Transplanting hope

by Shreyashi on Aug 30, 2010      Category: Health & Disability Tags:


Transplanting hope

M. Somasekhar

With over 800 liver transplant procedures to his name, Dr Mohamed Rela is one of the world's top liver transplant surgeons. His work won him an entry in the Guinness Book of Records in 2000.

On `Mothers Day', a unique story in organ transplantation unfolded in Hyderabad. The mother of a brilliant young school boy, Aditya Kaushik, who lost his life in a tragic and ill-fated fall from a terrace, took the rare and brave decision of donating all his organs. Consequently, the CARE hospitals harvested the heart, the Global Hospitals took the liver and kidneys and the boy's eyes went to the L.V. Prasad Eye Hospital. This noble act by the parents and the quick coordination by MOHAN (Multi-Organ Harvesting Aid Network), a Chennai-based NGO, to intimate hospitals about the organ donations gave a fresh lease of life to five people. Among the doctors involved in the memorable feat was Dr Mohamed Rela, a UK-based Liver transplant surgeon of international fame and Indian origin. He led the team at the Global Hospitals where the liver transplant was done.

At 45 years, he is considered to be among the top liver transplant surgeons of the world. Dr Rela has a record of 800 liver transplants against his name, including the one preformed on his youngest patient — a five-day-old Irish boy, which won him entry into the Guinness Book of Records in 2000.

The surgeon, who heads one of the four top-notch transplant teams at the King's College and Hospitals, London, has pioneered the `split liver' transplant surgery which involves the division of a healthy donor organ to ensure that two patients' lives are saved. In addition, he is an expert at live donor transplants.

However, the journey to the top for this native of Mayiladuthurai village in Tamil Nadu has been a rough one. A student of the well known Kalakshetra School, Chennai, and later a graduate in medicine from The Stanley Medical College, Chennai, Dr Rela says he always wanted to be a doctor, especially a surgeon. However, in Chennai he had to wait for two years before he could specialise in surgery. So, after an MS from Stanley, he went to the UK, where he did an MS from Edinburgh and also got an FRCS by 1988.

For five to six years Dr Rela worked as a surgeon in various hospitals in the UK before he made it to the prestigious King's College and Hospital in 1994. "The first liver transplant was done here in 1989 and I was really fortunate to enter the field and King's College at the right time. It gave me the opportunity to develop new techniques. I have now worked for over 10 years in the field of liver transplantation at the largest liver transplant programme in Europe, where over 190 liver transplant operations are performed every year, " he says.

Dr Rela started the successful programme of split liver transplantation at King's College Hospital and popularised it in the country. King's now has the largest experience in the world for split liver transplantation with results not matched by other major international units. It is also the only centre in the UK performing living related liver transplantation.

On treatment procedures in India, he says that as the incidence of liver complaints was not high and hence the awareness levels were lower. He says that only five per cent of liver diseases can be attributed to alcohol, while hepatitis B and C are the major risk factors. Liver cancer is triggered by hepatitis B or C. While the former can be prevented by a vaccine, there is no vaccine for hepatitis C. Further, liver cirrhosis is not reversible, says the surgeon.

Liver transplant is offered today to people who are likely to die in one year. The success rates for stabilising chronic liver diseases is 90 per cent, while in acute liver diseases it is 80 per cent. If the recipient survives 5-10 years post transplant, he is likely not to die of liver-related diseases later. Today, there are patients who have survived a liver transplant for 25-30 years, compared to about 10 -15 years survival in heart transplant cases. Interestingly, the incidence of rejection of the organ is also comparatively low, since "the liver is an immunologically privileged organ compared to the heart or kidney."

However, the big problem is getting donors. In eastern countries such as Japan and China, cultural beliefs come in the way of organ donation. Even in India, the donora are a handful in a population of over one billion. It is estimated that in Western countries, the figure of organ donors is about 15-16 out of a million population and most of them are multi-organ donors. In Spain, this number touches 32 per million. For organ donation to improve there is an urgent need for high quality and well-equipped Trauma Centres.

While there has been tremendous success in other organ transplants such as the heart and the kidney, liver transplants, and even developing an artificial liver, has been far more challenging, says Dr Rela. This is because the liver is a much more complex organ. Whereas the heart's main function is to pump blood and the kidney functions like a filter, the liver performs numerous tasks from aiding digestion, to metabolising fat to blood clotting. However, liver transplants with a good success rate have become a reality in select countries in spite of the high cost of the procedure. In some cases, an artificial liver is used, which provides dialysis as in the case of a kidney, and acts as a temporary life support system.

Having published more than 100 scientific papers and trained a large number of surgeons who have set up the liver transplant programme around the world, Dr Rela is now concentrating on developing techniques which would help do away with liver transplant. These include, cell therapy and stem cells. The third area is research on new immunosuppressant drugs, which will be better tolerated by the human body, and therefore reduce the rate of rejection.

In cell therapy, the thinking is that instead of replacing the liver, a single cell injected into the recipient would slowly grow into a normal liver. Experiments have been conducted from foetal cells, cadaver cell and even cells from certain animals like dogs, but there are ethical questions attached to these procedures.

Stem cell therapy, on the other hand, is an area that needs to be more intensively researched before it becomes reality, says Dr Rela. The surgeon believes in sharing of expertise, especially among developing countries. He has been personally involved in building up the infrastructure in some units apart from performing operations at different centres.

Dr Rela's association with India has increased in recent times after his collaborative efforts at the Hyderabad-based Global Hospitals, which has established a full-fledged liver transplant facility. The Technology Development Board (TDB) venture fund, under the Department of Science and Technology (DST), has provided a funding of Rs 10 crore. During the last one year, Dr Rela has been the main driving force at the Global Hospitals, conducting liver transplants in Hyderabad.

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