world. Of the six patients we have operated upon, five have survived. Our one-year survival rate for patients is 83 per cent, higher than the global average of about 75 per cent,” he said.

The cost of the surgery, at about Rs. 35 lakh, may seem prohibitive. But doctors said this is 1/40th of the cost in the U.S., where the average expenditure for the procedure would be USD 2.3 million.

“The main problem is, most patients come to us at the very end,” said Paul Ramesh, also a senior consultant at the hospital. However if a patient is on ventilator, the outcomes of the procedure are poor, he said.

Heart and double lung transplants give a quality of life that is far better than being on medication, said doctors. But the surgeon’s job is not over after the technically-complicated surgery, said Dr. Sunder.

“Follow-up is crucial in these cases. The hospital has a dedicated heart and lung transplant intensive care unit for these procedures,” he said. Preetha Reddy, executive vice-chairperson, Apollo Hospitals, said credit for all the successes goes first to donors and their families.

Chairman Prathap C. Reddy said though the country is doing very well in organ donation, more donations should be encouraged. “A system could be set up where everyone automatically donates unless they specifically opt out of the programme,” he said.

 

The procedure

1 Heart and lungs are harvested from a brain-dead donor. The organs are packed and transported by road, through a green corridor, or by flight to the hospital where the transplants are to take place. Hearts should be used within four to six hours, and lungs within eight to 10 hours
2 At the hospital, the organ recipient is prepped for surgery. General anaesthesia is given. This is a very complex procedure with these patients, as their lung function is extremely poor.
3  When the organs arrive, the patient is connected to a heart-lung machine, and first, the diseased heart is removed. Lungs are then removed in sequence. At this point, the surgeon makes sure the five major nerves coursing through the chest are intact and the food pipe and aorta are undamaged.
4 The wind pipe from the donor lungs is connected with the remnant of the recipient’s wind pipe and lungs are transplanted. Next, the donor heart is connected through the superior and inferior vena cava and aorta is connected with the recipient’s remnant aorta and heart is transplanted.
5 Then comes the complicated process of allowing the recipient blood to go through the new organs. This is done in a controlled manner to avoid reperfusion injury and can take 30 to 40 minutes.
6 The new heart and lungs are then separated from the heart-lung machine after ensuring their ability to function well.

Some things to remember

1 Average time for the entire surgery is six to eight hours. A team of about 15 surgeons, anaesthetists, nurses, technicians and perfusionists take part.
2 The patient is discharged from the ICU in about four days and from the hospital in 10 days. In the first month, there are four to five follow-ups, with biopsies to ensure the organs are not rejected.
3 After this, every three months or so, the patient needs to go in for a follow-up. The patient is on immunosuppressants for the rest of her life.

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