A heart transplant that overcame even the COVID lockdown crisis

(Dr Jose Chacko Periappuram, who made history by performing the first heart transplant in Kerala, shares experiences that touched his heart. Click here to read previous columns in the series.)

It was very late at night when I got a phone call from Shibu from Munnar.

He started by apologising and then said: “Leena is having severe shortness of breath and I am not able to be by her side at Kothamangalam. I have not had time to come and see you, doctor, due to the COVID lockdown and my busy work schedule in the last few weeks.”

After listening to all that he had to say, I told Shibu to bring Leena to the hospital the very next day.

About two months earlier, Leena was admitted to the hospital for tests. It was at that time that I told Shibu that there was no other option but to have a heart transplant for her to get better.

But the soft-hearted Shibu could not sum up the strength to tell Leena about it. He said: “Let's get ready for the transplant, doctor. Please have the name registered in Mrithasanjeevani (a network in Kerala for organ transplant).”

My secretary Lakshmi Nair started the process of getting Leena's name registered with KNOS (Kerala Network for Organ Sharing) by getting in touch with the transplant department of Lisie Hospital. Even then Shibu could not tell his wife about the need for the transplant.

The day after he called from Munnar, Shibu came to the hospital with Leena. I was busy with a complicated surgery, so they had to wait for two hours outside my cabin.

As Leena entered the OP unit, my mind whispered: she’s not the same person I had seen the last time. She was unable to even speak. Her sentences were broken. Her face had shrunk. And her legs had swollen with fluid accumulation.

On seeing Leena's condition, I could not hide anything from her and said: “Leena, your heart's muscle has completely lost its ability to function.”

“I know, doctor, I'm ready for anything,” she said.

Her reaction suggested that Shibu may have told her during the trip to the hospital about her illness and that there was no alternative but to have a heart transplant to cure it.

Leena's heart transplant could have been performed only after removing the swelling around her lungs. Leena's blood group was A positive.

While I was talking to them and making entry in the chart for Leena’s admission to the hospital, my colleague Lija came to me with a phone. It was a call from Dr Jacob. He usually calls me when there is a problem in the ICU.

“Sir, our transplant section has got information through Mrithasanjeevani that the family of a 50-year-old woman with A Positive blood group who is brain dead at the KIMS Hospital in Thiruvananthapuram has volunteered for organ donation. But we don’t have anyone on the active list right now with the same blood group needing a heart transplant. Shall I say we don’t need?”

After telling Dr Jacob to hold the phone, I asked Shibu and Leena to wait outside for a while. I picked up the phone again. “We have an urgent situation, Jacob. Leena's condition is very serious. She has only days left. Leena is waiting outside my clinic with her husband, unable to even talk. I am admitting her in hospital. That heart is essential to us.”

Everything after that happened fast. It was a time when there was heated political debate over helicopters being rented by the state government for the needs of the police force.

Hospital director Fr Paul Karedan instructed PRO Rajesh to enquire with Chief Minister Pinarayi Vijayan through former MP Rajeev whether the helicopter could be used in this situation.

Then I went back to the operating room for daily surgeries. When I came out of the operating room about an hour-and-a-half later, Rajesh said, “Assistant commissioner of police (ACP) Lalji sir had called. Please call him back.”

In the meantime, the chief minister, realising the seriousness of the situation, had directed the DGP to provide us the helicopter service. The service was made available to us completely free of charge.

ACP Lalji wanted to know where we wanted the helicopter to land. We chose the helipad of the Hyatt Hotel in Bolgatty Palace as it was the safest place near the hospital. Lalji assured the heart would reach Lisie Hospital from there in four minutes through the ‘green corridor’ that would be created for the purpose.

This was followed by a phone call from police IG Sreejith from Thiruvananthapuram, phone conversations with ADGP Manoj Abraham, and calls with Thiruvananthapuram airport assistant commissioner Aishwarya... we then got in contact with officials in various other posts.

Leena was admitted to the ICU and she was given medicines that would help control the functioning of her heart and lungs at least a little bit.

A group of colleagues was preparing her and her family members for the heart transplant surgery.

After all this, when I returned home, it was 1am. At 4:30 am, we started our road journey to Thiruvananthapuram by ambulance. We reached the KIMS Hospital in Thiruvananthapuram around 9 am and we were greeted by the doctors there and their colleagues.

Meanwhile, there were calls from the police officers and the airport commissioner.

When we arrived, we were greeted with great joy by Dr Sahadullah, director of KIMS Hospital. Accompanying him were Dr Shaji Palangadan, head of cardiac surgery, Dr Murali, head of intensive care unit, and Dr Ameer, all ready to cooperate with us.

The work of Mrithasanjeevani nodal officer Dr Noble Gracias and coordinators Aneesh and Saranya was of great help to us. What made all this possible was the permission given by the family members of Laali Gopakumar, a teacher and a native of Chempazhanthy in Thiruvananthapuram, for donation of her heart.

It was May 9, 2020, Saturday, when the COVID lockdown was in place. Due to the pandemic, there weren’t too many organ donations and transplant surgeries happening. There was only one heart transplant surgery that had been performed till then after the outbreak of the pandemic.

COVID examination was a must for organ donors, doctors who would be performing the surgery and other staff members. There were many such problems. Moreover, there was also the threat of strong winds and rain from 3pm.

As I looked out of the operating room through the window, I could see dark skies and thick clouds. I had my doubts about undertaking a journey by air with a heart on such a day, but I hid them in a corner of my mind.

As we rushed to the hospital lobby with the heart kept in a chilled solution in the middle of ice in a blue box, all of us were anxious about the journey with the heart in the helicopter that was rented by the government.

As we reached downstairs, we found minister Kadakampally Surendran and the children of Laali teacher waiting for us. Their tears drenched our heart. We shared a few moments with them. Soon after, we were escorted by a police vehicle to the airport.

It was a 55-minute air travel, in a climate with clouds and rain, with hardly any visibility. As we stepped on the helipad of the Grand Hyatt in Bolgatty, it was not only the prayers of our family members that we thanked. Our thanks were also to the whole state community.

From there, we arrived at the Lisie Hospital in less than four minutes with the help of the police. At the hospital, people including, MLA TJ Vinod, were waiting to receive us.

As I hurried towards the operation theatre, PRO Rajesh, who was with me, handed over his phone to me. It was health minister Shailaja teacher at the other end. She wished us all the best and said we could call her if we needed anything. The whole care of the state was filled in the words of the teacher. Her words showed that the care of the whole state was behind us.

Besides giving Leena, who had just days left in her life, a new life, the successful surgery also was a great example of the effectiveness of collective action in organ donation.

It was a happy ending that had resulted from the goodness of the Chief Minister, ministers, hospital employees, police officers, ambulance drivers, helicopter pilots and family members who had signed the consent for organ donation.

What made the success even more memorable was that as a token of gratitude for the new life that their mother had got, Leena's two children, Shiona, an MTech student, and Basil, a law student, pledged to donate all their possible organs.