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LIFE-GIVING JOURNEY

Dr. Harischandra’s team preparing to harvest the kidneys at the A’pura Hospital

A medical first is created as a team of doctors go to Anuradhapura to get two kidneys from a cadaver organ donor, bring them back to Kandy and carryout transplants on two patients. Kumudini Hettiarachchi reports

Only a few would have cast a second glance at the ambulance with flashing red light carefully wending its way from Anuradhapura to Kandy, little realizing that the four-hour journey was in fact a trailblazer.

For, the medical team ensconced in the ambulance that Sunday in February was carrying precious “life-savers” – two healthy kidneys from a young man who had unfortunately succumbed to a head injury sustained accidentally.

Thanks to those kidneys “harvested” from this brain-dead soldier from a remote village in the North Central Province, 21-year-old K.M. Dharshana Ruwan and 30-year-old G.M.S. Gunatilleke have received a new lease of life.
And the memories of that weary but fulfilling day, February 12, would remain etched forever in the minds of Dr. P.K. Harischandra, the Consultant Surgeon of the Nephrology and Transplant Unit of the Kandy General (Teaching) Hospital, and his team of two more doctors and two nurses.

“It was Sunday and happened to be a poya day,” recalls Dr. Harischandra. The call from Anuradhapura’s Medical Superintendent Dr. L. Gamlath came on Saturday night, telling him that there was a brain-dead patient in the ICU. “Commending Dr. Gamlath’s initiative, we told them how to look after the patient, maintaining his physical condition optimally.”

Getting the consent of the brain-dead patient’s family was of vital importance and Dr. Harischandra’s anxious wait began, with the other members and an ambulance on standby. “Sunday morning, we were informed that the patient’s wife had given her consent,” says Dr. Harischandra stressing that her decision helped save two lives.

Events happened quickly thereafter for in such delicate procedures time is of essence. The ambulance left Kandy for Anuradhapura and the operation on the brain-dead patient took place at 3 the same afternoon.

“We harvested both the kidneys of this brain-dead person whose family willingly consented and helped save the lives of two others,” says Dr. Harischandra, whose team immediately set their sights on Kandy soon after without considering fatigue or the need for sleep, leaving Anuradhpura at 5 p.m. and reaching Kandy at 9 p.m. on Sunday.

The story is different in the west, where with state-of-the-art facilities, organ harvesting is done in one centre, the organs are matched and in many instances airlifted to hospitals where the patients are awaiting transplants.
In Kandy, working against the clock, the team transplanted one kidney at 10 the same night and the other at midnight, putting down their scalpels only around 3 the next morning.

“We have been doing transplants with kidneys taken from cadavers or people who are brain dead since November 2004. But both the cadaver organ donor and the kidney recipient had been at the same hospital -- the Kandy Hospital. This was the first time that we went to Anuradhapura, got the kidneys from there, brought them back here and carried out the transplants,” says Dr. Harischandra.

So far Dr. Harischandra and his skilled and dedicated team have carried out eight transplants with kidneys harvested from five cadavers. “From two cadavers we could get only one kidney each,” he says explaining the numbers.
The procedure is tedious, for once it begins it cannot be halted. “These are long procedures and happen at odd times,” he concedes.

The transplant programme of the Kandy Hospital began in 2000 and so far 248 transplants with kidneys from living donors and from cadaver organ donors have been carried out for men, women and children, the youngest being just 10 years old. The transplant programme was expanded to include, for the first time in the country, cadaver organ donors in 2004.

Sri Lanka also carried out another pioneering procedure in May 2005 when the team in Kandy harvested a kidney from a non-heart beating cadaver. “Usually, if the heart stops, all the other organs stop as well within 20-40 minutes. We were able to get the kidneys out before that,” says Dr. Harischandra simply.
Explaining why transplants with organs from cadaver donors are not common in Asian countries like in the west, Dr. Harischandra says that most governments in Asia are not motivated to implement such a programme as there are socio-cultural and also religious taboos. “Singapore and Hong Kong have good programmes but not other countries.”

The Sunday Times learns that the cadaver concept originated in the west about 40 years ago, with most organs such as heart, liver, pancreas, kidney and lung being harvested from cadavers. Stressing the dire need for more kidney donations, both by living donors and from cadavers, Dr. Harischandra laments that the number of patients on the dialysis list is growing bigger. At the Kandy Hospital, there are 120 on the list who are suffering from end-stage renal failure whose kidneys have packed up forever. “Some have living donors, but as many as 40 don’t and for them the only hope is a kidney from a cadaver,” he says.

His words ring true as The Sunday Times visits Dharshana Ruwan, recipient of one of the kidneys brought from Anuradhapura, temporarily living in tiny rented rooms close to the Kandy Hospital, after the transplant. From Kirimetiya in Polonnaruwa, his mother, K.A. Ranjanie relates their agony since 2002. Ruwan, who was finding it difficult to even walk fast without panting, left school before his O/Ls. He helped his father plough their fields one season and found his ankles swelling up.

At Gal Amuna Hospital, he was told that he had wakugadu amaruwa and sent to the Polonnaruwa Hospital from where he was directed to Kandy. A battery of tests was followed by treatment to keep him alive because he too was a victim of end-stage renal failure. “My stomach was washed for three days with 60 bottles of saline,” adds Ruwan. Thereafter he underwent 47 dialysis sessions.

Sighs his mother, “We had a donor but the match was not right.”
His life changed when he went for dialysis on February 12. He was told to come to ward 64 and “wakugaduwa badda kara eda re”. “Den hodai,” he smiles adding, “I have got my appetite back.”

While Ruwan makes arrangements to go home soon, with future plans including opening a tiny shop in his village with sillara badu, Dr. Harischandra’s vision encompasses distant hopes.

“Maybe 30-50 years down the road we will be able to harvest not only kidneys but also organs such as the heart, pancreas, liver and lungs from cadavers and transplant them in men, women and children who would otherwise have died,” he says.

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