Chennai: In a scenario where hundreds die every year in a wait to receive suitable heart donor and every single donated heart holds a great significance, it is observed that a large number of cadaver organs like heart and lungs are going waste, owing to lack of awareness and smooth networking between medicos.
That no single heart should go waste but be used to give a new lease of life to another is grossly overlooked and can be corroborated by the fact that the number of patients registering themselves for a heart transplant are still minute as compared to the number of heart donors, even as the country is slowly learning significance of donating organs shedding superstitious beliefs. The lack of recipients for heart or lungs as compared to donors points to a serious problem of mismatch due to various glitches in the overall organ sharing machinery.
Dr Nandkishore Kapadia, director, heart and lung transplant programme, Global Hospital, Chennai told India Medical Times, “In India more than 10 million new heart failure patients are added to the existing number, with a mortality rate of more than 30-35 per cent annually. Heart failure as an option is not at all discussed with patient or their relatives. With government-supervised organ sharing registry already active in Tamil Nadu and slowly being more formally introduced in Maharashtra, Delhi, Madhya Pradesh and Karnataka, cadaver organ availability has improved considerably.”
According to Dr Kapadia, the government and NGO initiative has had some impact on common thinking of the organ donations posthumously. Altogether, in a scenario when 135-150 donors are available in Tamil Nadu, and other states, only 30-35 heart transplant receivers are available annually. This mismatch is causing wastage of at least 110 heart and 220 lungs each year.
“The paucity of ‘Donor Cadaver Organs’ is slowly being addressed in our country with Tamil Nadu, Andhra Pradesh and Mumbai taking the lead. But it is a matter of disappointment that of the 150 cadaver hearts available every year in Tamil Nadu and accessible to all transplant hospitals by the Government Organs Sharing Network only 20-25 heart transplants are done every year in this state. This means there is a gross wastage of donor organs like heart or lungs due to lack of recipients,” he said.
Talking about other options available for the heart transplant waiting patient Dr Kapadia said, “Heart transplant wait listed patients may go into severe heart, kidney and liver failure. Such patients can be well stabilised on ECMO (extra corporeal membrane oxygenation) till they recover their kidney and liver function and may again become fit for heart transplant. Some patients may not improve on ECMO and will require support on LVAD (left ventricular assist device), externally (Berlin Heart Excor) or internally like HeartWare and HeartMate II. If the organ is not available, they may be left alone on LVAD with good quality of life. But in India the cost of LVAD will be somewhere between Rs 60 lakh and Rs 1.2 crore and with the dollar price going up day by day soon it will be out of the reach of many potential patients for LVAD. So, there cannot be a better option than a heart transplant. But efforts need to be stepped up.”
“It is estimated that there might be 2 million new heart failure patients in India, of which at least 2,000-5,000 can be cured with a heart transplant or a heart lung transplant. If a kidney transplant is an accessible operation in India, there is no reason why heart transplant cannot be a routine surgery,” said Dr Kapadia.
According to Dr Kapadia, the low number of heart transplants can be attributed to lack of nationwide co-operation among medical professionals, lack of adequate organ-sharing network infrastructure and transport facilities and lack of public awareness on organ transplant besides the high cost involved in such transplants.
The lack of awareness among people about organ donation and organ transplant is the most pressing reason for poor progress in the area of heart transplant. Taking the issue of organ donation awareness as a priority campaign could really pay dividends.
Generally, people come to understand the importance of organ donation only when their own relative is in the last stage and doctors convince them to donate the organs.
“By the time one agrees for getting listed for heart transplant, the patient usually does not remain suitable for heart transplant due to end-organ (kidney, liver) failure. These patients are excluded or are very high risk for heart transplant,” Dr Kapadia said.
“We need to spread the awareness that the organs are useful to someone needy and they are not needed in heaven. The family members can decide promptly if they are aware about the brain death and organ utility for others. If donation is accepted by them, it will give the life to others. This is responsibility of doctors, NGO, government at state and centre, schools, colleges, in various government departments to spread the awareness about organ donation and issuing organ donation card,” he said.
Even as the country has progressed in establishing speciality centres, both public and private, the fact remains that the cost involved in the transplant and the post-transplant care is a deterrent to many. The cost of operation and immuno suppressants is still a concern among heart patients, which overshadows their hope of a new lease of life or any positive benefit of heart transplant procedure.
Dr Kapadia said, “Heart transplant is affordable surgery like any other open hearts. The immuno-suppression drugs are costly and the overall cost for transplant is Rs 6-7 lakh. The various state government is now giving Rs 2-3 lakh for heart transplant for needy poor or lower middle class patients through various schemes specially in Tamil Nadu, Karnataka, Madhya Pradesh, Maharashtra, Gujarat and Goa. Soon, the insurance companies may start paying for heart transplant surgery. After all the cost of a car is Rs 4-5 lakh and many Indians can afford it, why not the heart transplant?”
Organ transplant could make a rapid stride in India, provided there is maximum cooperation among medical professionals across the length and breadth of the country along with a smooth organ sharing network between various organ sharing centres and hospitals of all states.
Any positive contribution by the government in the form of incentives in the form of various schemes and insurance facility can entirely change the organ donation and transplant scene in India.
What is also of prime importance is that public-spirited citizens from all walks of life help in educating the public on organ donation and proper counselling of families involved. The success of various cadaver transplant programme operating in India could bring the country on international map for best in this field besides saving many valuable lives every year.
by Vidhi Rathee