A third chance at life

In some patients, the need for repeat transplants of some organs could arise 

November 05, 2017 12:02 am | Updated 12:02 am IST

  Reena Raju

Reena Raju

Eight years ago, Reena Raju, 36, replaced the heart she was born with. Frequent bouts of illnesses and tests back in 2006 revealed that her birth-heart worked at only 15% of its capacity. Since her heart transplant in 2009, however, she’s skydived, para-sailed, run, cycled and in June, participated in the World Transplant Games — an athletic meet for those with successful transplants. She’s even set up a foundation to promote organ donation and help support transplant patients.

But this September, whilst being administered a routine injection, she collapsed in a hospital at her hometown Bengaluru. Rushed by road to Frontier Lifeline Hospital, in Chennai, where she’d had her transplant, she had a cardiac arrest in the emergency room there and remembers nothing much of the next few days. When she came around, her partner Raj reassured her that all would be well. On September 23, she’d just got herself a second, new heart.

Reena’s case, experts say, encapsulates the rising need for repeat transplants of some organs. Tamil Nadu’s deceased-donor organ transplant programme is now nine years old and serves as model for other States with transplant programmes of their own. Livers can last a lifetime but kidneys and hearts only about 10 to 15 years.

Every year, the country performs 200 heart transplants, a majority in Chennai. Survival rates are over 80% for one year and about 70% for five years. Over 8,000 kidney transplants are done every year, and of these around 1,600 are from deceased donors. This year, Tamil Nadu has performed 82 transplants of the heart and 241 involving the kidney. But transplants bring with them their own challenges.

Hearts and kidneys

Transplanted hearts, says K.R. Balakrishnan, Director, Cardiac Sciences, Fortis Malar Hospital, Chennai, may be challenged by chronic rejection, for instance, due to allograft vasculopathy, or blocks that develop in the arteries of the new heart, as was the case with Reena. They are usually difficult to treat. While about a quarter of patients with transplants can survive 30 years, for the rest — especially younger adults and children — second transplants may become necessary. However, Dr. Balakrishnan foresees better results, with improved immunosuppressants — the drugs that transplant patients have to be on to prevent their immune system from attacking the donor hearts — as well as HLA typing (human leukocyte antigen) that involves testing the compatibility of the immune systems of donor and recipient organs for better matching.

With kidneys, it’s trickier, says Dr. Georgi Abraham, nephrologist, Madras Medical Mission. Second transplants are needed in many cases but if the patient has a high level of antibodies from a previous transplant, it makes a re-transplant harder.

What needs to be done

In the next few years more patients will come in for repeat transplants, says Sunil Shroff, Trustee, MOHAN Foundation, which promotes organ donation and transplantation. What could be put in place to cater to this is better infrastructure, laboratory support as well as a centralised lab facility. Currently, organs are allocated on the basis of similar blood groups, which is not ideal, he says.

Also, at present, Dr. Shroff says, a patient who needs a second transplant may get back on the list for an organ, but is not on the priority list as per the programme’s rules. While those who require kidneys can stay on dialysis until an organ is available, those who require hearts, he says, may need to be on the priority list.

Dr. K.M. Cherian, Reena’s surgeon, also says that those who require repeat transplants after a period of some years ought to be on the priority list as per international guidelines.

However this is something that requires a discussion of rules among all stakeholders to come to a consensus, says Dr. Shroff.

What is also important, says Dr. Abraham, is to regularly follow-up with patients who have received deceased donor transplants within the ambit of the State transplant programme, and to check how long they survive and why, if not, have their organs failed.

Now back in Bengaluru, Reena — who sings at weddings, composes jingles and enjoys vacationing by the sea — is slowly getting back to life as usual. “I will do everything to make this heart rock.”

zubeda.h@thehindu.co.in

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