(Dr Jose Chacko Periappuram, who made history by performing the first heart transplant in Kerala, shares experiences that touched his heart. Read Part 1 and Part 2 of the series.)
The 32-year-old's face reflected his desire for life — a young man wearing thick glasses with a black thick frame, but his days were numbered due to a failed heart.
Jithesh tried many treatments but when they didn’t work, he realised that the only solution was a heart transplant. As soon as he entered my clinic with his father, we knew that his life expectancy was limited.
Jithesh got admitted in hospital and in the following weeks, he underwent various tests. We have to conduct many tests because it is quite possible that by the time patients approach us, they have probably passed the phase for a successful heart transplant. This delay may be either because the treating doctor may not have mentioned about heart transplant or the patients and their family may have thought such an operation is not possible. Conditions such as excessive blood pressure in the lungs and significant impairment of kidney function may make a patient unfit for a heart transplant surgery.
Jithesh's name was registered for organ donation after conducting the tests to ascertain that the functioning of his other organs was not adverse to a heart transplant surgery.
As he was experiencing shortness of breath and other difficulties every day, the decision to keep him in the hospital and monitor him was unanimous. That is what Jithesh and his father also desired.
As the days passed, his health began to decline. The swelling of his feet due to fluid accumulation, the unresponsiveness to medicines, and the need to increase the amount of medication and oxygen on a daily basis all heightened the anxiety in everyone.
One day, while I was performing another heart operation, I heard loud footsteps outside. Usually in an emergency, it is when a patient has had a heart attack that doctors and nurses rush quickly to start first aid. In such a situation, each second and every minute is crucial to keep the person alive.
Within a minute of hearing the footsteps, I got a message: Jithesh's heart had stopped beating. By the time I got out of the operation theatre, I received the next message: ‘Jithesh is shocked and revived’.
He had suffered ventricular fibrillation (VF), a severe abnormality in the heart’s rhythm. It is a situation where life is lost if the heart is not restored to normal within two to three minutes. Senior doctors, technicians and nurses all brought Jithesh back to life within seconds and with extreme caution.
When I went to see Jithesh in the ICU after completing the heart surgery, I saw only a dim light in those eyes, a facial expression that had lost half its radiance… everything bothered me a lot. There was the possibility of a cardiac arrest recurring at any moment; worse, it may happen when there are no doctors. As it is, it was a condition where there was no response to treatments... I mulled over all of this.
I spoke to Jithesh’s father about his extremely serious condition. The face of that father looking at me helplessly, without uttering a word, without raising his eyes but with both hands raised in resignation, still lingers in my mind.
When the doctors and nurses met, the discussion was about what could be done if a heart cannot be found as replacement before another heart attack.
Machines such as ventilators, balloon pumps, and ECMOs can help patients with heart failure for a few hours to a few days.
It was a time when all sorts of rumours about heart donation were rife in the community, and we wondered if an immediate organ donation would happen.
It was finally decided to prepare the machinery support that would be required to sustain Jithesh's life if organ donation was delayed for weeks or months. When he was shifted to the ward after two days in ICU care, Jithesh's face was filled with doubts.
On the third day, Jithesh had another heart attack and doctors could not restore his heartbeat despite trying for a long time. He was put on a ventilator and provided first aid in the ward itself. He was then rushed to the operation theatre where his chest was opened. He was put on cardiopulmonary bypass (CPB), a machine that performs the functions of the heart and lungs from outside the body. This machine can support life for up to six hours.
It is nothing more than just a temporary machine and it cannot help restore the functioning of a motionless heart. A heart donor had to be found within six hours. A donor with the same blood type as Jithesh's; a heart that matches Jithesh’s in every aspect... dreaming of the impossible.
A machine called ECMO was the answer to the question of what next. The machine can hold life for about a week. With the consent of his father, Jithesh was attached to the machine. It has a pump like the heart and a machine part that delivers oxygen to the blood like the lungs. This machine transports the impure blood from the patient's body through special pipes. The machine then purifies the blood and sends it back to the body through other pipes. It is a sophisticated device.
Days passed like this. As the blood passed through this machine, the changes in the blood cells began to complicate the functioning of many organs in Jithesh's body. The possibility of getting a heart that would match Jithesh’s was also fading fast. The platelet count in the blood kept decreasing, resulting in a very dangerous condition.
We attached Jithesh's heart to a device called CentriMag BIVAD, which can control the functions of the two pumping chambers of the heart through two different pumps attached from outside the body. This machine does not affect the platelet count and it can support life for up to a month. And there was a ventilator to keep his lungs functioning.
Jitesh became the first person in India to have this very sophisticated device attached to control both the chambers of the heart.
But the problem was very serious. It was an excruciating wait for a donor who is brain dead, can donate a heart, has the same blood group as Jithesh, with weight and blood type matching that of Jithesh. It was a stage where science and humans couldn’t do much; days that were left to fate. Jithesh's life was hanging by the thread called CentriMag.
A phone call with the message about organ donation came 13 days later. The heart was from a young man who was brain dead at Pushpagiri Medical College in Thiruvalla after a road accident. The treatments and surgeries done by expert doctors could not bring him back to life.
The young man's parents and close friends desired for him to continue living with them. Their decision to keep his heart ticking through another person was a reflection of this desire of theirs .
The young man's heart was brought to Ernakulam from Thiruvalla in one hour and 25 minutes with a police escort. Jitesh's artificial heart and his own heart were removed and the new heart was attached to him.
The heart transplant was another proud moment in medical history for Kerala — for the first time in India, a new heart was successfully transplanted on a patient whose life had been sustained for 14 days with mechanical equipment that kept both the chambers of the heart functioning.
It’s been four years. Jithesh is working and living a healthy life. He is a perfect example of how organ donation can help extend someone's life.
