Liver Transplant Success in Rajasthan: What It Takes

Yes, transplant (read kidney and liver) is a predominately living donor industry in India (and an extremely successful one at that), but there is room for deceased donor transplant to grow here alongside the impressively world class living donor transplant activity.
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I left Jaipur in early March 2015 thinking that I would never return. Although we made history with the first two deceased donor multi organ recoveries--first at Mahatma Gandhi Hospital (MGH) then at Sawai Man Singh (SMS) Government Hospital--along with the first deceased donor kidney transplants and sharing of livers via Green Corridors to Delhi through the transparent online allocation system run by the Rajasthan Network for Organ Sharing (RNOS), I was frustrated with the lack of progress regarding establishment of a quality liver transplant unit.

As I have written before, a liver transplant unit requires a multidisciplinary effort in the truest sense. It's not just the surgeon's technical capabilities. The Anesthesiologists, OT/ICU/Ward Nurses and Techs, Intensivists, Organ Donation Coordinators, Hepatologists, Radiologists, Psychiatrists, Social Workers, Infectious Disease Experts, Pathologists, Immunologists, Blood Bank Doctors, Pharmacists, Nutritionists and--I would say--Sweeper Boys all need to come together for the common cause of saving and improving the lives of these desperately ill people. No small task, but achievable even in the Indian Government Health Care sector. I still believe this, but at the time I was throwing in the towel on this particular project.

So I went back to my beloved adopted Indian city of Chennai to learn how to calm down in this wonderfully strange and often difficult land.

Dr. ML Swarankar, famous Indian In Vitro Fertilization expert and Founder of Mahatma Gandhi University of Medical Sciences and Technology (including MGH), came down South to meet me after a few months. He wanted me to come to MGH to build a liver transplant unit there. MGH is a private trust hospital, economically in between a Government Hospital and a Corporate Hospital. Government Hospitals offer free care to BPL (Below Poverty Line) Indian citizens, but the overall quality of care pales in comparison to that provided by the Corporates. Unfortunately, the Corporate Hospitals are almost purely profit driven, so although the quality of health care is equivalent to that found all over the world, these hospitals are prohibitively expensive for the average Indian. MGH seemed to me to represent the perfect marriage of private health care efficiency and dedication to serving the needy. It was a good place to give deceased donor liver transplant a go in Rajasthan, especially given the vision and support of the State Government (Chief Minister Vasundhara Raje and Health Minister Rajendra Rathore) and Dr. Swarankar of MGH Management.

It took only six months to start the program. Within that time, we had built and trained our multidisciplinary team (thanks in large part to Dr. Mohamed Rela of Global Chennai, Dr. Philip Thomas of Lakeshore Hospital in Kochin and Dr. Subash Gupta of Apollo Delhi), constructed a state of the art liver transplant ICU, purchased all necessary equipment and instruments, listed a number of transplant candidates on RNOS and performed the first two liver transplants ever in the State of Rajasthan. I performed the liver recoveries with Drs. TC Sadasukhi and Manoj Maloo, and Dr. Giriraj Bora, Head of Department of Liver Transplant at MGH, performed the transplants. Both recipients received deceased donor whole organ grafts from brain dead declared, family consented donors and they both enjoyed remarkably smooth postoperative courses.

So I've been back here in Jaipur (in between regular jaunts to my home base in Chennai) thoroughly marveling at what everyone here has been able to achieve. There's more to come, not only here but everywhere in India. Yes, transplant (read kidney and liver) is a predominately living donor industry in India (and an extremely successful one at that), but there is room for deceased donor transplant to grow here alongside the impressively world class living donor transplant activity.

We just want to save even more lives through transplant. In addition, it is paramount that India finds viable and sustainable funding mechanisms to make transplant accessible to all Indian citizens regardless of socioeconomic status, religion or caste. At MGH, we were able to build Rajasthan's first Liver Transplant Unit at approximately 1/10th of what it would have cost in the U.S. We are also able to offer liver transplant at less than 1/10th of typical U.S. costs. This type of sophisticated medical care is possible even in the Government sector, but it will take serious investments--both capital and personnel--to make it work. Transplant, I believe, is a metaphor for India's capability as a nation. If you can do a good liver transplant, you can do anything.

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