After suffering three episodes of cardiac arrest, two of which lasted for 45 minutes, an 18-month-old child, who was flown down from Bulgaria, underwent a heart transplant at a private hospital in Chennai. With the organ donor belonging to a different blood group, doctors performed an ABO-incompatible heart transplant on the child, crossing the blood group barrier.
Suresh Rao K.G., Co-Director, Institute of Heart and Lung Transplant and Mechanical Circulatory Support, MGM Healthcare, said the girl suffered from dilated cardiomyopathy and developed heart failure. “She was in end-stage heart failure. Her doctors in Bulgaria planned a ‘Berlin Heart’ implant, in which an artificial pump will support the child till a heart transplant is performed. But they had no facility to do the procedure and referred her to us,” he told reporters on Tuesday.
However, her journey was not uneventful, he said, adding that the baby suffered a cardiac arrest over Karachi airspace and was resuscitated after nearly 45 minutes of cardiopulmonary resuscitation (CPR) and reached Chennai. On arrival at MGM Healthcare, the baby suffered another cardiac arrest and was resuscitated after 45 minutes of CPR with chest compressions.
Extracorporeal CPR was done and she was put on extracorporeal membrane oxygenation (ECMO) support. “We were contemplating the ‘Berlin Heart’ implant when we received information from the Transplant Authority of Tamil Nadu that a donor heart of a 3.5-year-old boy, who suffered a head injury in a fall and was declared brain dead at a Mumbai hospital, was available. While his blood group was ‘B’ positive, our patient was ‘A’ positive. As there was no Indian recipient for the organ, the National Organ and Tissue Transplant Organisation allocated the heart for the child,” Dr. Rao said. The doctors turned to plasmapheresis to remove the antibodies.
K.R. Balakrishnan, Director, Institute of Heart and Lung Transplant and Mechanical Circulatory Support, MGM Healthcare, said: “Despite the two long periods of cardiac arrests, the child woke up after 48 hours. Our team went to Mumbai and retrieved the donor heart.” The heart was transplanted in the child, who needed ECMO support for several days after surgery for the heart to completely recover.
He added that ABO-incompatible paediatric heart transplants were uncommon. “It was started in Toronto nearly 20 years ago,” he said, noting that paediatric donors were rare. Dr. Rao added that ABO-incompatible heart transplants could be done in children as their immune system was immature.
Ananth Mohan Pai, Director of medical services of MGM Healthcare, also spoke.