Dr Anvay Mulay
A surgeon feels most frustrated when he does not have a cure for his ailing patient. I too face it many a time--irreversible conditions where a surgeon feels helpless. I always feel that heart transplant could have saved some of the patients I lost.
So, on the first day of my new job as a cardiac surgeon at Fortis Hospital, Mulund, I suggested to the CEO that we should attempt a heart transplant and she agreed. Since this is not a job that one can do alone, I looked for some like-minded doctors. With much ease, I found four colleagues who were equally passionate about the endeavor. I was happy the management had agreed, and I soon had a team in place. But little did I know that getting a heart would be the most difficult part.
There are many patients who require a heart transplant surgery, but I feel helpless every time we are unable to get a donor heart for them. I knew that the idea of organ donation wasn’t very popular in our country, but did not realise the extent of the problem.
As my patients waited for heart transplant, I would go to various places, from gatherings of doctors to elderly homes to Rotary clubs to colleges and schools, to talk about the importance of organ donation. I spoke to them about the ‘opt-out model’ of donation followed in many developed countries. I explained to them how organs from a brain dead person could help save lives and that their dear ones could live through the donated organ. I did this for more than one- and- a- half- year, but to no avail.
One day, I had this patient who was very sick. Only an early heart transplant could have saved her. We tried our best to get a donor heart, but failed. I ordered a mechanical assist device(temporary artificial heart) to keep her alive until she got a donor heart. She could not afford it, but we arranged for it.
The mechanical assist device was supposed to reach us on Monday morning; however, on Sunday night I had to give her close to 100 electric shocks to keep her alive.
But all in vain, we could not save her.
Losing her deeply saddened me. Some patients deteriorate so fast that we do not get much time to provide adequate medical treatment.
I studied the donation pattern in India—it was a meagre 0.05 per million. That means chances of getting a donor in our country were almost non-existent. But I didn’t want to miss any chance of getting a donor heart for my ailing patients.
I had not yet lost hope of performing a heart transplant for my patients.
So, I did not go out of the city for one-and-a-half year. I called up the Commissioner of Police to notify them that I would need a green corridor anytime I got a heart for transplant. The police showed enthusiasm, they asked me to alert them a few hours in advance.
It was end of July 2015.Two patients who had suffered heart failure were admitted in the hospital in the middle of the night. They were already registered for a heart transplant. For a family emergency, I was in Pune when the call for the first potential donor came from Jehangir Hospital, Pune. I immediately decided to leave for Mumbai, to attend to my recipients and to coordinate for our first transplant.
It had rained heavily the previous night, and there was a landslide on the expressway. Our Medical Social Coordinator reached out to the Social Coordinator at Jehangir Hospital, Pune, to enquire about the potential donor. As I travelled by road, I had little time in hand, and I was 150Kms away from Mumbai. I didn’t want to waste a second; there was a lot of coordination to be done at the hospital. As I left for Mumbai on Sunday afternoon, the coordination for the transplant began on a Whatsapp group, which my team uses to communicate with each other.
We had to decide which one of my patients would benefit the most by this donor heart. I had two potential recipients in the ward - one was very sick and the other one was slightly stable. So, we decided to give the heart to the patient who was slightly stable, as his chances of accepting the heart were higher. The second step was to ensure that the donor heart was good enough for the recipient. So, we asked the doctor taking care of the donor in Pune to conduct a few tests. It was his first such experience and he was not very confident about the procedure. I had no option but to convince him to do the tests to see if the donor heart was good enough to be transplanted.
It was 11.30pm when I reached Mumbai. I thought, I should go home and take some rest. On the way home, I thought, it took me five-and-a-half hours to reach Mumbai from Pune, on Sunday evening. It could be worse tomorrow. I needed a plan B
Here in Mumbai, I asked the team to conduct a few blood tests on both the potential recipients, to examine the match with the donor. It was 11.30pm when I reached Mumbai. I thought, I should go home and take some rest. On the way home, I thought, it took me five-and-a-half hours to reach Mumbai from Pune, on Sunday evening. It could be worse tomorrow. I realised brining the heart by road to Mumbai on time could be a huge problem. I needed a plan B.
I though of airlifting the heart.
It was already past midnight. I wanted the heart to reach Mumbai safely and as fast as possible. But both the patients were economically weak, unable to bear the cost of airlifting the donor heart. So we decided to ask the chief cardio thoracic surgeon at army hospital in Pune if he could help bringing the heart by an airplane. But, he said that he had only fighter planes and the permissions would have to come from the Ministry of Defence.
A friend working at the navy hospital in Colaba, Mumbai, came to my mind. I asked him for help. He gave me a few numbers of his senior officers. I called them at midnight and they agreed to help with their naval helicopters. They even agreed to allow one civilian to accompany the heart. But there were technical problems pertaining to visibility during rains. The hilly terrain and heavy rains posed a challenge, so we needed plan C.
We booked a chartered plane at our own expense.
The whole night went into making arrangements and I thought I have everything streamlined. At 9 am, the doctor at Pune hospital told me that the donor’s family has not given their consent in writing and they will give it only at a particular auspicious time of 11.30am. Now, I had to postpone everything—from OT preparations, to ICU, to asking for a green corridor in Pune and Mumbai. The police needed two hours’ notice and so did the charter plane operators.
I called the aircraft operator, I wanted them to be there at the Pune airport by 1.30pm. But they said they could reach only by 1.45pm. So, I calculated everything backwards, again. One has 8-10hours to transplant a liver, up to 12hours to transplant a kidney but for a heart transplant, one has only 4 hours. It is a race against time. Once we got the family’s consent at 11.30am, I asked the Pune doctors to wait until 12.30pm.
I knew that harvesting the heart might take about half an hour and then 15 minutes for it to reach the aircraft. I called the aircraft company to confirm the exact time they could fly from Pune, but the phone number I had was not reachable until 1.50pm. My heart was literally pounding.
At the Pune hospital, the donor was laid on the operation table, his chest was opened by the surgeon and now he had to stop the circulation. But how could I give him the permission to do that until I had confirmed timely availability of the aircraft? And we kept waiting.
At 1.55 pm, I could reach the pilot of the aircraft. He confirmed his landing at the Pune airport. I asked him to keep the plane ready and I asked the surgeon at Jehangir Hospital to go ahead with the process. The heart was finally brought and transplanted under the 4 hour window. The surgery was successful.
The 22- year old recipient is now hale and hearty!
The writer is chief, cardiac transplant, Fortis Hospital, Mulund