Three city hospitals now game for pancreas, intestine transplantation

After gaining a fair bit of expertise in the transplant of heart, liver and kidneys, three city hospitals are now looking forward to transplanting other organs like pancreas and intestines. While one of the hospitals have already got the permission from the state health department, two others are expecting the final nod soon.

Global Hospital, Parel; Fortis Hospital, Mulund; and Kokilaben Dhirubhai Ambani Hospital (KDAH) are the hospitals that have come forward to start pancreas and intestine transplants. While Global Hospital received the licence – mandatory for conducting organ transplants – last month, others are waiting for the inspections from the health department.

Dr S Narayani, Zonal Director, Fortis Hospital said Mumbai has seen a jump in cadaver donation programme and that this is the right time to start with pancreas, intestine transplants in the city. "There is high level of awareness on organ donation now. We have trained doctors for pancreas and intestine transplant and this is the right time to begin with them so that more patients get benefited," said Dr Narayani.

Sources from the health department confirmed to dna that they have already received applications from two hospitals. Expert committee members will be visiting these hospitals soon to check the infrastructure and to find out whether they have the expertise to perform such complex procedures, said a senior official.

Dr Ravi Mohanka, chief surgeon and head of the department, Liver transplant and Hepato-Biliary Surgery at Global Hospitals added that they have requested the Zonal Transplant Coordination Committee (ZTCC) to form a sub-committee for pancreas for a better transplant programme. "For a type-1 diabetes patient with kidney failure, a combined kidney and pancreas transplant is beneficial. Sub-committee will help prioritize such patients," said Dr Mohanka. Global Hospital has already started screening such patients.

It is estimated that India has 97,700 children with type-1 diabetes. In US, around 1,200 pancreas transplants are done in a year for a baseline population of 17.7 million diabetics. Most of these are type diabetics in the age range of 35-49.

"Some centres abroad are successfully conducting pancreas transplants for non-obese type-2 diabetics with low insulin levels. But here, we will begin with type-1 diabetes, those suffering from kidney failure," said Dr Vinay Kumaran, head of the department, Liver transplant and Hepato-Biliary Surgery at Kokilaben Dhirubhai Ambani Hospital (KDAH).

Dr Mohanka said the common cause behind intestinal failure in adults are short bowel syndrome, that results from extensive bowel removal due to blood clots in major veins or arteries of intestine, major abdominal trauma, or inflammatory bowel diseases like Crohn's disease.

"As an alternative to intestine transplant, these patients are dependent on total parenteral nutrition (TPN) for their daily nutrition needs. This intravenous nutrition procedure is expensive and requires a central venous catheter, which can lead to chronic/repeated infections," he said.

Agreeing to Dr Mohanka, Dr Kumaran said the intravenous nutrition solution carries the risk of venous thrombosis and liver toxicity and jaundice. "Intestine transplant is a boon for such patients," he said adding that every year around 3,000 people are added to those suffering from intestinal failure and in need of permanent TPN.

Ejaz Siddhique (28), a type-1 diabetes with kidney failure said the hospitals' decision is a boon for people like him. The Wadala resident was suffering from kidney failure for last four years. "I spend more than Rs 20,000 every month on dialysis and other medications. I didn't opt for kidney transplant as that will not cure me of type 1 diabetes because of which my kidneys failed. I am happy that now I have a choice," said Siddhique, who runs a chemist shop.

Sarang Pandey (30), an accountant staying in Andheri said because of type 1 diabetes and kidney failure, his life has got affected. "I can't lead a normal life. I will be happy if pancreas and kidney transplant can happen. I also feel that government should take some action to make organ transplants affordable," he said.

Dr Narayani also informed that Fortis Hospital, which has so far conducted eight heart transplants in the city, has also got permission from the DMER for combined heart and lung transplant. "We got the licence last week. We presently have three patients in the waiting list who requires heart and lung transplant," she said.

Pancreas transplantation
A pancreas transplant is a surgical procedure to place a healthy pancreas from a deceased donor into a person whose pancreas no longer functions properly. Almost all pancreas transplants are done to treat type 1 diabetes. Pancreas is an organ that lies behind the lower part of your stomach.

A transplant of the pancreas is usually reserved for those with serious complications. Pancreas transplants are most often done when a patient also receives a new kidney. The pancreas transplant adds little further risk in this situation and offers big benefits. However, transplant surgery is risky. Each person needs to carefully weigh the potential benefits and risks.

The benefits
You may be able to maintain a normal blood glucose level without taking insulin.
Many of the diabetes-related side effects are prevented or delayed. Most people with nerve damage who receive a pancreas transplant do not get worse and sometimes show improvement.

Intestinal transplant
It is an organ transplant surgery where the dead or gangrenous organ is replaced with new graft taken from donor. Small intestine can be donated by both cadaver or live donors.