Days after a set of conjoined twins was born at the Lokmanya Tilak Municipal General Sion Hospital, doctors are now facing the ethical dilemma of saving only one of them. The rare twins have two heads but share a heart.While the mother – 26-year-old Mumtaz Bano (name changed) – recuperates in the hospital’s gynaecology ward, paediatric surgeons at the hospital are busy assessing the twins’ diagnostic reports to come to a decision. “2D echo, MRI and CT scan of the heart have been done. We also did MRI fibre tractography, which will give a clear picture of the spinal tracks arriving from the brain,” said Dr Paras Kothari, head of the paediatric surgery department.Dr Kothari and his team are currently scanning medical literature and calling experts to draw opinions while waiting for all the diagnostic test reports.”Medical literature shows that only two such conjoined twins with single heart have survived across the world. But only one of the babies can be saved. It will be a surgical challenge and an ethical dilemma,” said Paras.The babies are in a stable condition in the neonatal intensive care unit. Their father, a cobbler by profession, is yet to be briefed about their medical condition. “We first want to be sure with all the diagnostic tests before briefing them,” said Paras.A doctor from the paediatric surgery department, who didn’t wish to be named, said the hospital’s ethics committee has refused to give its opinion in the matter, stating that it didn’t come under their jurisdiction. “We will have to take a legal opinion in this case. Both babies are stable and have survived for four days. Letting them grow without a surgery will lead to social stigma for both the twins and their parents. Since both are stable, we can’t take the decision of saving only one of them. A legal opinion is a must,” said the doctor.
Another doctor from the department where the 2D echo test was done said the twins have one-and-a-half hearts. “One heart is normal. The other is not developed and has two chambers instead of four,” said the doctor.The babies were born by caesarean section at the hospital at 9.25am on Wednesday with the birth weight of 3.6kg. They share a heart but have two stomachs, two spinal cords, and a spinal column till the sacrum. The sacrum is not well developed. They have two lungs, two kidneys, three hands, two legs and a single pelvis between them. The condition is known as single-hearted thoraco paraphagus.”We have started feeding the babies via ryles tube. They are passing stool and urine normally but we cannot say who is passing the stool and urine, as they have common genitalia,” said Dr Kothari.Dean Dr Suleman Merchant said the hospital will provide all facilities to the twins free of cost.”These conjoined twins have a very complex internal architecture. Externally, they have two separate heads and necks, but a partially common thorax; and are completely fused below the umbilicus level. 3D rotational CT angiography, multiplanar re- constructions and other complex CT techniques have been utilised to diagnose the complex internal architecture of the babies. MRI fibre tracto-graphy will be utilised to establish the communication between the brains and other parts of the nervous system, including nerve supply to limbs. The twins will require many more investigations. After all investigations are complete, the next course of action will be decided upon,” said Dr Merchant.Amit Kharkanis, a lawyer who handles medico-legal cases, said, “First of all, there is no ethical dilemma in such cases as doctors have to decide which baby has a higher survival rate. After the medical investigations, they have to take the parents’ consent.”Twin taleConjoined twins is a rare sporadic event, with a prevalence of 1 in 200,000-5,00,000 births. The mortality rate remains quite high.There are nearly a dozen different types of conjoined twins. The twins born at the Sion hospital are called cervico paraphagus.Female conjoined twins are three times more likely to be born alive than male conjoined twins.
Most conjoined twins are separated weeks or months after they are born, to give them a chance to grow and become strong enough to survive surgery and to let doctors study their anatomy.Conjoined twins are genetically identical and are therefore always the same sex. They share the same amniotic cavity and placenta and develop from the same fertilised egg.BJ Wadia hospital currently houses a pair of former conjoined twins, born to a couple from Panvel on May 6, 2013. The girls were attached by their hip at a 90 degree angle, because of which it was impossible for them to walk. They were separated on January 17, 2014, and have since been recuperating in a special room at the hospital’s paediatric ward.