Have A Heart?

Arya, the son of a Delhi garments exporter, is only the sixteenth patient to have had a heart transplant at AIIMS. Less than 30 Indians have been fortunate enough to get a new heart, and AIIMS is only one of three Indian hospitals that performs the rare operation the Madras Medical Mission and Apollo Hospitals in Chennai being the others. Only last month, a meeting of representatives of 15 Delhi hospitals 8212; private, government and charitable 8212; agreed to take the first step in organising a heart-retrieval chain. Arya8217;s new heart is the first result of this remarkable new cooperation.

Arya first found it difficult to breathe when he was playing badminton two years ago. He took a little rest, and started playing again. Again, his breathing became ragged 8212; and this time the problem would not go. Doctors first told him it was probably just a build-up of gas, but it rapidly became clear that Arya8217;s heart was dying. 8216;8216;I used to be very scared,8217;8217; he says softly, sitting on on his hospital bed. No surgery could help him 8212; he needed a new heart.

Chandora met with a road accident on September 2 while visiting his grandparents. He was airlifted to Apollo Hospital in Delhi but in time he was declared brain dead. With that, his heart became an ideal candidate for a transplant 8212; medically at least.

8216;8216;This is normally a very traumatic situation,8217;8217; explains Dr Aarti Vij, head of the Organ Retrieval Banking Organisation at AIIMS. 8216;8216;You must explain to the family that though the heart is beating, the patient will never wake up again. And as they digest that, they must be asked if they will donate the heart.8217;8217;

Fortunately, Chandora8217;s parents were enlightened enough. His father is a psychiatrist and did not need counselling. They were told of Chandora8217;s death on their way to Apollo. Dr Deen Bandhu Chandora asked his son to be taken off life support as soon as he arrived. Apart from his son8217;s heart, the kidneys and eyes were also donated his liver wasn8217;t good.

Normally, Apollo could not have done anything with the heart. But since he was now part of the new organ-retrieval chain, Dr M R Rajshekhar, surgeon and organ coordinator at Apollo, informed Dr Vij of Chandora8217;s heart. It was ideal 8212; the donor was young, free of disease, and the heart was in good condition.

At 9 am on September 5, an eight-person retrieval team was put together at AIIMS. It included cardiac surgeons, nurses, technicians and a forensic doctor. Apollo is not authorised to do autopsies, and time was of the essence, so the forensic doctor did his examination as Chandora8217;s heart was removed from his body and stored in a special cold solution. Time is critical though, because a heart can be detached from a person8217;s circulation for only about four hours.

After blood group, body weight and other parameters were checked, Arya 8212; who had spent the last two years in and out of hospital, his heart slowly failing 8212; was told he had a donor. In an hour, he was at AIIMS. After confirmatory tests, he was under the scalpel and surgical saw.

If more examples of cooperation like this get off the ground, there could be hope for those on the heart wait list of 35. The idea is to initially network Delhi hospitals; eventually, all of India. It won8217;t come a moment too soon. Hearts for transplant are in massively short supply even in the US, which does more than 2,000 transplants a year, while 16,000 Americans 55 or younger could benefit from a new heart.

In India, the skill needed for a heart transplant matches the world8217;s best. The first heart transplanted by Dr Venugopal beats strongly in Devi Ram, 48, a Delhi mechanic who puts in a full day8217;s work, eight years after the procedure. But since the expertise is limited to only a handful of surgeons, the need for ORBO to organise the donor procedure is critical.

There is much else to be done meanwhile: getting religious acceptance for the practice itself, counselling the donor8217;s family of course, even counselling a prospective recipient8217;s family. A woman once asked Dr Vij if she could provide an assurance that her husband would live after a heart transplant. 8216;8216;I prefer he lives for two years than die now,8217;8217; she said plainly.

There are other special problems that might arise. Donor families and recipients have not met until now in India because of the trauma it might cause. In the West, families of donors have even made legal claims on recipients. An emotional Arya now accepts the Chandoras as his second parents. 8216;8216;I have to meet them after I8217;m discharged,8217;8217; he says.

For their part, the Chandoras left behind a message of hope and emotion for the Aryas, telling them how special their son was. 8216;8216;This doesn8217;t happen with other organs like the liver,8217;8217; says Dr Vij. 8216;8216;But the heart, it has emotional attachments.8217;8217;