In a significant change in procedure, every patient waiting for a heart and lung transplant in Tamil Nadu will be on the wait list for one year.
The Transplant Authority of Tamil Nadu (TRANSTAN), along with heart and lung transplant surgeons from across the State, has decided to bring in a time-frame for end-stage organ failure patients to be wait-listed for heart, dual lung and combined heart-lung transplants, and do away with the inactive list. The changes came into effect from January 31, 2019.
“We had a meeting with heart and lung transplant surgeons during the end of December 2018. They agreed to keep the patients on the list for one year from the date of registration. Through this, we will know the actual number of patients in need of transplants. In the 11th month, an automatically generated mail will reach the transplant surgeon. He/she can request for keeping a patient on the wait list. Then the patient’s registration will be renewed for one more year and seniority will be maintained,” said R. Kanthimathy, member-secretary of TRANSTAN.
Need for time-frame
Why a time frame of one year? Paul Ramesh, senior consultant, Cardiothoracic, Heart and Lung Transplant Surgeon, Apollo Hospitals, explained: “First, the average wait for organs for most patients is three to six months in Tamil Nadu. So a wait of one year is exceptionally long. Secondly, most patients with heart and lung failure requiring transplant have a dismal outlook with regard to a one-year survival without transplant.”
In fact, TRANSTAN and stakeholder hospitals have also updated the wait list. Old patient registrations, including those dating back to 2011 and 2012, and multiple registrations of the same patients were removed. Patients who had died were removed from the list.
“There were names of patients wait-listed more than two years ago. Despite repeated offers of organs, the organ was not utilised for them. They were either not contactable, or had improved and did not need a transplant, or were not alive. So a decision was taken to remove them from the list and re-register them if need be. This was done because it leads to misleading statistics about the number of patients waiting for a heart,” said K. R. Balakrishnan, director, Cardiac Sciences, Fortis Malar Hospital.
A decision to do away with the inactive list was also made at the meeting. Previously, inactivation status was meant to help patients, who for instance developed fever suddenly while waiting for transplant, and give them time to recover. But this inactive status was not being used appropriately, a surgeon said.
Streamlining the list
“There was overwhelming response from the surgeons to abolish the inactive list and maintain all current patients on the active list. This has streamlined and simplified the list,” Dr. Ramesh added.
Only a small percentage of patients diagnosed with heart failure require evaluation and transplantation, he noted. “The primary job of a good heart transplant programme is to identify which patients require heart transplants, and more importantly, those who do not require heart transplants immediately. There are ways to assess patients and determine this through heart failure score and biomarkers.”
