21August2014

World’s First Liver Transplant Chain saves 3 child

Gist:

  • Chain of liver transplant surgeries saves three children
  • The world’s first transplant chain, first-of-its-kind chain of liver transplants in the world, saving the lives of three children
  • Six simultaneous liver transplants save lives of 3 kids
  • 40 docs complete 6 liver operations in 20 hours
  • Three children get a new lease on life after staff  complete six simultaneous liver transplants in Gurgaon hospital

Doctors at Medanta Medicity in Gurgaon claimed to have conducted a first-of-its-kind chain of liver transplants in the world, saving the lives of three children. The surgeries involved a simultaneous swap-exchange of donated livers between families, besides domino liver transplant — wherein a patient undergoing liver transplantation is, in turn, able to donate his liver to another recipient.

The procedure, which stretched over 20 hours, involved six surgeries performed by a team of 110 surgeons — led by Dr A S Soin, chairman of Medanta Liver Institute. The children — three-year-old Tejasree Ramanathan, 23-month-old Anees Kakroo and 21-month-old Ansa Munshi — did not have any suitable donors in their families. While Anees had no donor at all, Tejasree and Ansa had mismatched ones.

Dr. A.S Soin Chairman Institute of Liver Transplantation and Regenerative Medicine

Dr. A.S Soin Chairman Institute of Liver Transplantation and Regenerative Medicine

Dr Soin said, “This surgery, the world’s first transplant chain, was like a rocket launch — with prior allocation of time and target-bound responsibilities to individual team members. We started at 4 am and wrapped up the procedure by 12 midnight. With this surgery, we also made the best use of an organ that seemed like a waste.”
The liver transplant team at Gurgaon’s Medanta Hospital created history of sorts by performing a chain of six liver transplants simultaneously on three children.
The situation resembled a scene from famous TV drama series Grey’s Anatomy where 40 doctors combine their medical genius to save the lives of three children. After toiling away for 20 laborious hours, they and 110 other medical and para-medical staff emerge from the six operation theaters victorious after the procedure was completed successfully.
Making history: Ansa, Anish and Tejasree after their complex liver
transplants with Dr A S Soin and Dr Neelam Mohan (in blue saree) in
Gurgaon yesterday. Doctors say this was the first time six simultaneous
liver transplant surgeries were carried out including a domino liver
transplant. pic/Rajeev Tyagi

But this was no rehearsed scene from a television drama but played out in real life when three children were operated upon simultaneously for the world’s first chain liver transplant operation at Medanta Liver Institute in Gurgaon.

Only a month ago, toddlers Tejasree, Ansa and Anish were complete strangers. But, their destiny was intertwined, as all three of them needed a liver transplant for them to survive their life-threatening complications.

However, none of the three could receive a transplant from their respective family members and that’s when they were brought together.

Explaining the three patients’ complications, a doctor from the institute said that 22-month-old Ansa and one-year-old Anish suffered from biliary atresia while three-year-old Tejasree suffered from a rare genetic condition called Maple syrup urine disease (MSUD), owing to which she could not digest any amino acids.

Tejasree’s father said that she could not even consume milk and had to only drink milk that their relative would send from the US that cost about Rs 50,000 a month.

Medanta Institute chairman Arvinder Singh Soin said, “Nowhere has anyone performed six simultaneous liver operations. This in itself is a record. All the six liver operations were linked to each other, which made it a Herculean, marathon task for us.”

Unique procedure

Tejashree Ramanathan, 3, Anish Kakroo, 1 year 11 months old and Ansa Munshi, 1 year 10 months old, were three strangers united by the common destiny for the need of liver transplant to survive.

Tejashree was suffering from a genetic disorder where the liver lacks a particular enzyme. Anish and Ansa had a congenital defect called biliary atresia, where the bile duct is missing.

The surgeries that were performed at the hospital on December 25, took 20 hours, a team of 110 medical staff members, including 30 surgeons and six operation theatres.

Two of the liver transplants were swap surgeries, wherein Tejashree’s father donated a part of his liver to Ansa, and vice-versa. The liver donation had to be swapped because the blood groups of both the children did not match their father’s and the mothers were unfit to donate. There was also a domino transplant, wherein a part of Tejashree’s old liver was transplanted into Anish’s.

Dr AS Soin, chairman, Medanta Liver institute, who led the team, said, “This surgery is the world’s first transplant chain and it was like a rocket launch with prior allocation of time and target-bound responsibilities to the individual team members. We had started at 4am and got over only after midnight.” “All of them were struggling for liver donors and it just clicked us that they could be of help to each other,” said Dr Neelam Mohan, paediatric liver specialist, Medanta.

The case is unique because the surgeries were linked to one another. If any one of the surgeries would have failed, the entire chain would have been broken, risking lives of all the three children.

Explaining the link and domino liver transplant, Neelam Mohan, chief paediatric hepatologist at Medanta Institute, said, “In swap or donor liver exchange Tejasree’s father donated a portion of his liver to Ansa and saved her life. Ansa’s father, Ajit Sajjad Mushi, donated a portion of his liver to Tejasree and gave her a new lease on life. The domino liver transplant happened in the case of Anish who did not have any suitable donor. After preliminary tests we realised that Tejashree’s liver which was otherwise normal but not medically of any use to her could work wonders for Anish.”

Parents of the three miracle patients are pleased at the success of the operation and say that the procedure was their last ‘glimmer of hope’ for their children.

The operation brought Tejasree’s family from Gandhinagar in Gujarat and Ansa’s family from Kashmir to Delhi. The surgery cost more than Rs 15 lakh for each child but the parents were satisfied.

“Before the surgery, Anish was admitted to the ICU four different times owing to heavy blood loss and even suffered a cardiac arrest. We were quite worried about the surgery but realised that this was the only way to help our child. Initially, we didn’t know the other children and their families but now we are all one big family,” said Ghaziabad resident Anuj Kakroo, Anish’s father.

The Medanta Liver Institute Medanta-The Medicity
Gurgaon (Delhi-NCR)
For further details, please contact
Dr AS Soin 9811207735
Dr N Mohan 9811043475
Mr Ajoy Sehgal , 09654079078 Mgr Media

kids reborn after liver swaps

Kids reborn after liver swaps

They were born miles apart but a common need brought Tejasree, Ansa and Anish together: all three children suffered from congenital liver disease and required a transplant to survive but none of them had a matching donor. In a rare medical accomplishment, doctors at Gurgaons Medanta Medicity Hospital conducted a chain of transplant surgeries swapping the liver of the father of two children and using a recipient’s organ for transplant to save all three children.

Twenty-two-month old Ansa and one-year-old Anish, suffered from biliary atresia, the congenital absence of the bile duct, while three-year old Tejasree suffered from a rare genetic condition called Maple Syrup Urine Disease (MSUD), due to which her body couldn’t digest milk or any other protein-rich food.

According to the Dr A S Soin, chairman and chief cardiac surgeon of the Medanta Institute of Liver Transplantation, where the operation was conducted, more than 100 doctors and paramedical staff worked simultaneously in six different operation theatres (OT) to conduct the transplant as any delay would have proved fatal.

The six liver operations, each linked to another, all at the same time, were a marathon task. We performed the transplant on Christmas Day because it was a holiday and the OTs were largely not in use, said Soin.

Dr Neelam Mohan, chief pediatric hepatologist at the Medanta Liver Institute, said the parents of Tejasree and Ansa readily agreed to swap their liver to save the kids. Tejasree’s father’s blood group was O-positive, while she was B-positive. In case of Ansa and her father, it was vice versa. We persuaded both parents to donate for each others child and they agreed readily. Tejasree’s liver was structurally and functionally normal, lacking only in a particular enzyme which is present in the muscles of non-MSUD patients so we used her liver to conduct the transplant in Anish’s case. We were able to pull it off and save all three children, she said.

Muhee, Ansas mother, was unable to hide her happiness.  She has become fairer after the surgery. Due to liver disease and jaundice, her color was pale, she said. P M Rangnathan, Tejasrees father who donated part of his liver, said he had sold off his property for his daughters transplant that cost him Rs 15 lakh (approx).I have two children. The elder one is deaf and dumb, he said.

Monica Kakroo, Anish’s mother, said he had suffered two heart attacks earlier but survived. This operation was a godsend opportunity and we thank the doctors, said Kakroo.

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