31 Oct - 6 Nov 2014 #730

“Great sense of satisfaction”

Interview by SBS Nepali, Australia with Kumud Dhital who carried out the world’s first transplant of a dead heart, 25 October

SBS Nepali: How important to medical science were your transplants?

Kumud Dhital: It is quite important because DCD (Donation after Circulatory Death) transplants had not been attempted before. It involves taking the heart and other organs out immediately after the heart stops beating, putting it into a machine to provide it with the necessary nutrients, and the heart starts beating again. We monitor how well the heart is working, and only if it is working well do we prepare a recipient and transplant it. We have now done this three times. In that respect, taking the heart that had stopped beating, transporting it to another hospital in a machine and transplanting on a patient had never been tried before.

How quickly do you have to perform the transplant?

Within 30 minutes of the heart beat stopping, we should already have preserved the heart in the nutrient fluid, otherwise that heart won’t work. Only then do we put it in the machine for transportation. DCDs had been tried in transplantation of kidneys and lungs, but we are the first ones to have tried it on hearts.

Is this going to make it easier to address the problem of donor shortage, or are there complications that we have to be aware of?

Our first patient got the transplant three months ago, the second got a heart two weeks ago and are being discharged from hospital, and the third only a few days ago.  So far they are doing well.  And we think the outcome will be the same as with transplants from brain dead donors. As you say, this technique will make it possible to increase the number of potential donors from the DCD pool at a time when there is a real shortage of donors. For those wait-listed for transplants, this is going to make a big difference. Some patients die waiting for a heart.

Asians are said to have a higher incidence of cardio-vascular diseases, will it help them?

In Sydney, we do about 30 transplants a year and about 100 all over Australia. In countries like China and India there is a big problem of heart failure, yet the transplant program is very small. Also, due to cultural reasons, they find it difficult to source hearts from donors in ventilators. So the DCD path could be easier for them, and this could increase the number of transplants in those countries as well.

Are there any religious sensitivities about taking the heart of a dead person and putting into another person?

Yes, such questions are bound to be raised. We don’t meet the donor’s family, we have no interaction with them. Only once the patient is declared dead does the patient come to our operating room. Brain dead patients, in many countries including Australia, are considered to be legally dead but are kept on a ventilator to keep the organs alive. This allows us to carry out organ retrieval in a controlled fashion. In DCD transplants, however, it is slightly more risky. But we have been able to carry it out successfully in these three patients.

How does it feel to be the first in the world to successfully carry them out?

My team and I are really happy that the operations went well. You get a great sense of satisfaction that a patient who was bed-ridden is now climbing stairs.

Audio of interview

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