A racing heart: Behind an organ donation

Santosh Sorate was getting desperate. He had been calling Madhukar Thakur, an autorickshaw driver from Kharghar, Navi Mumbai since 8pm — it was almost midnight now. A heart was available and Thakur, 44, who has been on the waiting list for a month was a match according to the records maintained by the Zonal Transplant Coordination Committee (ZTCC).

Donor hearts of a matching blood group don’t come easy and if Thakur doesn’t respond in time, the heart will go to the next match on the regional waiting list.

‘‘He finally picked up the call at 1.30am and almost immediately left for the hospital which was around 40 minutes away by road,” said Sorate, who is the transplant co-ordinator for Fortis hospital, Mulund in Mumbai. Every hospital registered for organ donation is required to have such coordinators who form the link between patients, other hospitals and the ZTCC. They also take care of the logistics — from informing traffic officials about the need for a green corridor to ensuring the flights are booked for the retrieved organs to be brought back.

“In 2016, there have been around 760 cadaveric donations and around 3,000 end-stage patients have got a new lease of life,” said Lalitha Raghuram, country Director, MOHAN Foundation that works with governments and hospitals across India to train healthcare professionals and educate masses about organ donation.

The number though is nowhere close to adequate. Mumbai alone has around 3,000 patients on the waiting list for just a kidney transplant.

The entire process of a cadaveric donation — one that involves taking organ from a brain dead person — can take as long 40 hours. Government is keen to promote this kind of donation as opposed to the one involving a live donor, like in kidney or liver transplants.

At the end of the process, many patients who receive healthy organs live longer.

One heart, two lives

The night of October 18, 2016, was no different. This time the heart was coming from Nanded’s Dr Shankarrao Chavan Government Medical College. In an unfortunate incident, a 35-year-old RJ working for AIR, from the second largest city in Maharashtra’s drought-prone Marathwada region, had been declared brain-dead following a road accident. The donor’s wife had agreed for the donation almost instantly. Thus, calls were made to the regional ZTCC to find a match for his organs — liver, two kidney, two corneas and heart. In some instances, the donor families donate skin as well.

“We first made calls to the Aurangabad ZTCC and then to Mumbai,” said Dr Kananbala Yelikar, Dean of Nanded Hospital. “By 10pm on October 18, once we had the family’s consent, we started doing the tests to check which organs were viable and to find out other parameters needed to match it with those on the waiting list. By 1am, we knew the heart was going to Mumbai, liver to Pune and kidneys to Aurangabad. There was a lot of excitement among the doctors as it was something new for us,” she added.

Fortis hospital staff carrying an organ for a transplant surgery in Mulund, Mumbai —File Photo

At Fortis, Thakur had reached the hospital and was going through another battery of tests, results of which would be matched to that of the now brain-dead donor in Nanded to ensure a complete match. A medical team stayed with him, ready to wheel him in the operation theatre, while another left for Nanded to retrieve the heart. By 7am on October 19, 2016, the team was on a charted flight to Nanded and by 9am they were outside the operation theatre of the hospital.

“It was like a circus. There were 50 people inside the operation theatre including local press with cameras. We had to shout to get the people out,” said Dr Sandeep Sinha, surgical physician assistant.

From the heartland

2016 saw a lot of smaller centres like Nanded, Indore and Aurangabad conducting cadaveric donations. Governments of Rajasthan and Odisha too are making efforts to push up cadaveric donation. While the southern states are clear leaders, north-east and Kashmir remain ignored.

A green corridor was formed to transport an organ of a brain-dead patient from Jaipur to New Delhi —File Photo

Once the organs are retrieved, a green corridor — in which traffic is cleared for the ambulance carrying the organ to ensure it reaches the recipient at the earliest — is needed. A heart has only four hours before it becomes lifeless. Timing is everything.

“The traffic police initially refused to organise a green corridor which was so far done only when politicians arrived. We spoke to the district collector and it was finally resolved,” said Dr Yelinker.

For Dr Anvay Mulay, head of the cardiac transplant team who in August 2015 did Mumbai’s first heart transplant after a gap of 47 years, the condition of the heart was most important which can’t be ascertained till the donor’s chest is opened. He was heading the retrieval team that day and heaved a sigh of relief when all seemed to be normal.

The entire process requires not just coordination but a lot of money too. Doctors have to use the latest technology and medicines to ensure that recipients on the transplant list remain stable and the costs of retrieval is also borne by the recipient. An average heart transplant costs nothing less than Rs 25 lakh, enough to be a deterrent. Mumbai’s current waiting list for a heart is in single digits.  

“We have had experiences when the chartered flights have charged us as much as Rs 7 lakh for a trip. If we refuse, the heart goes waste and if we agree, it pushes up the cost of the entire transplant for the patient,” said Dr Mulay.

It is a situation the state too finds unable to control. “While we are aware that the chartered airlines often charge exorbitant amounts to carry an organ, at times from remote locations, the capping has to come from the centre since it is with regards to the aviation industry,” said Dr Gauri Rathod, Assistant Director at Directorate of Health Services (DHS) who looks after the department of Human Organ Transplant Act in Maharashtra.

In a recent development, the Aviation Ministry, in collaboration with the National Organ and Tissue Transplant Organization (NOTTO) released the first set of Standard Operating Procedures (SOP) to be followed which gives aircrafts carrying organs priority take off and landing. There is no mention of capping of prices though.

During a retrieval process, heart and lungs are the first organs to be retrieved followed by liver and then kidney. Cornea and skin tend to be the last as they can be stored for a longer duration.

The last mile

With the heart safely in a solution that is kept at 0 degrees, Dr Mulay and his team left the hospital, racing against time to place it in Thakur’s chest cavity.

A call is made to Sorate to inform that the heart is arriving and back in Mulund, Thakur is wheeled into the operation theatre. Every second now is precious. The team leaves the Nanded hospital at 2.24pm and are airborne for Mumbai by 2.41pm.

In Mumbai, it takes one call to the main traffic control room to get a green corridor in place. It was not like this. “When we did it for the first time in August 2015, we had to talk to each and every traffic police station and plan the route in advance. In case there is a festival or traffic on certain route, arranging a green corridor in the city is much smoother now,” said Roopesh Nimbalkar, Manager, Safety at Fortis.     

As the flight lands at the Mumbai airport at 3.54pm, doctors begin to open Thakur’s chest cavity, in anticipation of the incoming heart. 22 minutes later, the heart is at the suburban Mulund hospital — a time reduced to less to almost half the usual time — thanks to the support from the traffic police.

“Stitching the heart in place takes another hour-and-a-half and the moment blood rushes in, the heart starts beating, as if by some miracle,” said Dr Mulay.

But it is not over yet. At hospitals in Pune and Aurangabad, the other transplant operations are still on. The last message about the liver transplant comes only by October 20, 2016. The two days were tough for the Nanded hospital that worked with  a limited staff. “Every hour as calls came in, I took a sigh of relief,” said Dr Yelikar.

For Raghuram who donated organs of her 19-year-old son in 2004, two years after she started the MOHAN Foundation, the relief is in the number of lives saved by the process. “It takes a lot of courage to take this step. When me and my husband counsel families, we tell them that we have walked the talk, so we understand,” she adds.