Miracle operation Sri Lankan doctors perform heart transplant
By Methmalie Dissanayake and Rishini Jayarathna
The future of medicine hit a turning point in December 1967, when a South African doctor, Prof. Chris Barnard, performed the world's first ever heart transplant. A 25-year-old woman, Denise Darvall, was dying due to the fatal injuries caused in a car accident. Dr. Barnard using a technique developed by a group of American researchers in the 1950s, transplanted her heart in 53-year-old Lewis Washkansky on 3 December. Washkansky was also a South African and he was suffering and dying from a chronic heart disease.
Unfortunately, the 53-year-old man died after 11 days of the transplant due to double pneumonia. He was given drugs to prevent the rejection of the given heart and to improve his immune system. Even though the patient died, the transplanted heart had functioned normally until his death.
After Washkansky's transplant, Prof. Barnard continued to perform heart transplant operations, and by the late 1970s many of his patients were living up to five years with their new hearts. (Source: History.com)
After 50 years
When Prof. Barnard's heart transplant marks its 50th anniversary, a group of Sri Lankan doctors performed a miraculous surgery to transplant a heart in a 37-year-old woman at the Kandy General Hospital.
A young man was admitted to the hospital after a fatal motorcycle accident and the doctors noticed his brain was dying. Therefore, after a few days, they made a request from his parents whether they could give their permission to donate his organs.
The parents, despite being in the middle of an agony which will remain etched in their memories forever, understood the importance of the doctor's request. They agreed to donate the youth's normally functioning organs. It should be noted that they even refused the compensation of Rs 600,000 which was to be given by the hospital authorities.
So, the youth's heart was transplanted in a woman who was transferred from Anuradhapura. After the seven-hour operation she still receives treatment at the Incentive Care Unit (ICU) in the hospital.
Because of his kidneys, two more people today see the world with a hope of a steady future.
The Transplant Surgical Team included Consultant Cardiothoracic Anaesthetist Dr. Jagathi Perera, Consultant Cardiac Surgeon Dr. Anil Abeywickrama, Cardiac Surgeons Dr. Muditha Lansakara and Dr. K. Gnanakanthan, Cardiologist Dr. Sunethra Irugalbandara and Transplant Surgeon Dr. P.K. Harischandra.
Story behind the curtain
"That was a collective effort which took a number of discussion rounds. We wanted every step to be well planned and perfect.
Therefore, we discussed everything regarding the operation among our group of surgeons both before and after the operation. Our main concern was to take the minimum time to transfer hearts. Normally, for such kind of an operation, it will take four hours. But it took only one hour and 55 minutes to do the transplant and establish the blood supply in the transplanted heart."
Dr. Muditha Lansakara, one of the three Cardiothoracic Surgeons who led the heart transplant told Ceylon Today during our visit to the Kandy General Hospital.
Explaining the way in which the operation took place, Dr. Lansakara said, "While Dr. Anil Abeywickrema was harvesting the heart of the young boy in a separate partisan in the same room where the surgery took place, we took measures to keep the other patient's body temperature in a steady low level to prevent blood leakages. After finishing the harvesting, one of our assistant surgeons gave the heart to us within 10 – 15 seconds. Then we took another two to three minutes to check the patient's condition. After that we placed the heart in her and began to do stitches."
They had taken measures to compare the weights of the two hearts prior to the surgery and the young boy's heart showed a match to the patient's heart, Dr. Lansakara pointed out. However, there were some minor differences between the two hearts. Therefore, the doctors took steps to adjust them during the stitching process. Moreover, they considered technological facts as such and took immediate steps for adjustments, he added.
When asked about the possible blood leakage during an operation, Dr. Lansakara said the surgeons cannot consider a leakage just after an operation. Blood is not a steady fluid. For example, the patient's heart beats 90 times per minute at the moment. With every beat the blood flows in her body. So there can be some minor leakages after the operation, he explained.
"However, our intention was to keep such leakages and other complications to a minimum level. That is why we kept monitoring her every second," Dr. Lansakara said.
"Now the patient breathes without any machinery assistance. It is a wonderful achievement for us because even after a normal operation we keep patients under the machinery aid for two to three days. She even can recognize her family and communicate with them for a few seconds."
Risk of infection
"Even though the operation was successful there is still a risk of infections. That is why the doctors who perform the surgery do not go near her. There is a main doctor with a special team. Only they go near her and monitor her condition to avoid that risk."
Ceylon Today then spoke to Dr. Jagathi Perera, the Chief Cardiothoracic Anaesthetist in the team. It was Dr. Perera with her junior staff who had taken care of the patient throughout. Dr. Priyantha Dissanayake and Dr. Aruni Jayasekara assisted her during the surgery while Cardiologist Dr. Sunethra Irugalbandara had been in charge of organ care.
Their biggest challenge was to anesthetize a patient with a poor cardiac function. Handing over the heart to a machine during the operation is a risky task. Supervision after the transplantation to keep the blood pressure at normal level too has been a serious task, she said. While a surgeon operates, anesthetists take care about the life and other essential services, she said.
Dr. Perera also mentioned about the people's lack of knowledge about brain deaths.
"Brain dead patients cannot recover, and it is medically guaranteed that they do not live more than a week. Therefore donating the heart to a person who needs it is a good cause. The donation should be done either with the consent of the family or the donor's will given prior to the brain death. The problem is that people are unaware of it," she said.
Three Cardiothoracic Surgeons, Dr. K. Gnanakanathan, Dr. Lansakara and Dr. Anil Abeywickrama took part in the heart transplantation surgery. It could only be done to a brain dead patient.
Dr. K. Gnanakanthan, Consultant Cardiothoracic, said even though kidney transplantation started in 1981/82, it is not as critical and risky as a heart transplantation. That is because only one of the two organs is transplanted, he said.
"With the success of the operation we hope to do more of lung and heart transplantations in Sri Lanka. We have plans to do lung transplantations especially at the Welisara Chest Hospital," he stated.
Elaborating their future plans he said, "Initially there were some legal issues that needed to be solved before the surgery. According to the Medical Ordinance, a heart can only be taken out of a braindead person for transplantation. The patient has life although his/her brain is dead. However, in this case we could get the heart with the patient's parental consent.
"Usually for heart transplantations the relations' consent is taken, but in the future we will try to get the heart donor's consent as well. Time is usually a challenge in heart transplantations as the heart needs to be transplanted and given blood supply within four hours. The heart transplantation was done in the same theatre complex in two rooms. Therefore the time factor was not much of a challenge. Dr. Anil Abeywickrema harvested the heart, and it was taken to the other room within seconds. It was planted by me with Dr. Lansakara's assistance. Within one hour and 55 minutes the transplantation was completed," he added.
"Heart transplantation is the most complicated surgery. It really is a victory to have succeeded in a heart transplantation in Sri Lanka. It specially gives a good image of the country. Sri Lankan citizens cannot have this type of surgery from any other country as the patient's citizenship matters in receiving an organ. Heart transplantation is the only surgery recommended when a heart failure happens. All the patients who had had heart failures in Sri Lanka died within six months," Dr. Anil Abeywickrema, the Consultant Cardiac Surgeon who harvested the heart pointed out.
"I worked at the Freeman Hospital in Newcastle, England. Receiving advice from the President of the International Society for Heart and Lung Transplant (ISHLT) in England, Andrew Fisher, and Dr. Steve Clark, I took the initiative to start a similar society called Sri Lankan Society for Heart and Lung Transplantation (SLSHLT) in September 2015. The society was initiated with the assistance of Dr. K. Gnanakanthan, Dr. Methsala, Dr. Kanchana, and Dr. Waruna Karunaratne."
"The first reason, I should say, of doing the surgery at the Kandy General Hospital is due to the availability of Sri Lanka's best Cardiothoracic Anesthetists, and the unavailability of certain facilities in Colombo. Cardiothoracic Anesthetists, Dr. Jagathi Perera, Dr. Aruni Jayasekara, and Dr. Priyantha Dissanayake have dedicated themselves to make the surgery a success. Doctors from the Kandy General Hospital, Anuradhapura General Hospital, Kurunegala General Hospital, Sirimavo Bandaranaike Hospital, Welisara Chest Hospital, and Lady Ridgeway Hospital facilitated the transplanting." Dr. Abeywickrema elaborated.
He further said the Kandy General Hospital will continue to do more of lung and heart transplantations together with other hospitals.
"Sometimes when I go abroad, I bring necessary equipment. That is how we started. But we now have an assurance that we will get all the necessary equipment and medicines in the near future," he added.
Minister of Health Dr. Rajitha Senaratne who visited the hospital to meet the doctors who performed the surgery on 13 July assured that the hospital will get every facility to establish a heart and lungs transplant unit.
Senaratne further said the government hopes to enter details of citizens whether they like to donate organs to the proposed e-driving licence.
Hopes of the citizenry
Outside the ICU, the patient's family members were waiting impatiently.
"About seven months ago my wife's health condition began to get weaker day by day. Doctors who checked her informed us that it was due to cardiomyopathy. We did not have an idea about what it was. But she had to be admitted to the Anuradhapura General Hospital at least four times a month," the patient's husband told Ceylon Today.
"We were gradually losing all our hopes but then the Anuradhapura Hospital authorities told us that an operation could be done and there was a matching heart found in Kandy. So we agreed."
The patient's mother was also outside the ICU. With tear-filled eyes she said her daughter could recognize them when they visited her.
"She cannot talk more than a word or two. But she can recognize us and she even waved her hand and smiled with us. She has a 13-year-old daughter. Now my granddaughter will grow up under the guidance of her mother. I do not have enough words to say how happy I am," she said with a smile.
The family expressed their sincere gratitude to the parents of the young boy who gave permission for the heart donation.
"They are like gods, the family of that son and the doctors. We wish they will be able to do more surgeries like this so that poor people like us can get another chance to live."
Pix by Sajeewa Chinthaka
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