Liver transplantation in Calcutta - a mirage?
I fumble to give a proper reply.
Liver transplantation has established itself as a definitive treatment modality for a wide range of liver related diseases with 5 year survival rates reaching 80% worldwide.
It means that 80 people out of 100 receiving a liver transplantation will remain alive at the end of 5 years.
Without transplantation none or only a few of them would be living at the end of 5 years.
India was as usual late in picking up livers for transplantation, but its catching up pretty fast.
Two centers in Delhi collectively perform around 600 annually with other Indian centers catching up especially Hyderabad.
Calcutta features nowhere in the scene much like in everything else.
These are some musings on Calcutta's dismal performance in the field of liver transplantation.
India was as usual late in picking up livers for transplantation, but its catching up pretty fast.
Two centers in Delhi collectively perform around 600 annually with other Indian centers catching up especially Hyderabad.
Calcutta features nowhere in the scene much like in everything else.
These are some musings on Calcutta's dismal performance in the field of liver transplantation.
Situation in Calcutta
A handful of transplants have been performed till date in Calcutta. Some at a Government Hospital, others at a private setup.
Most were live donors and a few bold attempts at cadaveric transplantation were made.
The results are not encouraging, which is acceptable ( every transplant programme in the world suffered setbacks in their early years)
Most of the transplants were performed by surgeons flying in from Delhi- the indigenous surgeons were restricted to a supportive role.
I don't have much information on the follow up- were the operating surgeons involved in immediate postoperative care?
Dismal performance (like in everything else in Bengal)
My lame explanations
Liver transplantation is not a one man activity. It is rather a part of a comprehensive hepatobiliary service that includes hepatology, surgery, radiology, pathology, anaesthesiology.
In the absence of a center that provides dedicated comprehensive hepatobiliary service, a liver transplantation programme cannot work effectively.
This, in my not so humble opinion has got to do with the bengali mindset of 'ekla cholo re'.
Bengalis are poor team players by character and its hard to find a situation in clinical practice where hepatologist, surgeons, radiologists, anaesthetists(most important member of the team) have worked in a team.
The mindset among practitioners to focus their work in a particular institute is particularly lacking- the surgeons would rather have multiple attachments than work in a single institute- HPB and transplant cannot function effectively that way.
There is a critical shortage of liver transplant trained surgeons , hepatologists, radiologists and anaesthesiologists and other professionals.
A training framework has to be in place for 2/3 years to build up dedicated transplant professionals. The Government is too myopic to do so, and a private player too money oriented to invest in such training.
The few people whom we can call trained are those who have trained with individual,personal effort.
A liver transplant programme relies heavily on trained para clinical staff to be successful, not only in the immediate postoperative period but in the months and years that follow a succeful transplant. I cant see such training happening in the foreseeable future.
Follow up is an integral part of any successful program. A framework for followup has to be in place for effective care of the patients.
A transplant programme can't just afford to say- that a patient has been 'lost to follow up'
Is there a demand?
There certainly is. Patients are going to other parts of the country to get it done- spending considerably more money and human resources
A recent publication suggested that cadaveric organs (harvested from dead people- for the uninitiated) might be more useful in Calcutta because of peoples' pro donation mindset. In such a scenario the entire network of potential donor identification, organ retrieval , organ preservation, has to be built up.
This calls for painstaking effort involving an entire fleet of doctors from wide ranging specialities working in tandem with social organizations.
Things are changing - slowly but steadily. But are they changing fast enough to keep up with the times?
I would like to be in a situation where I dont have to explain to people from other parts of the world why we dont have a liver transplant program in a city with a population of 20 million.
Liver transplantation is not a one man activity. It is rather a part of a comprehensive hepatobiliary service that includes hepatology, surgery, radiology, pathology, anaesthesiology.
In the absence of a center that provides dedicated comprehensive hepatobiliary service, a liver transplantation programme cannot work effectively.
This, in my not so humble opinion has got to do with the bengali mindset of 'ekla cholo re'.
Bengalis are poor team players by character and its hard to find a situation in clinical practice where hepatologist, surgeons, radiologists, anaesthetists(most important member of the team) have worked in a team.
The mindset among practitioners to focus their work in a particular institute is particularly lacking- the surgeons would rather have multiple attachments than work in a single institute- HPB and transplant cannot function effectively that way.
There is a critical shortage of liver transplant trained surgeons , hepatologists, radiologists and anaesthesiologists and other professionals.
A training framework has to be in place for 2/3 years to build up dedicated transplant professionals. The Government is too myopic to do so, and a private player too money oriented to invest in such training.
The few people whom we can call trained are those who have trained with individual,personal effort.
A liver transplant programme relies heavily on trained para clinical staff to be successful, not only in the immediate postoperative period but in the months and years that follow a succeful transplant. I cant see such training happening in the foreseeable future.
Follow up is an integral part of any successful program. A framework for followup has to be in place for effective care of the patients.
A transplant programme can't just afford to say- that a patient has been 'lost to follow up'
Is there a demand?
There certainly is. Patients are going to other parts of the country to get it done- spending considerably more money and human resources
A recent publication suggested that cadaveric organs (harvested from dead people- for the uninitiated) might be more useful in Calcutta because of peoples' pro donation mindset. In such a scenario the entire network of potential donor identification, organ retrieval , organ preservation, has to be built up.
This calls for painstaking effort involving an entire fleet of doctors from wide ranging specialities working in tandem with social organizations.
Things are changing - slowly but steadily. But are they changing fast enough to keep up with the times?
I would like to be in a situation where I dont have to explain to people from other parts of the world why we dont have a liver transplant program in a city with a population of 20 million.
