Post Covid life talks by Ruby Hall Clinic warriors

Dr. Manoj Shrivastav Consultant Hepatobiliary and Liver Transplant Surgeon, Dr. Rela Institute @ Ruby Hall Clinic Pune

Yes, it's true, COVID-19, a 120 nm virus brought the world to virtually a standstill. It has made every individual pause, stop and think. In the midst of a crisis, we often see ordinary people do extraordinary things. Our #HealthcareHeroes have gone above and beyond their call of duty while a number of patients have emerged victorious during this pandemic. In this series, the frontline warriors of Ruby Hall Clinic answer some of the many questions you may have regarding life post coronavirus while patients elucidate their journey to recovery. Find out the world’s new definition of normal, a normal that has taken shape in 2020. #LifePostCovid will never be the same again, but we’re ready to face it - head on.

• Are liver transplants a reality during the COVID-19 pandemic? If so, could you share an example?

A: Yes, liver transplants are a reality and a strong signal that life must go on despite the challenges that the novel coronavirus throws at us. We too conducted an extremely challenging liver transplant in such a time. The patient was a 62-year-old man who was suffering from a complex liver condition known as decompensated chronic liver disease along with a hepatocellular carcinoma — a type of liver cancer.

As a result of this ailment, fluid accumulated in his stomach and had to be drained every alternate day. Since his condition had progressed to the point that his liver was having trouble functioning, our challenge was to help rectify this condition with a liver transplant as well as treat his liver cancer. Of course, the risk of the patient developing a viral infection was high at this stage, along with the probability of contracting the dreaded coronavirus due to his low immunity.

• What steps were taken to ensure a successful surgery and smooth postoperative recovery?

A: The moment we found a suitable donor with a blood group match, our CEO Mr. Bomi Bhote and COO Dr. Kishor Pujari asked us to proceed with the transplant surgery. After administrative and clinical formalities, we proceeded with the surgery on the 23rd of May, in the midst of the lockdown. The procedure took close to 9 hours and was extremely challenging, but went ahead without any complications due to a number of stringent protocol we followed. These included:

• Testing both the donor and receiver twice for COVID-19 to ensure no risk of the virus
• Minimising OT traffic to shorten the duration of the procedure while also reducing the chances of infection
• The utilisation of PPEs by all OT personnel and the post operative team
• Strict OT and equipment disinfection
• Superior ventilation within the OT by means of HVAC systems and laminar airflow to absorb gases; negative pressure within the ICU to prevent virus transmission through air droplets
• Segregation of staff caring for the patient post operatively. The dedicated team and support staff caring for the patient within the ICU as well as the private ward were kept separated from all other hospital teams during this duration to minimise virus spread. They were also provided with food and accommodation within the hospital during this period

Due to these strict measures, the patient had an extremely smooth post operative recovery. After about 3 days in the ICU and 5 days in a private ward, the patient was fit for discharge — a commendable recovery despite the obstacles put forth by coronavirus.

• Who all were part of the team involved in the procedure?

A: At Ruby Hall Clinic, we realise that liver transplants can be one of the most challenging times in a patient's life. Throughout the transplant process, we partner closely with donors and recipients to enable a seamless continuum of care. From careful pre-transplant assessment to post-surgical monitoring, our dedicated team of surgeons, doctors, nurses, social workers, support and admin staff help give our patients a new lease of life.

In this particular case, the team included:

• Chief Hepatobiliary and Transplant Surgeon: Dr. Manoj Shrivastav
• Hepatobiliary Surgeons: Dr. Anuja Athale and Dr. Vidhyachandra Gandhi
• Hepatologists: Dr. Vineet Shah and Dr. Kiran Shinde
• Anaesthetists: Dr. Shrikant Kote and Dr. Nandini Londhe
• ICU Intensivist: Dr. Sushil Yadav
• Transplant Co-ordinator: Mrs. Surekha Joshi

THE #HEALTHCAREHEROES THAT MADE THE LIVER TRANSPLANT A REALITY IN TIMES OF COVID-19

For more details visit us on:- https://rubyhall.com/