The number of heart transplants in Maharashtra has multiplied by 25 times in five years, from two in 2012 to 50 such procedures last year, but most of them took place in only four of the 12 hospitals registered across the state to carry out the surgeries.
A heart transplant centre requires considerable infrastructure, surgical expertise and high standards of follow-up care. The procedure also requires a large team comprising immunologists, cardiologists, a medical social worker and a dedicated OPD with post-operative care personnel. As many as 12 hospitals in Maharashtra — eight in Mumbai, two in Pune and two in Aurangabad — have been registered as heart transplant centres. These include Jaslok Hospital, P D Hinduja Hospital, Asian Heart Institute, Fortis Hospital, Jupiter Hospital, Kokilaben Dhirubai Ambani and Medical Research Institute, Global Hospital and H N Reliance Hospital in Mumbai, Ruby Hall Clinic and Military Hospital Cardio Thoracic Centre (MH-CTC) in Pune, and United CIIGMA hospital and Kamalnayan Bajaj Hospital in Aurangabad.
Most of the heart transplants in the state have been performed at Fortis Hospital and Ambani Hospital in Mumbai, Ruby Hall Clinic in Pune and United CIIGMA in Aurangabad, said Dr Gauri Rathod, state nodal officer for organ donation. On why the procedure is not carried out too often in other hospitals, she said, “While there is a need for more donor organs, the entire procedure, along with post-operative care, costs between Rs 40-50 lakh”.
Several patients, however, are in desperate need of the surgery. The Zonal Transplant Coordination Centre (ZTCC) at Mumbai has a waiting list of 20 end-stage heart failure patients, and the waiting list at ZTCC Pune has 16 such patients. The ZTCC Nagpur is yet to be registered as permissions are awaited for at least three hospitals in the city to be registered as heart transplant centres.
While there are 12 registered transplant centres, there are other hospitals where they can retrieve the heart, but can’t perform the transplant. In Pune, 10 heart transplants have been performed at Ruby Hall Clinic, but MH-CTC is yet top open its account, said Aarti Gokhale, central coordinator at ZTCC, Pune. Even as the MH-CTC in Pune has been performing complicated paediatric and adult cardiac surgeries and there is a huge willingness to perform cardiac transplants, administrative arrangements and logistic issues have to be dealt with.
According to Madhur Verma, CEO of Sahyadri Hospital, the state only recently registered the Deccan branch of the hospital as a registered heart transplant centre. Dr Manoj Durairaj, heart transplant surgeon at Ruby Hall Clinic, admitted that despite having state-of-the-art modular operation theatres and surgical expertise, it took a couple of years for the first heart transplant surgery to take place. “Our teams have performed 10 heart transplants… instead of being competitive, hospitals should work together to ensure that the city becomes known as a heart transplant centre,” said Dr Durairaj.
On the discrepancy in the number of heart transplant centres and the number of procedures carried out by them, heart and lung transplant surgeon Dr Sanjeev Jadhav said if a hospital has been registered as a heart transplant centre, then it it already has the requisite infrastructure and resources. “But all hospitals need large teams to ensure that the procedure is a success… the process includes extensive monitoring so that the potential donor heart is compatible with the recipient’s immune system, to minimise the chances of rejection,” said Dr Jadhav.
Dr Ajay Chandanwale, Dean of Sassoon General Hospital, said there was a need to step up awareness among family members of brain dead patients, who have to be encouraged to volunteer to provide the organs to other patients. Sassoon General Hospital has applied for permission to perform both heart and liver transplants.