HT Spotlight: PGI to give heart transplants a push

A good heart is hard to find. And the wait becomes even longer when you are lying on the death bed, but waiting for someone else to die so that you can live.

In the last five years, doctors at the Post Graduate Institute of Medical Education and Research (PGIMER) could find four such ‘good hearts’, but only two are still beating. With 50% success rate, the institute is all set to give heart transplant a push in the coming years.

The first heart transplant was performed over 50 years ago in Cape Town, South Africa. India was a latecomer to the field , performing its maiden transplant in 1994. Today this number stands at over 350. The Advanced Cardiac Centre (ACC), PGIMER, joined this elite club only five years ago when it transplanted the heart of Kashmira Singh, a 40-year-old from Hoshiarpur who had been declared brain dead, into M L Arora, a 53-year-old from Ambala, in August 2013.

Though doctors declared it a successful surgery, Arora died of organ rejection six months later in January 2014. This was a big setback to the team, which attempted its second transplant after two years on 16-year-old Mohit from Haryana. He received the heart from a brain-dead teenager from Kurukshetra.

Though Mohit contracted many infections during the process, the doctors managed to save him. The third heart transplant recipient, a young boy from Punjab, was not as lucky and died a month later after his transplant in 2016. The fourth and the last transplant was performed on 11 May 2017. A year after the surgery, the recipient, Mansirat Singh, 23, of Jagraon is leading a normal life.

A tale of two boys

In 2014, 15-year-old Mohit, was trying to help his father build their new house in Ratiya village on the border of Punjab and Haryana. But unlike other days, he found it difficult to carry a brick from one place to another. As his breathlessness worsened, his father Gurjant Singh father took him to a private doctor who diagnosed him with tuberculosis. But when Mohit’s condition deteriorated, a doctor performed angiography.

“He said ‘dil wadh reha hai, wadde hospital lae jao’ (the heart is getting bigger, take him to a bigger hospital),” recalls Gurjant Singh, who took him to a government hospital in Hisar where a doctor said his chances of survival were only 21%.

Mohit was put on a 6-month-long medication but one day his face swelled and turned red, following which the doctor referred him to PGIMER.

“It was in July 2014 that Dr Ajay Bahl at the Advanced Cardiac centre, PGIMER, informed that the way out is heart transplant,” said Gurjant, who gave his consent even though he had never heard of it.

The family had gone to attend a village festival when Gujant got a call from PGIMER around 6 pm. “They asked me to reach PGIMER in 3 hours,” said Gurjant, who called his son, booked a taxi and reached the hospital 15 minutes before time.

“Around two dozen doctors were waiting of us at the entrance, the operation started at 10 pm and continued till 9 next morning,” recalls Gurjant Singh.

The transplant was successful but the next one year was not easy for Mohit, who was confined to Room No 24 on the fourth floor of PGIMER.

“Doctors and staff became my family. They would being me homemade food, games and even soap,” recalls Mohit, who battled one infection after the other, including TB. “These doctors saved m,” he says.

The entire cost of the heart transplant (Rs 4-5lakhs) , cost of private room (Rs 7,80,000 for a year) and medication was borne by the PGIMER.

After discharge, Mohit was taken to a newly-built air-conditioned room where no outsider was allowed. Two years on, he has joined 9th grade. The only issue now is the costly medicines. “I don’t have a BPL card. Officials who come for inspection refused to give me the card because of the house I had to renovate for Mohit,” cries Gurjant Singh, a vegetable vendor.

The medicines cost 2,000 a day, while Gurjant earns only Rs 500.

Mohit is grateful to the donor family, which is in touch with him. “The boy who gave me his heart was of my age. His elder sister is my sister now and she tied rakhi on my wrist. Now I am planning to visit her on Diwali.”

New heart at 25

Mansirat Singh, (25) is the latest recipient of heart transplant at PGIMER. The newly-married youth was at his workplace, the drug de-addiction centre at Jagraon, when he complained of cough and vomited after meals. The problem persisted and when he didn’t get any relief even after three months of medication, he came to PGIMER.

He was admitted to PGIMER in April, and on 12 May 2017 he underwent a heart transplant.

“Mansirat was in a very critical condition and would have died if there was a delay of two more days,” recalls Dr A Bahl. Throughout the treatment, Mansirat and his wife Tejinder were not informed about the grave situation.

Tejinder learnt about the transplant on the day they planned it, and Mansirat was told after it had been performed.

“I was at my maternal home when I got a call from my mother-in-law. She told me that doctors have given us a few seconds to decide. I got the shock of my life,” recalls Tejinder, who rushed to PGIMER.

Once Mansirat came out of the operation theatre, he was informed that he’d got a new heart. “I didn’t know how to react. I was safe and that’s what mattered,” he said. Mansirat had to be admitted to the hospital twice for a month because of infections.

A year after the surgery, he has crossed the risk period and has been allowed to join work.

“The heart beating in my body is of a generous lady from Chandigarh. Her son is in touch with my father and often asks about my well-being. I am grateful to the family,” says Mansirat.

The only worry the family has now is the monthly bill of 60,000 for the medications.

‘Cost and acceptability twin issues’, says Dr Ajay Bahl, Cardiologist, PGIMER

Q. How challenging is a heart transplant?

It is not as challenging as a liver transplant is during the acute stage. Basically there are two problems with this transplant: infection and rejection. Everything else is a balance between the two.

Q. Can you tells us the first case?

It was in 2013. Whenever you start a new thing, the first thought is whether it will work or not. But fortunately the patient did well in the initial years.

Q. What went wrong?

He had an acute rejection. Normally, this occurs in the first few days or months after the transplant. It can even occur after 4-5 months, but once these critical months have passed, the risk decreases.

Q. Which case was the most challenging?

Mohit’s case was very challenging. He had lots of problems. Name an infection and he had it.

Q. When does a transplant become unavoidable?

Normally, we do a transplant when the patient’s chances of survival are less than 50% a year. In the last three years, over 50 patients were considered and evaluated for heart transplant, but only one or two are alive. In the last month alone, we had evaluated four patients for heart transplant. Out of them, two have already passed away.

Q. At any given moment, how many patients are in queue for heart transplant?

There are lots of patients who need active transplant, but this time we have two patients on the waiting list. One is being admitted for check-up, and there is one more patient in the queue.

Q. What are the challenges associated with the transplant?

Heart transplant is expensive. A person spends around 5– 6 lakh during the first year. Then, medicines cost 2,000 a day. Acceptability is another issue. There are lots of patients, who are advised a heart transplant but are reluctant to get it done. At other times, there are no donors.

Q. Any plans to strengthen the programme?

Yes, we have to increase the numbers.

Q. Any message?

Heart transplant is a very reasonable option. The first year is difficult, but after that the quality of life improves. One should not ignore any symptom of breathlessness or chest pain.