Sunday, July 8, 2018

How generous people are!

How generous people are!

Yesterday morning, I met a Plastic Surgeon, Dr Hemant Saraiya at GCRI Ahmedabad. He made a piece of tongue of a cancer patient which was removed in operation. He made it by using the skin of patient’s wrist area. Cutting the affected part of the tongue and making it with plastic surgery is a long operative procedure of 6 hours and may cost ₹5 lakh in market is free of cost for the poor patients in GCRI. The remuneration to the visiting surgeon is not much but Dr. Hemant is doing with a motive to paying back to the society. He is the only Plastic Surgeon of the world who has donated Blood for 151 times.

Afternoon, we had an opportunity to visit a kidney transplant surgery. A healthy young man was donating his one kidney to his cousin of 44 years old whose both kidneys were in failure. Removing a kidney of a healthy person from the side of his body is an art of surgery. Dr. Jamal took utmost care to minimise the cuts to the donor. With two small size cut the laparoscopes were inserted and by fixing clips over the ureters, artery and vein and after cutting them disconnected the 11 centimetre bean shaped kidney from the body. And just applying seven centimetre cut over body for the entry of the surgeon’s hand the kidney was softly taken out and put in the bowl full with ice.

The nurse then immediately moved with the bowl to the adjoining OT where the donor’s cousin was kept ready to receive it. The recipient patient was kept in readiness with a cut over the lower right abdomen. Before transplantation of the donation, they do a procedure over the kidney, draining out the blood (with RBC and WBC), sealing the extra openings and keeping the right length of ureter, artery and vein. It took 10 minutes to Dr Jamal and Dr Sajani to complete the task, then they started the fixing, connecting artery with artery, vein with vein and ureter connecting to the bladder rout. The non functioning and shrunken kidneys of the patient were not disturbed. God has made our body as such a wonderful machine that it will pump more blood to the new kidney and use it for the filtration function. Kidney of a healthy man filters 110-125 ml blood a minute. The new organ will start with small count and may function at 50-60 ml/minute. The donor’s filtration with remaining one kidney will go down to 50 ml/minute, but will slowly rise to 80 ml/minute.

Management of the human auto immune system is a great challenge in kidney transplant. If the patient’s immune system rejects the donation, the entire exercise goes waste. Therefore, they do some tests and perform checks and do the match making before the surgeries. To make the auto immune system of the recipient dormant, little quantity of blood of the donor is injected to the recipient. The immune system then fight and with repeated experiments, it accept it as a permanent visitor of the body. Therefore, when the kidney of the donor is transplanted over the recipient, it remains dormant. WBC is the biggest challenge in transplantation. If the donor’s kidney carry WBC with it, it will be a tarter fight like India and Pakistan and the kidney will die in the immune attack of the recipient. Most of the WBC are removed during the drainage process, but for the residuals, the medicines takes care creating resistance wall against the attack of the immune system. There are methods to make corrections in case of adverse match making, therefore, the kidney chains are traveling beyond the near relatives.

HLA typing is very important for match making of patient and donor. It is the 6th chromosome which encode Human Leukocyte Antigen (HLA) in human. HLA are proteins or markers found on most cells in our body. Our immune system uses these markers (HLA) to recognize which cells belong in our body and which do not. The immune system come in attack when the foreigner enters. To avoid failure of transplantation, it is necessary to make immune system dormant. This was the research work of Dr H L Trivedi. This is not done routinely. In routine transplant, serum and white blood cells of recipients and donor respectively are cross match in the laboratory. This is known as leukocyte cross-match. If there is no reaction, the donor organ is suitable for transplant in to the recipient.

Now the transplantation is done through Robots. It is a fine surgery with minimal cut and better perfection but expensive. Very few hospitals in the world do this. IKDRC Ahmedabad has this facility. Dr. Pranjal Modi is the surgeon for Robotic surgery. IKDRC is a well known centre in the Country has reached to the present height under the great leadership of Dr HL Trivedi, MD. He has been awarded with Padma Shri. This week, the 27th International Congress of the Transplantation Society in Madrid, Spain has awarded him with ITS Award for Mentorship or Education and Training in Transplantation. This award is considered Nobel Prize in the field of Transplantation Surgeries. Salutes to Dr HL Trivedi.

I wonder, why don’t we match the 6th Chromosome of the couple before marriage to avoid fightings at home. 😂 However, in India Wife (Savitri) is the first donor to her Husband (Satyavan) to save his life. Therefore, there are many cases of wives donating kidney to husbands but rare cases of husbands donating kidney to wives.

8 July 2018

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