Special delivery: young girl’s new heart survives 550km journey through India’s airports and traffic

When cardiologists in Mumbai heard that a donated heart had become available 550km away, they had just four hours to transport the organ by air and through the city's notorious traffic before performing the operation on their youngest patient to date.

Dr Vijay Agarwal carried out the first successful paediatric heart transplant in Mumbai on January 3, 2016, operating on Sweden D’Souza, his 16-year-old patient who suffered from a chronic heart musclShow more

NEW DELHI // Paediatric cardiologist Vijay Agarwal was driving back to his home in Mumbai in the evening of January 2, preparing to host a small New Year’s party, when he received a phone call. A 20-year-old woman had just died in Indore — nearly 550 kilometres from Mumbai — and her heart was available for transplant. Didn’t he have a patient awaiting just such a heart?

Dr Agarwal, who works at the Fortis hospital in the Mumbai suburb of Mulund, thought immediately of Sweden D’Souza — his 16-year-old patient who suffered from a chronic heart muscle disease called cardiomyopathy.

Sweden certainly qualified for a transplant. It was the distance the heart had to travel that worried Dr Agarwal.

What followed was hours of frenzied coordination as determined doctors, and traffic and police officers worked through the night to ensure the success of Mumbai’s first paediatric heart transplant. It also marked the furthest distance that a heart has travelled within India to be transplanted.

A heart must be transplanted within four hours after it is taken out of the body, or its muscle will begin to atrophy. That window of time is already narrow, but the stakes are even higher given the logistics of transportation on India’s clogged roads and possible complications in surgery. Adding to the complexity was the fact that no central authority in India co-ordinates such transplants.

“I sent a retrieval team of four people to Indore that same night, within an hour of us receiving the call,” he said. “A private jet would have saved a lot of time, but they were charging 800,000 rupees (Dh43,200).”

Sweden’s father, a security guard at the office of an oil corporation, could not afford that fee. “So we booked a flight the next morning at 7.40am,” Dr Agarwal said. “I tried a friend in the navy to see if they had any aircraft for this emergency use, but they were all deployed elsewhere.”

It is common, in India, for surgeons and doctors to try to make such arrangements themselves, with the help of their hospital administrators. Although efforts are being made to set up a government-backed network for organ donations and transplants, no such system exists at present, said Sujata Patwardhan, the head of urology at the King Edward Memorial Hospital in Mumbai.

Dr Patwardhan is the secretary of a zonal transplant coordination committee, which reports to a government agency but is otherwise made up of volunteer doctors. The committee keeps in touch with similar voluntary bodies elsewhere in the country to exchange news about donated organs.

“It is, right now, about 100 doctors around the country who are on a Whatsapp group together,” she said with a laugh. “That’s how I heard from Indore that this heart was even available for transplant, so that I could pass on the information to Fortis hospital.”

The donor, a 20-year-old epilepsy patient, had injured herself during a seizure and was subsequently declared brain dead. Her heart, which was still healthy, fit the medical parameters of Sweden.

Just two weeks earlier, Sweden had moved up on the paediatric waiting list for heart transplants, following the death of another patient awaiting a donated organ.

In Indore, Anil Bandi, a kidney surgeon, was coordinating the process. “In our state, Madhya Pradesh, no one performs heart or liver transplants at all,” Dr Bandi said. “Which is why we had to contact other states to see if they could use these organs.”

Through the night on January 2, Dr Bandi and his staff coordinated with Indore’s police commissioner to set up a “green corridor” — a traffic-free route — from the hospital to the airport.

The next morning, at 6.52am, Fortis’ retrieval team began taking out the heart. By 7.15am, the heart was packed in layers of saline solution and ice, and transported in a red medical cooler which was whisked away by an ambulance to the airport. It boarded the 7.40am flight from Indore to Mumbai.

Waiting on the other side was S Narayani, the faculty director at Fortis hospital, who was fretting about the traffic. The flight would arrive at 8.50am on a Sunday. But there was always a chance that Mumbai’s notorious traffic would delay the heart during its 18km trip from the airport to the hospital.

“As soon as our retrieval team had made sure that the heart was OK to be transplanted, we had told the police in Mumbai,” Dr Narayani said. “They created a green corridor here. We get phenomenal help from them. They take care of everything.”

By 7am, Dr Agarwal had already opened up Sweden’s chest and was waiting in the operating theatre for the heart. It reached him at 9.07am. Complications might have pushed the transplant past the four-hour time window, Dr Agarwal said, but within an hour, the heart was beating inside Sweden.

“All these teams have to pull together to make this kind of transplant happen,” Dr Narayani said. Sweden’s health is flourishing now, she added. “There’s a feel-good factor to being involved in this, which is why, I think, everybody does it. However small your role is, you think: ‘Wow. I’ve contributed to a life’.”