It was a race against time in Delhi on November 12 as doctors prepared for a heart transplant on a 54-year-old patient at HCMCT Manipal Hospitals, Dwarka.
“She was a case of heart failure and had needed repeated admissions. Luckily, we got a call that a heart was available at a private hospital in Gurugram,” said Dr Yugal Kishore Mishra, chairman of the Manipal Institute of Cardiac Sciences and chief cardiovascular surgeon at the Dwarka, Delhi.
The patient had whole-body edema (swelling), severe fatigue, and breathlessness, which made it difficult for her to walk or even lie down comfortably. “She was on intra-aortic balloon pump (IABP) support, which helps in pumping of the heart for 10 days. And even after undergoing cardiac resynchronisation therapy (CRT-D), an advanced type of pacemaker, her condition continued to worsen, making heart transplant the only option,” the hospital said in a release.
“In this case, the heart of a brain-dead 64-year-old man was transplanted into the 54-year-old woman, and the ischemic time was three hours and 20 minutes,” said Dr Mishra.
What is Ischemic time?
Ischemic time is the period during which an organ remains without a blood supply. In a heart transplant, this is the interval between the heart being removed from the donor’s body and blood flow being restored in the recipient. While an ischemic time of up to four hours is considered ideal, crossing the five-hour mark can be detrimental, the doctor explained.
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In a conversation with The WEEK, Dr Mishra discusses the case, outlines the eligibility criteria for heart transplantation, and explains why an increasing number of young people are developing heart disease.
Q: Could you talk about this case a bit?
A: Firstly, with most other organs, like the liver or kidneys, you can have a live donor. But for a heart transplant, the donor has to be brain-dead. So once the heart is retrieved, it needs to reach the recipient’s hospital as quickly as possible.
In our case, the donor heart was at a hospital about 30 km away. The Gurugram Police were kind enough to create a Green Corridor, so we were able to get it at the earliest.
The ischemic time was only 3 hours and 20 minutes. Now, in the West, people have started using organ care systems, where the heart is put into an organ care system, and there is continuous circulation into the heart. But that is extremely expensive.
In this case, we were also lucky that we had a very good outcome, because for implants, there can be problems such as rejection or infections. And although it’s too early to say, there hasn’t been an early rejection or infections. The recovery was quite smooth. We were able to discharge the patient in 15-16 days after surgery.
Q: What are the key eligibility criteria for a heart transplant?
A: It’s any individual who has heart failure. Initially, it’s treated with a medication. If medicines don’t help, the next step is usually devices like a pacemaker. However, if there’s a persistent heart failure, they would need a heart transplant.
Q: Similarly, what are the eligibility criteria for a donor?
A: For donation, a brain-dead patient has to be certified twice by a brain death committee. The family’s consent is absolutely crucial, and there are other criteria as well.
Ideally, the donor should be under 55 years of age. However, because of the severe shortage of donor hearts, we sometimes go beyond that limit. In this case, for instance, the donor was 64, but we accepted the heart because there were no other suitable donors available.
Also, the heart should be healthy, and there shouldn’t be infections. Some centres also perform an angiography to ensure there are no blockages in the arteries.
Q: We’re seeing a lot of cases of heart disease among youngsters. Why is that?
A: In many such cases, people may already have an underlying heart condition but are simply unaware of it—whether it’s coronary artery disease, heart arrhythmia, or something else. Some also exercise intensely without paying enough attention to hydration.
In certain situations, the person may have a mild heart condition, and excessive or unmonitored exercise can actually do more harm than good.