Heart Transplantation and Deceased Organ Donation - Gujarat's Story - Dr Dhiren Shah, Director, Heart & Lung Transplant Program Marengo CIMS hospital

Ahmedabad: India's thoracic organ transplant program has evolved over the years and is currently the number one program in the South Asian region. Global coverage of heart transplant is 1.06 PMP (2016-18). About 8,000 to 9,000 heart transplants are performed worldwide each year, and about 50 percent are performed in the United States. South and South-East Asia perform less than 5% of global heart transplants, and India performs more than 90% of these surgeries. The same is true of lung transplantation. More than 7,000 lung transplants are performed globally, of which more than 40 percent are performed in the USA alone.

Dr Dhiren Shah, Director, Heart & Lung Transplant Program Marengo CIMS hospital, “India's progress with heart and lung transplantation in the last decade reflects the growth of the deceased organ donation program in the country. Currently, there are very few cardiac units in the country who have invested significant time and resources in this program. The growth and momentum has been made possible by the local champions who have done this tireless work. Although the growth has been largely confined to private sector hospitals, the progress has been truly remarkable despite all the logistical and financial challenges.”

Heart transplantation has been an excellent treatment modality for advanced heart failure in the modern world for the past 40 to 50 years. Ten years later the number of heart transplants performed worldwide has increased by more than 300% and in the US by more than 400%. The number of heart transplants increased rapidly after the 1980s in Western countries, particularly in North America, reaching about 3000 to 4000 heart transplants annually. Heart transplants have reached high levels due to the increase in the number of organ donations.

The first successful heart transplant in India was performed in 1994 at the All India Institute of Medical Sciences in Delhi. However, it was not until 2010 that the number of heart transplants increased. In fact, in January 2020, India achieved the milestone of 1000 heart transplants. Almost 25 years after the Human Organ Transplant Act passed by the Government of India. It is quite clear that the number of cadaveric organ donations in India is very low compared to the number of organs required for transplantation. It was only after 2010 that organ donation gradually increased especially in South India and at the same time heart transplants started in the southern states. However, the number of heart transplants in western India is negligible. Nevertheless, in some cities, especially cities like Surat, Bhavnagar and Rajkot in Gujarat, the number of organ donations was continuously increasing.

In 2016, Marengo CIMS Hospital, Ahmedabad got a heart transplantation license and Gujarat's first heart transplantation was performed on 19 December 2016. Due to heart transplantation, which is undoubtedly the most famous and prestigious transplant procedure, awareness about organ donation has increased exponentially to every comer of the state.

Between 2017 and 2019, there has been a nearly 20% increase in deceased organ donation in Gujarat. Marengo CIMS Hospital was still the only heart transplant hospital in Gujarat and following the turnaround the numbers were steadily increasing. When Covid-19 hit in 2020, the spirit of organ donation was still high. Even amid the lockdown, Gujarat conducted India's first cadaver organ donation during the Covid pandemic where hearts, livers and kidneys were procured. Deceased organ donation in Gujarat doubled from 36 organ donors in 2020 to 70 in 2021 and increased from 110 to 223 in 2020 and 2021 respectively.

The Gujarat model adopts a multi-pronged approach to the deceased organ donation programme, which includes:

• Government initiatives, policies

• Dedicated and committed support from the medical community

• Unremitting work and persistence from NGOs

• Media collaboration to spread awareness about organ donation

• Government hospitals and medical colleges take initiatives to increase organ donation

If these measures are taken into consideration, it will not take long to reach the number of organ donations of 10 per million populations. Which is currently 1 per million populations in India. With the increase in organ donation, there is a need to have a fair and transparent organ sharing policy and this will be possible through organizations like the National Organ and Tissue Transplant Organization (NOTTO).

The support of reputed organizations like Institute of Kidney Disease and Research Center (IKDRC) and non-governmental organizations (NGOs) has helped in reaching these heights. It so happened that in recent years Surat became the city with the highest number of organ donors in the country, but surprisingly, the city did not have a single heart transplant centre. The number of heart transplants may be a key indicator of the status of deceased organ donation in a particular state or country. The number of heart transplants seen in Tamil Nadu, Kerala and Andhra Pradesh in early 2010 and later in Gujarat and Maharashtra clearly shows that it can act as a catalyst to increase cadaveric organ donation in the country.

Ahmedabad's Civil Hospital, one of the largest hospitals in Asia, hardly had any organ donation until 2020. Although 30 to 40 patients are on ventilators in the neurosurgical ICU at any given time, a large number of brain-dead potential organ donors cannot be found. In 2020-21, the state government launched an organ donation campaign at the civil hospital with the support of non-governmental organizations, which resulted in a significant increase in the hospital's cadaveric organ donation. Civil Hospital, Ahmedabad has donated 100 of its deceased organs in a period of two years including 77 livers, 152 kidneys, 23 hearts and 18 lungs.

Despite a severe second wave of Covid-19, Marengo CIMS Hospital, Ahmedabad performed 14 heart transplants in 2021, of which 9 were performed in the last two months of the year. In fact, three heart transplants were performed in a span of 6 days in December 2021. The dream run of organ donation in Gujarat continued in 2022, reaching the magical figure of 100 deceased organ donations in a span of eight months and declaring Gujarat as one of the states with the highest number of deceased organ donations in the country.