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It was Pune that set the wheels of the state’s heart transplant programme in motion last year when the family of a 42-year-old woman from the city donated her heart to a young Mumbai-based graphic designer. This successful heart transplant in Maharashtra, a first, paved the way for over 25 heart transplants in a little more than a year.
Ever since that first donation, Pune has harvested six more cadaver hearts which had to be donated to hospitals in Mumbai and Delhi, simply because the lone heart transplant centre in the city, despite being well-equipped with skilled doctors, cannot perform heart transplant surgery as it has yet to get the needed permissions from the state government.
“Be it infrastructure, expertise or skilled workforce, we have everything in place to start a heart transplant programme in Pune. We have waited for the state government’s permission for more than a year now but (have) yet to get it though we have made all the requisite compliances,” Bomi Bhote, CEO of Ruby Hall Clinic, told TOI.
Ruby Hall Clinic had applied for the licence to carry out heart transplants on July 4, 2015.
Pune is a metropolitan city and has almost eight major multi-specialty hospitals where cadaver organs become available. More than 100 organs were harvested from 40 cadavers, including six hearts, so far this year. Hence, the city has a lot of potential for a dedicated heart transplant centre.
“Even though Mumbai has four hospitals where heart transplant is currently carried out, there is an increasing demand for heart transplants in Pune. We have already identified 11-12 patients who need transplants in the city, and I am sure there are many more. AFMC is a registered heart transplant centre since last year but to the best of our knowledge, not a single heart transplant has been reported till date,” said transplant coordinator Surekha Joshi.
Any effective transplant depends on the ischaemic period of the harvested organ, and standard and expected time varies from organ to organ. In the case of the heart, it is between just four and six hours. Ischaemic period is the time during which the blood supply to an organ is less than what is needed.
For the purpose of transplantation following the surgical recovery of organs, it is important to be aware of the warm and cold ischaemic times which have an impact on the long-term survivability and functioning of the organ in the eventual recipient.
“Hence, transporting the heart from Pune to Mumbai diminishes the ultimate outcome of the transplant surgery. So if the heart transplant is carried out in Pune, it will have a good outcome as the ischaemic time is reduced,” said heart transplant surgeon Anvay Mulay.
“The city has evolved considerably in organ transplants. Starting heart transplants will take this image a notch higher. It will not only make the transplant available within Pune but also bring down the cost comparatively,” said nephrologist Abhay Huparikar, secretary of the Zonal Transplant Coordination Centre, Pune.
Huparikar, along with a medical team, performed the first live and cadaver kidney transplant in Pune. Various government committees carried out inspections of Ruby Hall Clinic over the last year.
The inspection which was carried out by the civil surgeon in April 2016, submitted their report to Directorate of Health Services (DHS) through deputy director of state health services in Pune, stating that the facility was fit to conduct heart transplants.
“Recently again on August 26, state health department officials sent us a letter stating the need to re-inspect the facility with the reason that there was no cardiac surgeon in the earlier inspection committee. Now the inspection is scheduled forOctober 6. But we fail to understand why a cardiac surgeon was not included in the earlier inspection committee,” said Bhote.
When contacted, H H Chavan, deputy director of the state health department, Pune, said, “The licence will be granted to Ruby Hall Clinic after all processes and inspections are carried out.”
Gauri Rathod, assistant director at Directorate of Health Services (DHS), who looks after the department of Human Organ Transplant, could not be contacted despite repeated attempts.
Pune: It was Pune that set the state’s heart transplant programme in motion last year when family of a 42-year-old woman from the city gave her heart to a Mumbai-based young graphic designer. This first successful heart transplant in Maharashtra later led to over 25 heart transplants within little more than a year.
Ironically, ever since the first donation, city harvested another six cadaver hearts which had to be donated to hospitals in Mumbai and Delhi simply because the lone heart transplant centre in Pune, despite being well-equipped with skilled doctors, cannot perform the crucial heart transplant surgery as it is yet to get the mandatory permissions from the state government.
“Be it infrastructure, expertise or skilled workforce, we have everything in place to start a heart transplant programme in Pune. We are waiting for the state government’s permission for more than a year now but yet to get it, although we have made all the requisite compliances,” Bomi Bhote, chief executive officer (CEO) of Ruby Hall Clinic told TOI. Ruby Hall Clinic applied for the licence to carry out heart transplant on July 4, 2015.
Pune is a metropolitan city and has 7-8 major multi-specialty hospitals where cadaver organs become available; more than 100 organs were harvested from 40 cadavers including six hearts so far this year. So it is obvious that Pune has a huge potential to have dedicated heart transplant centre.
“Even though Mumbai has four hospitals where heart transplant is currently carried out, there is an increasing demand and frequent queries from people for the facility of heart transplant in Pune. We have already identified 11-12 patients who need heart transplants in Pune. And I am sure there must be many more. AFMC is a registered heart transplant centre since last one year but to the best of our knowledge not a single heart transplant has been reported till date,” said transplant coordinator Surekha Joshi.
Any effective transplant depends on the ischaemic period of the harvested organ, standard and expected time varies from organ to organ. In case of heart it is between 4-6 hours only as compared to other organs.
For the purposes of transplantation following the surgical recovery of organs, it is important to be aware of the warm and cold ischemic times. These times have an impact on the long-term survivability and function of the organ in the eventual recipient.
“Hence transporting heart from Pune to Mumbai eventually reduces the ultimate outcome of the transplant surgery. So in a given situation if heart transplanted is carried out in Pune it will have a good outcome by means of reducing ischaemic time,” said heart transplant surgeon Anvay Mulay.
“The city has evolved considerably in organ transplant over the period. Starting heart transplant will take this image a notch higher. It will not only make the transplant available within Pune but also bring down the cost comparatively,” said nephrologist Abhay Huparikar, secretary of the Zonal Transplant Coordination Centre, Pune. Huparikar along with a medical team did the first live and cadaver kidney transplant in Pune.
Various government committees’s carried out inspection of Ruby Hall Clinic hospital in last one year.
The inspection which was carried out by the civil surgeon in April 2016, submitted their report to Directorate of Health Services (DHS) through deputy director of state health services in Pune, stating that the facility was appropriate for conducting heart transplants.
“Recently again on August 26, the state health department officials sent us a letter stating the need to re-inspect the facility with the reason that there was no cardiac surgeon in the earlier inspection committee. Now the inspection is scheduled on October 6. But, we fail to understand why a cardiac surgeon was not included in the earlier inspection committee,” said Bhote.
When contacted H H Chavan, deputy director of the state health department, Pune said, “The licence will be granted to Ruby Hall Clinic after all processess and inspections are carried out.”
Gauri Rathod, assistant director at Directorate of Health Services (DHS) who looks after the department of Human Organ Transplant could not be contacted despite repeated attempts.
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Why Pune needs a heart transplant centre?
Doctors say, every year 150 to 200 patients with end-stage cardiac diseases in Pune require heart transplants
They have no other option but to head to Hyderabad, Bangalore, Chennai and Mumbai for heart transplant.
Only four hospitals in Maharashtra, all from Mumbai, have the licence to perform the procedure
Pune has an extensive pool of medical experts, best operation theatres and many hospitals with the national accreditation board – National Accreditation Board for Hospitals and Healthcare Providers (NABH) tag.
Besides, the state government has now simplified the processes and defined rules for declaring brain dead persons, hence medico-legal issues are no more a hurdle
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Process of applying for the licence to start heart transplant centre
Initially hospital has to apply to the Directorate of Health Services department as per Human Organ Transplant Act 1994 in the prescribed format (Form No. 11)
Form number 11 includes information regarding last three years relevant statistics, details of the expertise required for the heart transplant along with the medical council registration details
On receipt and evaluation of the above form, the Directorate Health Services formulates one inspection committee under the civil surgeon
The inspection committee conducts the facility inspection at a mutually convenient day and time and submits the report to the Directorate of Health Services through deputy director health services, Pune
The authorisation is at the discretion of the Directorate of Health Services, based on the inspection committee’s report
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The heart transplant team
A massive team too needs to be in place for a successful heart transplant programme
The hospital needs to have a team of medical professionals consisting of heart transplant surgeon, cardiologists, anaesthesiologists, critical care specialists, physicians, physiotherapists, paramedical staff and social workers
Besides, having a state of the art operation theatre, the hospital also needs to have intensive care unit with isolation facility and requisite medical equipment and devices
The staff should be trained on the clinical care protocols and also be trained on the key aspects of transplant surgery, immediate post-operative period, infection control aspects and nutritional aspects