I was 69 when I underwent a heart transplant last year. I had end-stage heart failure. My heart’s pumping rate had fallen to 15% (as against the needed 65%). My kidneys were getting affected. Death was, it seemed, imminent.
But god’s ways are so mysterious. I was airlifted to a major Chennai hospital by doctors and put through a pre-transplant test. I was found eligible and was enrolled on the National Organ Tissue and Transplant Organisation (NOTTO)‘s registry as a potential recipient. Then the search for a matching donor heart began.
The first time the doctors’ team went to get a heart for me, it was 700 km away. Unfortunately, the State Police refused to give permission for swift transport of the organ through a facilitated traffic corridor and the team came back empty-handed. The next time the alert came, the medical team found the heart to be in poor shape. I was kept on an empty stomach both times so that I may be wheeled into the operation theatre within minutes. Between the harvesting of the heart from the donor’s body and its implantation, the team gets just four to six hours.
The third time round, the donor was an accident victim and was brain-dead. Also, my blood group is AB+ which is a universal recipient, unlike O+ which is a universal donor. The Os can get a heart only from an O donor. A patient my age waiting for a heart there died because an O+ donor could not be found.
The heart transplant process is a life-saving intervention in patients with end-stage heart failure and coronary disease. In a transplant, the diseased heart is taken out and a living, healthy heart or a mechanical heart device, a Left Ventricle Assist Device (LVAD), is implanted. Since the first human heart transplant done by Dr. Christian Barnard in 1967, life expectancy has gone up to 15 years on average. It is the treatment of the future. Then why is it not more common than it is today?
A number of conditions have to be fulfilled before a heart can be used. The donor heart must be living, belong to a person under 55, match the recipient’s body weight, height, size of heart, blood group. Matching is done through a computerised process at NOTTO. The matching done, a potential alert for a heart is issued by the hospital which has a brain-dead patient. The cardiac team from the recipient patient’s hospital travels to the ‘donor’s’ hospital.
It was while I was in hospital that I realised the difficulties faced by doctors and patients waiting helplessly for good quality matching donor hearts from the limited pool available. I also got to understand the process of acquiring a donor heart.
Only brain-dead patients can become donors of a heart. A brain-dead patient is certified so by a special team of doctors and a civil surgeon. Some relatives donate organs readily. Others refuse for religious reasons, superstition or because they doubt brain death since the patient’s body remains warm while on life-support.
Dr. K.R. Balakrishnan explains brain death: “Once the supply of oxygen to the brain is cut off due to an injury or cardiac arrest, the heart may continue beating after resuscitation but the person is dead. Like the CPU of a computer which once damaged, the computer does not work.”
The Indian government recognised brain-death as death in 1994 and allowed organ donation from brain-dead persons. The first heart transplant in India was done by Dr. P. Venugopal of the All India Institute of Medical Sciences on August 3, 1994. Since then, a mere 400 transplants have been possible in India because of the paucity of donor hearts and transplant centers.
Unless donors pledge their organs in large numbers in every region of the country they will not be able to influence hospitals to set up centres. Currently, of the 78 centres in India only a handful are active. This gives no motivation to surgeons to train for transplant surgery.
While donor awareness has increased, more needs to be done. The younger generation is open to the idea. Awareness dissemination in schools and colleges can be accelerated by government, hospitals, medical colleges and doctors.
We can pledge our organs with bodies like the Zonal Transplant Coordination Centre (ZTCC) and keep the donor card with us in order to save time. The card carries one’s blood group and a signed declaration conveying our wishes to our family.
Let us pledge today itself to donate organs. Why burn or bury organs which will be of no use after death but can help others live?
How do I feel after a heart transplant? Very good! My life has changed completely and I thank my anonymous donor several times in the day.
