Mumbai: Heart transplant panel defines new system of organ allocation

The committee has Dr Anvay Mulay, cardiovascular surgeon at Mumbai’s Fortis hospital, as chairman and Dr Manoj Agny, cardiac and transplant surgeon at Jaslok hospital, Mumbai, as co-chairman.

Written by Anuradha Mascarenhas | Mumbai | Published: February 12, 2016 2:28:18 am

THE state has identified new criteria for selecting donors and recipients of heart transplants to ensure a higher success rate and smooth coordination among hospitals. At a meeting held on February 9, the state heart transplant committee has defined a new set of guidelines for heart transplants.

The committee has Dr Anvay Mulay, cardiovascular surgeon at Mumbai’s Fortis hospital, as chairman and Dr Manoj Agny, cardiac and transplant surgeon at Jaslok hospital, Mumbai, as co-chairman.

In Maharashtra, a total of six heart transplants have been conducted so far.

“The goal of transplantation is to improve the quality of life. The committee members had studied the entire issue and prepared a final draft of the revised guidelines that define an organ allocation system,” Dr Gauri Rathod, assistant director, Human Organ Transplant Cell, Directorate of Health, Maharashtra, told The Indian Express.

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The guidelines on how to allocate organs of the donor and identifying the really critical end-stage heart failure patients have been prepared in keeping with the framework set up by the United Network for Organ Sharing (USA), a non-profit organisation that brings together hundreds of transplant and organ procurement professionals.

Among the suggested criteria for a cardiac donor is the age limit. The donor should be up to 55 years that could be extended to 65 years in selected cases, Dr Agny, co-chairman of the committee, told The Indian Express.

Some of the other criteria for selecting a donor’s heart includes the patient’s health condition — he or she should not have had a prolonged cardiac arrest, severe hypotension, severe chest trauma with cardiac injury or any pre-existing cardiac disease.

Tests to check the donor’s past medical history and physical examination along with electrocardiogram and other laboratory tests need to be performed as part of the evaluation of the heart. The person set to receive the heart has to be necessarily an “end-stage heart failure” patient.

To be precise, only a patient with a heart functioning less than 25 per cent has been identified to receive a heart transplant.

Patients who have had systolic heart failure (as defined by ejection fraction< 35%), ischemic heart disease with intractable angina and who have had ineffective maximal tolerated medical therapy are considered for the heart transplant. There are also other conditions like “intractable arrhythmia”, which have also been defined as part of the new guidelines on who should receive a donated heart.

“Patients with cancers that have been in remission for five years and cancers that are low grade, such as prostate, may be acceptable for transplant,” said Dr Anvay Mulay.

In the USA, he said, as many as 2,500 heart transplants were done every year while another 4,200 were on the waiting list. “But in India, we need a proper system of identifying, which are the really critical patients and whose heart can be selected from among the brain stem deaths,” he said.

At present, there are five hospitals — Jaslok, Fortis, Kokilaben Ambani, Jupiter and Asian Heart (all in Mumbai) — which are conducting heart transplants. “We have also set guidelines to advise the hospitals to allow a donor organ for a patient with supra urgent needs. There are 14 patients on the waiting list for a heart,” said Dr Agny.

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