The Heart Transplant Program in India .. the direction & future

Dr. Sandeep Seth, Sr. Consultant Heart Transplant, AIIMS

Dr Christiaan Barnard conducted the first   human heart transplant in 1967 in South Africa with Louis Washkansky becoming the first recipient. Denise Darvall, a 25-year-old woman who was   injured in a car accident was the heart donor. In total the operation lasted for four and three quarter hours.  The world’s first heart transplant made headlines. It also encouraged surgeons all over the world to start heart transplant programs. Unfortunately transplant biology was in its infancy and not fully understood. A majority of the initial patients transplanted including the first few patients transplanted by Bernard died soon and the heart transplant program fell into disrepute.  Only a few surgeons persisted with the program including Norman Shumway who had actually trained Chris Bernard in the technique of heart transplant.

Norman Edward Shumway who worked at Stanford University was the first to carry out heart transplant successfully in United States in 1968. Shumway was the only surgeon in America who continued the transplant process when the rest had restrained themselves because of short survival rates. In 1970s, he pioneered the use of cyclosporine.  Developments which helped transplant results improve included Philip Caves developing transvenous endomyocardial biopsy technique (1973)  and Margaret Billingham developing a system of  diagnosing cardiac rejection. In 1978, cyclosporine was first tested in humans and year 1983 brought its approval by FDA. The major compromise for the health of the transplanted patients was opportunistic infection- fungal, cytomegalovirus  and pneumocystis carinii. The understanding and prevention of these infections also improved survival. Currently the median survival after a heart transplant is 10 years.

In India, Dr Profulla Kumar Sen became the first surgeon in India to do heart transplant in Kem hospital in Mumbai. Dr Sen performed the world’s 6th heart transplant (and the 1st in India)  . Unfortunately the right heart ballooned within 15 minutes of coming off bypass and the patient died within 3 hours.   There were no further attempts for a long time due to the absence of a law for Brain Death.  The next era of Heart Transplant in India started with the Law on Brain Death following which on August 3 1994,  the first successful heart transplant in India was done at AIIMS by Dr P Venogopal and his team. Devi Ram was the recipient and he survived for a long span of 17 years. From 1994 onwards till now, the number of transplants in India have been low.  In 1995 Dr KM Cherian did a heart transplant in Chennai.  But over the  next few years the number of transplants have been low  and very few centers have been picking up this technique. Slightly over 100 transplants have been done in India so far. In the recent past , more centers have been picking up the technique with heart transplant being now done in Andhra Pradesh ( Hyderabad), Tamil Nadu ( Chennai being a major center with as many as 10 authorized hospitals), Kerala  . In north India, in Delhi, besides AIIMS, Sir Ganga Ram Hospital and Army R and R hospital have  also done heart transplants. The latest hospital to have done a heart transplant is Post Graduate Institute of Medical Sciences Chandigarh . Therefore the technique is now gradually spreading to more centers  across India.  

 From the first transplant in 1968 by Dr PK Sen to the first successful transplant by Dr P Venugopal in 1994 to date, we have had a little over a hundred heart transplants. At this stage, in some of the southern states of India there have been reports of organ donations being done where the heart got wasted because there were no recipients. In north India, the recipient die waiting for a donor. All over the country, we have cardiac surgeons , cardiologist and all the rest of the infra structure needed to start a successful heart transplant program. What are the road blocks ?
Organ donation needs to be promoted more. Some regions of the country are more successful in organ donation. They can give lessons to the rest of the country. Post transplant immunosuppression is expensive and also not commercially viable for private hospitals, therefore philanthropic organizations and the government would need to provide support in a big way to give the heart transplant program a push. Infections are also a bigger problem in India but these can be tackled by suitable precautions and motivating the patients to take extra care and isolating the patients during the phases of more intense immune suppression.

In conclusion, the time has come to increase the volume of heart transplantation in India. We have in this article tried to trace the history of heart transplant not only in the world but also in India which includes such legends like PK Sen , P Venugopal and KM Cherian who have shown us the way. We have also listed some of the requirements to set up the transplant program which can provide the initial framework to get started. There are a number of centers in India already authorized for heart transplant and we hope the number of heart transplants will grow in the future.