New Delhi: Before 1994, the only way to get a heart transplant for Indians was to go abroad—a luxury most patients suffering end-stage heart disease could not afford.

After the Transplantation of Human Organs Bill finally received the President’s assent on 7 July 1994, a group of surgeons led by P. Venugopal successfully performed India’s first heart transplant at the All India Institute of Medical Sciences (AIIMS) on 3 August the same year.

It was a landmark legislation to regulate the removal, storage and transplant of human organs.

In the lead-up to the law, Venugopal and his team in the department of cardiothoracic and vascular surgery at AIIMS had been modifying the heart transplant surgery techniques by experimenting on animals.

“We were waiting for the bill to be passed for a long time as they were a lot of patients in the hospital who were suffering from end-stage heart disease and could not be treated through any existing medicines or procedures," said Venugopal, who was then the chief of the cardiothoracic centre in AIIMS.

Devi Ram, a 40-year-old heavy industry worker suffering from cardiomyopathy, had been admitted in AIIMS for three months. The patient belonged to the AB+ blood group, a universal recipient blood group.

“A 35-year-old lady who had suffered brain haemorrhage was brought into the hospital and her family agreed for the heart transplant. Devi Ram saw this as the only way and agreed too. All the conditions were suitable and compatible and so it was decided that the procedure will be carried out," Venugopal recollects.

On 3 August, 1994, in a 59-minute procedure, a team of 20 surgeons led by Venugopal conducted the successful heart transplant surgery. Devi Ram lived on for 15 more years until he died of unrelated brain haemorrhage.

“It was important that surgeons in our country be ready with technical knowledge to carry out this procedure. Those days patients had to go abroad for heart transplant and since hearts were in short supply in those countries too, often these patients would be disappointed," said Venugopal. “This surgery put India on the world transplant map and opened this facility and possibility for India," he added.

The full notification and law was circulated by the government in 1995 after which other centres in India performed heart transplants successfully.

Organ transplant surgeries, 22 years later

While there were challenges in performing such surgeries earlier, heart transplant surgeries have seen several advances in the past 22 years.

According to experts, the discovery of effective immunosuppressive drug therapy and the methods for managing acute rejection of the foreign organ by the recipient’s body, are key breakthroughs in medicine that have facilitated higher rates of success in organ transplant surgeries.

“Technological bottlenecks existed in terms of lack of artificial heart pumps and immunosuppressive drug therapy," said K.R. Balakrishnan, director-cardiac sciences and chief cardiothoracic & transplant surgeon at Fortis Malar Hospital, Chennai.

The first heart transplant surgery performed by him in India was in 1995. Till date, he has performed 125 heart transplants. More recently, Ventricular Assist Devices (VADs) have been used to buy more time for patients who need heart transplants while they wait for a donor;s heart.

VADs are implantable mechanical heart pumps and also increasingly being used as a substitute for transplantation. Experts at an organ donation campaign organized by Fortis Healthcare last week said coordinated efforts by doctors, traffic personnel, public and the government have in the past proved to be significantly helpful.

For example, green corridors are red-light free road access to transport donated organ to the suffering patient.

The discussion at the event unveiled the challenges faced for heart transplant surgeries. The most prominent of them concerns organ donation. Lack of awareness among the relatives of the brain dead continues to be one of the primary reasons for lack of donors.

The concept of brain dead still remains unacceptable among a majority. Unavailability of organ support systems which increase the life of the heart (which is maximum four hours) after its removal from the donor’s body add to the constraints holding back the number of heart transplants in India.

A heart transplant in India costs around 15-20 lakh with 15,000 as the follow up expenditure.

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