When Hitesh Kachariya, 40, a textile worker, the second of four brothers, husband and father of three, was declared brain dead after he suffered from brain haemorrhage on December 16 at Surat’s INS Hospital, his family decided to make a difficult choice – to donate his organs.
“They told us that if we consented to organ donation, it could take upwards of 36 hours before they could hand over the body for last rites,” Hitesh’s younger brother Dipak, who is in his 30s, tells The Indian Express. They consulted Hitesh’s family – particularly his wife Jitnagauri, in her late 30s, and oldest daughter Khushi, a first-year student of Zoology at MSU University in Vadodara, before deciding to go ahead.
“Our father Nathubhai especially was very keen to ensure that his organs were donated. After discussing it with our sister-in-law and Hiteshbhai’s eldest daughter Khushi, we ultimately decided that saving the lives of several other people outweighed the delay in the last rites and so we agreed to donate as many organs as possible,” says Dipak.
That set in motion the wheels of organ donation. Just a day later, his heart, lungs, kidneys, and liver were surgically removed and sent to different cities: the heart transplanted into a 47-year-old man at Marengo CIMS Hospital, Ahmedabad; his lungs to a 60-year-old patient at Medanta-The Medicity Hospital, Gurgaon; kidneys to patients of renal failure at Ahmedabad’s Shalby and Sterling hospitals; his liver to a 37-year-old Mumbai resident admitted to Surat’s Kiran Hospital and the corneas to two patients in Gujarat’s Navsari district.
What it took was complex planning, coordination and precise implementation that involved multiple agencies and green corridors – a traffic-free route for the quick transport of organs from one hospital to another for transplantation – all in a small window of 4-5 hours.
This was Gujarat’s 128th such green corridor since the first one on December 18, 2015, making it the ninth anniversary of the first such corridor. This number includes interstate corridors that have helped transport organs even as far as Hyderabad, Chennai, and Delhi.
Incidentally, the first transplant was also in Surat.
The logistical manoeuvring – and some stumbling blocks
Typically, the cost of such transplants – including the cost of transporting the organs – is borne by the recipient.
On December 16, doctors declared Hitesh, a stone setter in Surat’s textile industries, brain dead following some tests. According to Dipak, once the family decided to donate the organs, they contacted Nitesh Mandlewala, head of Surat-based NGO Donate Life, who came down to explain the procedure, including how green corridors are set up. Once the family signed the consent form, the Gujarat State Organ and Tissue Transplant Organisation (SOTTO) was informed and the process to contact possible recipients on the waiting list began.
Typically, green corridors, which can be set up on both road and air routes, take into consideration an organ’s Cold Ischemia Time (CIT) – the amount of time they can be left outside a body without blood circulation. Organs such as hearts and lungs typically have shorter CITs of 4-6 hours, while that for the liver is 12 hours and the kidneys is under 24 hours.
According to sources who were part of the process, Hitesh’s lungs found no takers either in Gujarat or in the western region of India. As a result, the National Organ and Tissue Transplant Organization (NOTTO) – the organisation that manages India’s National Organ Transplant Program (NOTP) – began to look farther afield, and finally found a recipient at Gurgaon’s Medanta.
This delayed the entire process by a few hours, and it was at 5:19 pm that doctors were finally able to retrieve the heart for donation, sources say. This was followed by the lungs, the kidneys, the liver and then the cornea.
Then came the part of transporting the organs. To accompany them at least partway, the Kachariya family divided themselves: while Khushi and Hitesh’s older brother Ashok went with the heart while father Nathubhai and Dipak accompanied the chartered aircraft that was to ferry the lungs to Gurgaon.
Because the distance between Surat and Ahmedabad is 285 km by road, doctors decided it was best to transport the heart by an air ambulance. This was because of the logistical complexities involved in transporting the organ given its short CIT, says Dr. Dhaval Naik, the cardiovascular surgeon at Ahmedabad’s Marengo CIMS Hospital – where the recipient was.
“If the heart is more than 200 km away, then we require an air ambulance or chartered aircraft because we simply cannot transport and transplant a heart within the four-hour time limit if we go by road,” In contrast, the kidneys were taken by road to two separate hospitals in Ahmedabad.
But transporting the organs to airports too required considerable logistical manoeuvring, such as involving the local police, creating traffic free routes, and providing personnel and vehicle escorts to help ensure smooth transport.
“Surat City Police had first been told that a green corridor from INS Hospital to the city airport would be required at 6 pm for the heart. But the change in timings had disrupted the retrieval, and the police were asked if they could advance the green corridor time to 5:30 pm… But ultimately, the green corridor had to be set up at 6 pm, according to the original time,” one source says, adding that the heart reached Surat airport around 6:15 pm.
What helped, however, was the Standard Operating Procedure that the Surat Police had in place to smoothen the process.
“There are only a few major hospitals from where organ donation takes place in Surat. So, we have mapped out the routes from these hospitals either to the Surat airport or to the Ahmedabad Highway, with critical points and bottlenecks as well as taking into account morning and evening commuter traffic,” Narmada SP Prashant Sumbe, who helped revised the SOP in 2020, tells The Indian Express.
While regular flights between Surat and Ahmedabad are routed through Bhavnagar, authorities sought a direct route. This made the flight shorter than its usual 1 hour, says Captain Siddharth Ravalia, Head of Operations for the Air Ambulance. The Air Ambulance is a 20-year-old Beechcraft 200 aircraft previously used by the Gujarat Chief Minister and was assigned as an ambulance in March 21, 2022. This fixed wing aircraft has ferried a total of 53 organs in 33 months of operations between March 2022 and December 2024. It has also ferried 45 patients to hospitals across the state, according to data from the Gujarat State Aviation Infrastructure Company Limited (GUJSAIL) which is under the Department of Civil Aviation.
From the Sardar Vallabhbhai Patel International Airport, the Ahmedabad Police created another green corridor to help transport the heart to CIMS Hospital. It took them 20 minutes, doctors who accompanied the organ say.
At the hospital, a transplant team immediately set to work. It was at 10:13 pm – nearly five hours after the heart was procured from Hitesh – that blood circulation began in the recipient’s body, doctors say.
“Since the recipient was in a fragile condition, having already undergone two heart surgeries before the transplant, it took approximately another 2.5 hours to stabilise them, transplant the organ and unclamp the aorta and restart blood circulation to the donated heart,” Dr Dhaval Naik from CIMS says.
Despite the success, a doctor familiar with these processes believes that the green corridors could be made better to save more time.
He says: “While corridors made for VIPs includes clearing the entire route of traffic and making sure all road signals are green, this isn’t done for organ transport where an escort is given by the police but the speed of the convoy still depends on whether others driving on the road give way to the vehicles bearing organs,” he says.
On December 16, Hitesh Kachariya was declared brain dead at a Surat hospital. What followed was considerable logistical gymnastics to transport his organs. (Express/Hanif Malek) 
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