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Monday, April 7, 2008

The gift of life

Shruti Maheshwari
February 28, 2008

TRANSPLANT SURGERY

If the story of the Hindu elephant god Ganesha, is to be believed, he is perhaps the world’s first case of xenotransplant, which is the transplantation of animal organs onto humans. Although this science is still in the very early stages of research, there have been some reported cases of human heart valves being developed from animal tissue, but that is about it.

Transplant surgery has taken the shape of a colossal medical as well as an ethical challenge. Will we be able to replace lost or diseased organs and limbs without the fear of rejection is a question that has befuddled many and forms the crux of serious debate and research . The latest, a face transplant, was also attempted a few years ago on a Chinese girl after her face was burnt beyond recognition following an acid attack. Much before this, the subject had already caught the fancy of Director John Woo who made the Hollywood blockbuster and Oscar nominee ‘Face Off ’ in which the face of a criminal is transplanted onto a policeman and vice-versa.

Reality, however is not as glamorous. For one, organised institutionalised organ donation is still alien to Indian society. This is one of the biggest stumbling blocks for research and advancement in the field since donors are hard to come by leading to alarming gaps between organ requirement and organ donation. About two lakh persons die of liver failure every year and still the number of liver transplants done annually is around 150-200.

Renal or kidney transplants is the more common of the two surgeries and close to 100 centres around the country perform 3,000-4,000 transplants every year. That is a dismal number considering it is only 3-5 per cent of the total annual demand. The situation will change once there is more awareness and media propagation of the issue feels Dr Samiran Nandy, senior transplant surgeon and consultant at Ganga Ram hospital. He is certain that the number of transplants will rise dramatically in the future.

Transplant surgeries involve huge team effort and require great stamina
Transplant surgeries involve huge team effort and require great stamina
Only 30 years ago, blood transfusion at AIIMS was conducted with bought blood since blood donation was far from the norm and not easily available. After about ten years of debate, it was made mandatory for hospitals to shift to donated blood to discourage trade and unethical transactions.

While the importance of live organ donation cannot be overstated, Dr Nandy believes that the future lies in cadaver donations or donations from those who have been declared brain dead. “Live donors are always from the poor to the rich, whereas, in cadaver, this is not the case,” he explains. Certain states like Gujarat and Kerala have shown a higher rate of live organ donation suggesting a strong correlation between willingness to donate organs and literacy.

Another area that is showing immense potential is that of research on anti-rejection drugs. As of now, the drugs that are available in the market cost Rs 10,000 per month upwards. There is an ample scope for research on the need to be able to develop more suitable drugs for the Indian body.

The biggest area of application is that of kidney transplant. It costs Rs 28,000-32,000 onwards in a government hospital and Rs 2-2.4 lakh in a private setup. Any other transplant costs multiple times the amount A liver transplant will cost nothing less than Rs 16-18 lakh. One can enter the field of transplant surgery either from the field of urology or general surgery. One has to complete an MBBS, an MD in surgery and then acquire a specialisation in transplants through on-the-job learning. It takes around 11-12 years to acquire adequate skills in this field.

While kidney is where the numbers are happening, upcoming areas include liver, bone marrow and tissue transplant, says Dr Rajesh Ahlawat, urologist and senior transplant surgeon at Fortis. Dr Anoop Misra, head of department of diabetes and metabolic diseases at Fortis vouches for the relevance of this field despite the small numbers, “Despite the limited number of transplants taking place in the country, it is still a very critical area for new professionals to get into.” He also vouches for the enormous returns in this area. A transplant surgeon can charge upto three times the cost of a regular surgery.

Following close on the heels of renal transplants is bone marrow transplant which is happening in a big way. In addition to this, there is pancreatic transplant (only one has taken place in the country so far, simultaneously with kidney), lungs and heart. The future of transplant lies in organised transplant and donation units and this is where the action will be.

Expert speak

Dr. Rajesh Ahlawat,
Fortis

Transplant surgery definitely has a very good future. For any transplant surgery that involves a live donor, there are two teams involving two anaesthetic and surgical teams and at least one head transplant surgeon synchronizing the whole affair. Unlike cadaver donors, transplants involving live donors are incredibly critical. Donor nephrectomy (removal of the kidney from the donor) is becoming very important since donor safety is uppermost in mind.

One of the things that has revolutionised live donor surgery is laparoscopic surgery because of which a donor can get back to work in the span of a few days. Unlike earlier years where bulk of the transplants were cadaver, now 30-40 per cent of the transplants involve live donors. The chances of a failure are always there in a transplant—there could be a technical failure where the transplant did not take place correctly (this is more prevalent in liver since that is more sensitive of the two).

There could also be a rejection failure where the body rejects the new kidney. There are many trained people but not in the transplant business. In the last ten years, a lot has happened in the field . In Delhi alone, two centres for liver transplant have been set up and more such centres that provide multiple organ transplants under one roof, will be set up.

Transplants are more paying than other surgeries. The future lies in organised donations and surgeries happening in these transplant centres.

Via: http://indiatoday.digitaltoday.in

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