I performed my first transplant surgery in 1995. When I received training, except for kidney, no other transplants would take place in India. While the scenario has drastically changed, our medical colleges in India are still not equipped to train students in conducting transplants.
Except for AIIMS, no other medical college in India can conduct heart transplants. Therefore, the exposure that the students get when it comes to transplants is very limited.
I have been fortunate to have done 320 heart transplants, including 105 paediatric transplants – the youngest recipient being six months old. The more surgeries you perform, the better you get at it. Since we do not have enough paediatric donors, we have to transplant an adult heart into children in a lot of cases. This requires years of understanding and practice.
Most organ donations happen in the south of India. The rates are increasing in Maharashtra because people are becoming more aware. One of the big challenges in heart transplant is that it should be transplanted within six hours.
Transport, in my opinion, is a big challenge here even in cities that have good infrastructure. We are now training to develop technology at the Indian Institute of Science at Bangalore to preserve a heart for 12 hours. If we are successful, the challenge of ischemic time or transport can be solved to some extent.
The other big challenge is the cost of transplants. In India, 95% of the patients pay out of their pockets. In Tamil Nadu, the government reimburses part of transplant expenses, but most other states are not providing this facility. Therefore, it becomes difficult to find the money to fund transplants.
The government needs to look at how they can fund transplants. One solution is using a portion of tax collections into providing health insurance for everyone. This is crucial and will benefit a lot of people as most insurance companies do not cover transplants.
Organ donation has its share of controversies. Illegal organ transplants are a blot on our system. In a country like India, people are poor and they are willing to do anything for some money.
To put a check on illegal organ transplants, cadaveric organ donation can be an effective solution. Another solution is to promote artificial organs. However, no matter how strict laws are people in desperate need for money will sell their organs. Therefore, the eradication of poverty is essential.
It is disheartening that even, in the recent budget, there was very little mention of health. We are dreaming of a 5-trillion-dollar economy but are spending only around 1% on healthcare. My suggestion would be to extend the Ayushman Bharat Scheme for every citizen of India.
While it can be free for those below the poverty line, for taxpayers, the proportion of tax that they pay should be the basis of their insurance scheme.
If this is not done, we will only have people spending out of pockets for treatment, and doctors getting beaten up if things go wrong. The situation we are in, currently, makes no sense to me. It only reflects the failure of policies and governance.
Education and health should be a priority in any election. All discussions in political circles and media should be about effective governance and not trivial matters. Health must be a major point of discussion in public policy discourse.
We have carried out 300 transplants in a small private hospital, but our government medical colleges have not performed a heart transplant in a state like Maharashtra. Why is it not happening? I think it is time the government should refocus on matters that are important like health and education.
Let me end with this thought. Some 25 years ago, there were no telephones in India. But today, most people have access to mobile phone. This has been possible by the way mobile technology has penetrated. Similarly, healthcare has to penetrate to every corner of India. Let’s not forget – expenditure on health is an investment as a healthy nation is a more productive nation.
The author is a Senior Heart Transplant Surgeon and Director of Cardiac Sciences, Fortis Malar Hospital, Chennai