Saturday, June 11, 2022

Cross-border tension puts fate of Pakistani patients in a limbo

 The hostility between India and Pakistan notwithstanding, dozens of patients from the neighbouring country continue to visit hospitals in the capital for treatment.

TOI spoke to the heads of several hospitals, including Apollo, Fortis and Medanta Medicity, who confirmed that there were at least 30 patients still recuperating from treatment in their liver transplant and paediatric cardiac surgery units.

They, however, fear that followup and treatment would get difficult if the tension between the countries escalates. “I brought my brother for liver transplant at Apollo through the Wagah border on September 20. There was some delay in getting medical visa. If the situation gets any worse, it will become impossible to get here,” said Choudhary Safdar Mumtaz Sandhu, a resident of the Gujrat district in Pakistan’s Punjab province. He added that people of both the countries want peace and development, not war.

While Pakistan has facilities for treating common health ailments, super-specialty services such as liver and bone marrow transplant, and complex cardiac surgeries for children, haven’t been fully developed yet. Hence, patients rush to India for treatment, said doctors. According to Dr Subhash Gupta, senior liver transplant surgeon at Apollo Hospital, they get 12-14 patients for liver transplant from Pakistan every month. “I had visited Pakistan earlier to conduct trans- plants. But over the last few months, after tension started building, Pakistan has been dilly-dallying on the issue of giving visa to doctors. It is relatively easier for patients to get a medical visa,” he said.

Chairman of the Institute of Liver Transplantation and Regenerative Medicine at Medanta, Dr A S Soin, said that nearly 15% of all foreigners treated at their hospital are from Pakistan. “They come to India because the cost of treatment is lower compared to western countries and the quality is as good,” he said. Many hospitals here, sources said, have tie-ups with hospitals in Pakistan for referrals and Indian doctors hold health camps there.

“We do not have a separate wing for foreigners. Most patients come through the walk-in system,” said Dr D S Rana, chairman, board of management at Sir Ganga Ram Hospi- tal, adding that they usually got at least 20 patients a month from Pakistan but there have been no patients in the last two weeks.

“Apart from liver transplants, patients from Pakistan come for advanced cardiac surgeries in children like transposition of great vessels and multiple congenital heart defects with failure to thrive,” said Dr Ashok Seth, chairman of Fortis Escorts Heart Institute.

India targets Gulf medical tourists

India’s Services Export Promotion Council (SEPC) delegation is in Dubai to woo medical tourists from the Gulf.

“The Indian government has recognised the fact that India has a huge potential for providing the best services to patients who need health care from other countries,” said the SEPC’s chairman, Naresh Trehan, at the International Medical Travel Exhibition and Conference (IMTEC) in Dubai yesterday.

The region accounts for around 8 per cent of the total number of medical tourists to India, he said, with the UAE representing five per cent.

India’s medical tourism market is expected to grow to $8 billion (Dh29 billion) in the next four years, according to a statement from the SEPC, citing data from recent medical industry reports. Globally, the medical value travel is projected to increase to $32.5 billion over the next five years.

India offers medical treatments that are not available in the Gulf, and at a lower cost, Trehan said. “If you need a liver transplant, a kidney transplant, a bone-marrow transplant or complex neurosurgery … they can only be done there and not … in the UAE and Gulf region.”

For instance, a complex heart surgery in India costs between $7,000 and $8,000. In the UAE, it’s priced between $15,000 and $20,000, he said. “We have very good technology … we have robotics for heart surgery, kidney transplant and liver transplant,” he added.

The Indian government is “improving its visa services”, said Anurag Bhushan, Consul General of India. “Almost 150 countries are offering electronic tourist visas, which means people can apply electronically without having to come to the consulate. We have also increased the [visa] duration, specifically for the UAE,” he said.

IMTEC attracted international hospital groups, medical travel organisations and health service companies. This year, the Indian pavilion hosted more than 10 hospitals and associations from India.


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Cadaver transplant awareness low

Though the number of organ transplant surgeries is steadily increasing, the proportion of cadaver transplants is still very low. Transplant surgeons said that though the technology is now available for transplants, it is lack of organs that is the major limiting factor.

Global Hospital here has just announced the completion of 200 liver transplants at its Lakdikapul facility. The hospital conducted its first liver transplant surgery in 2003. Liver trans- plant surgeon Prof. Mohammed Rela lamented the low awareness about cadaver organ donation.

“We should be able to see an increase in cadaver transplants as this will reduce the dependency on a donor within the family,” he said. He said that while about 20,000 patients in India require liver transplants every year, only 700 are able to undergo surgery due to lack of organs. The number could be approximately the same in case of other organs, he said.

Cadaver organ donations in the state are very low. According to estimates given by doctors, only about 15 to 20 cadaver organs are donated every year. Doctors said that while hundreds of people die from injuries in accidents, their organs are not donated by relatives due to lack of awareness and superstitious beliefs. “Awareness about organ donation is of immense importance,” Prof. Rela said.

Dr K. Ravindranath, chairman and MD, Global Hospitals, said the cost of a transplant will decrease as the number of transplant surgeries increase. “More transplant surgeries will definitely reduce the cost of the surgery. But for this, there needs to be greater awareness about organ donation,” he said.

What organs can a living donor provide

Q: What organs can a living donor provide? A: A kidney is the most commonly transplanted organ from a living donor, according to the United Network for Organ Sharing, or UNOS, the nonprofit group that manages the nation’s transplant system. (LifeLink of Georgia is one of 57 local organ procurement organizations that partners with UNOS).One entire kidney is removed and transplanted. Living liver donation, where a segment of the donor’s liver is transplanted, occurs less often, and the donor is usually related to the recipient. Also, in rare cases, a uterus or a segment of other organs such as a lung, can be transplanted from a living donor.

Q: What organs can a deceased donor provide? A: One donor can donate and save up to eight lives by donating organs after death. The organs that can be donated include the heart, intestines, kidneys, liver, lungs and the pancreas.

Q: What organ is most in demand? A: Kidneys are most needed and livers are second. About 83% of the people on a transplant waiting list in the U.S. are waiting for kidney transplants, and about 12% are waiting for liver transplants, according to UNOS.

Since its opening, 517 organs have been recovered from 175 donors. Already, the organ recovery center is averaging close to one more organ per donor compared to the average of organ donors who stay at local hospitals around the state.

The center receives patients from around Georgia who had made plans to be an organ donor and due to an accident or illness have been declared deceased. They are cared for and kept on mechanical support with blood and oxygen flowing, keeping organs viable until they can be transplanted. The machine is not keeping the patient alive — brain death is irreversible and is legally and medically recognized as death.

The space includes six ICU bays, two operating rooms, and private rooms for donor families. Grief and spiritual counseling are provided.

Surgeons perform complex liver transplant surgery

 Surgeons at a private hospital in Hyderabad successfully performed a complex liver transplant surgery on a 49-year-old police constable, who was suffering from a liver ailment.

The patient was admitted to Kamineni Hospitals with complaints of fatigue and loss of appetite initially, followed by jaundice and later, abdomen distention.

Doctors diagnosed the patient with Hepatitis-B virus-related decompensated liver disease, which necessitated a liver transplant.

“Decompensated cirrhosis is an advanced stage of cirrhosis, which is the scarring of the liver. When this scarring becomes severe, the liver loses its strength to function properly,” said Dr Rajasekhar Perumalla, director, hepatobiliary & transplant surgery, Kamineni Hospitals.

“In the run-up to the surgery, we faced many challenges, such as low platelet count, coagulopathy and infection. During surgery, the patient had severe bleeding due to high portal hypertension. Post-surgery, the patient was managed well and discharged on the 13th day,” Perumalla said.


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