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Heart to heart
Posted:Oct 2, 2017
 
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Heart disease is the number one killer worldwide among Non-Communicable Diseases (NCDs), with more than 17 million deaths annually. But what this statistic does not tell you is the sheer number of people saved by coronary non-invasive and surgical procedures every year. Percutaneous Transluminal Coronary Angioplasty (PCTA) or Stenting as it is popularly known is a relatively easy non-invasive procedure that can open up clogged heart vessels. With the cost of stents coming down on the instructions of Health Minister Dr. Rajitha Senaratne and the Government funding the entire cost of the procedure at state hospitals, more heart patients in Sri Lanka have received a new lease of life.
 
The other option, reserved for more serious patients, is Coronary Artery Bypass Grafting (CABG), where the chest is usually opened up and the patient connected to the heart-lung machine while the surgeons complete the bypassing with a vessel from another part of the patient’s body. In some cases, it is possible to operate on the heart without stopping it through a small incision on the chest (Laparoscopy or keyhole surgery), but not all patients are suitable for this operation.
 
However, there are rare cases when all these procedures are not suitable. This is especially applicable for patients with a congenital disorder (birth defect) in the heart. The only answer for most of these patients is a heart transplant, possibly from a young, disease-free donor.
 
Heart transplants are nothing new. The first heart transplant operation was performed exactly 50 years ago. On December 3, 1967, 53-year-old Lewis Washkansky received the first human heart transplant at Groote Schuur Hospital in Cape Town, South Africa. Washkansky, a South African grocer dying from chronic heart disease, received the transplant from Denise Darvall, a 25-year-old woman who was fatally injured in a car accident. Surgeon Christiaan Barnard, who trained at the University of Cape Town and in the United States, performed the revolutionary medical operation. Today, heart transplants are fairly common all over the world and the only drawback is the relative lack of donor hearts.
 
Although our doctors have been performing PCTA and CABG procedures locally for nearly 20 years, a heart transplant had eluded Sri Lanka until just a couple of months ago. Thirty-six-year-old mother of one Pushpa Kumari from Anuradhapura had only a few months to live with her ailing heart. Doctors knew that short of a miracle, the only option was a heart transplant. Dr. Anil Abeywickrama, who had undergone training in this sector in the UK, and the team of surgeons in Kandy were ready to undertake the surgery. All they needed was a donor heart. This came from Pradeep Kumara Sampath, a 24-year-old youth from Udunuwara who died in a motorcycle accident. In a groundbreaking operation, this team of doctors successfully completed the first successful heart transplant in Sri Lanka.
 
Just two months later, the same of team of doctors have performed the second successful heart transplant. The lucky recipient is 19-year-old Sachini Sewwandi of Aluthgama, who now has the heart that once belonged to 28-year-old Nalinda Sakalasuriya of Thalathuoya, another victim of a road accident. It was heartbreaking to watch Nalinda’s father speaking on television, saying that his son will now literally live on in a young girl who has her whole life ahead of her. And someone else will see through his eyes too.
 
Indeed, the entire nation should be grateful to the parents of Pradeep and Nalinda, who readily and graciously offered to provide the vital organs of their sons to total strangers. They did not receive or expect to receive any kind of compensation for this noble deed. The knowledge that someone else will live with the organs of their offspring was their only satisfaction, only reward.
 
But there could be critical time bound cases where even the delay caused by seeking a guardian’s consent could prove to be crucial for the recipient. There is a suggestion to allow health authorities to harvest the organs of young persons killed in road accidents for critically ill patients awaiting transplants without first seeking the consent of parents or guardians. Time is of the essence for transplants and even a slight delay could prove to be fatal for a recipient. Serious consideration should thus be given to this proposal. The authorities should also create more awareness on organ donation.
 
However, future developments may obviate the need for human organ donors altogether. There are two approaches – silicon-based artificial hearts and hearts obtained from pigs, an animal which has remarkably similar anatomical features. An artificial heart which closely imitates the real thing “in form and function” has been developed by Swiss researchers. In the other process, called xenotransplantation, genetically engineered pig hearts could be transplanted to humans. Experiments with other primates have already shown good results. However, there are ethical dilemmas surrounding this solution – is it moral to kill another being to get its organs for our use? In any case, both these methods could take a couple of decades to become perfect. In the meantime, human transplants will get more widespread and more reassuring. 
 
 
 
 
 
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