June 20, 2010

India needs 20,000 cadaver livers a year: Mohamed Rela

Deepa Suryanarayan / DNA
Monday, June 21, 2010 1:05

Beginning his career as a surgeon in Chennai, professor Mohamed Rela has worked over 15 years in the field of hepatobiliary (HPB) surgery and liver transplantation, and has personally performed around 1,300 liver transplants. He has even performed a successful liver transplant on the youngest patient ever (a five-day-old), a feat that earned him a place in the Guinness Book of World Records 2000 Edition.

Having worked in the largest liver transplant programme in Europe at King’s College Hospital, London, UK, since 1991, Dr Rela will now head the liver transplant and HPB surgery of Global Hospitals. DNA spoke to Dr Rela on the need for a liver transplant programme in the city.

Has liver transplant surgery changed over the years?

I performed India’s first liver transplant 14 years ago at Jaslok Hospital. Unfortunately, the child died five or six years later due to pneumonia and some complications that arose due to immuno-suppressants. Fifteen years ago, people had only heard of kidney transplant. But today, liver transplant surgeries are being performed at all leading metros. Earlier the problem was a lack of expertise, commitment and team-building. But, the situation has changed now. In the seven months that I have spent in India, I have already performed 52 liver transplants. I have also pioneered some major technical advances such as split liver transplantation — where a cadaver donor liver is divided into two for transplantation into two patients and auxiliary liver transplantation, which will soon be available in Mumbai.

How can liver transplant be made affordable to the common man?

The cost of a liver transplant — about Rs20 lakh, plus a lifelong commitment to immuno-suppressants, which cost Rs10,000 per month — is prohibitive and out of reach of the common man. One way to make it affordable is to rope in the government to subsidise it or to offer it free of cost at public hospitals. Liver transplantation is a complex procedure. It requires high infrastructure, an expert medical team, preserving the organs, expensive drugs, prolonged stay in the ICU — all of which add to the cost. But, it is still cheaper in India because the cost of the personnel and hospital fees is comparatively low. In the US, a liver transplant would cost $2,50,000 (Rs1.15 crore).

What is the biggest hurdle as far as organ donation is concerned?

According to me, lack of understanding of brain death condition is a big hurdle. You need a huge amount of public awareness about the concept of brain death as well as organ donation in order to make the organ donation programme a success. Government initiatives through legislative changes can also help. At the moment only an authorised transplant centre is allowed to retrieve organs, as a result of which the patient’s body has to be transported to the centre. This could be changed to permit any hospital with ICU facility and an equipped team of surgeons and neurologists to perform organ retrieval.

What is the need for a liver transplant programme?

Given the high incidence of Hepatitis-B and Hepatitis-C in India, as well as the prevalence of fatty liver disease which ultimately causes liver cirrhosis and cancer, a large number of people in the country are in need of transplants. In fact, India requires up to 20,000 liver transplants per year. Even if 1/10th of these patients can afford to pay for a liver transplant surgery, then 2,000 liver transplants are needed. However, currently, we are doing just 200-300 transplants. The need is huge.


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