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Thursday, 8 December 2016
Sricharan R

Chennai: Indian surgeon, Dr Mohamed Rela, is known all over the world for his work in liver transplantation. He has also entered the Guinness Book of Records for performing a liver transplant on a five-day-old kid.

Professor Rela, director and head of the Institute of Liver Disease and Transplantation, Global Hospitals, recently performed a liver transplant surgery where he and his team split a liver they got from a donor and gave it to two different patients (an infant and an 8- year-old kid). They also performed on the same day a third liver transplant on another infant who was from a different country - which was done in a record time of 18 hours.

Professor Rela talks to 'News Today' and shares his thoughts.

Q: How common is pediatric transplants here in India?

A: I would say the number of pediatric transplants done in the country will be around 100 -120 a year. But the requirement of transplants for children will be around 3 - 4 per million population. That's like 4,000 children a year needing liver transplants a year. Awareness is lacking and that is one of the main reasons for this mis-match. Other  reasons include that many are unsure of what is going to happen and what will be the outcome. Are they going to be normal? Are they going to be on immuno-suppressants life-long? The parents' perception is that the child won't be normal. 

These children need to be on life-long medication and they need to be  supervised regularly. The unique thing about the children is the usage of  immuno-suppressants is lower than that of an adult. Usually, when they are transplanted at a very young age they dont require that much  medications. 

When the immune system becomes mature, they will be able to recognise the foreign cells. But when children are transplanted within two years of age, their immune system is very young and immature. Which is why in a newborn child, before it is formed, if you implant anything it will accept it. The earlier you transplant a child, the better it is. It benefits the child. 

There is something called immunological tolerance, because of this the  child's immune system fails to recognise the foreign organ and accepts it.  So, they wont need too much of immuno-suppressants. There is also a possibility of withdrawing the immuno-suppressants for children. There is no need to even match the blood group if it is done on a one-year-old child. If you think the child needs a transplant, it's better to do it at an early stage. 

Q: Why is it earlier the better?

A: If the child is unwell for 4-5 years and we do the transplant at a later  stage, it takes time for them to recover. If we put them back in school,  they don't catch up in education.They are always considered mentally at  the bottom in school. It is always recommended and particularly for  biliary atresia children to have transplant just before school-going age. That makes them physically and mentally ready. 

Liver disease produces a sort of a sub-clinical illness that is very difficult to recognise -  it can cause encephalopathy, which is slowness in thoughts. That is difficult to diagnose in a child. Parents may come to the conclusion that their children is slow in their education and may get used to it. But that may not be the actual reason. It will be because of a liver disease.

Q: How are they diagnosed?

A: Children may not perform well because of clinical encephalopathy. They will not be bright, they cannot concentrate, they will be sleepy all the time and won't play in school. Some parents may accept these conditions as normal. If the family has a backgrournd of liver disease, they should get their children checked.

Most children's parents will know if they have a liver disease. The child will have a pot belly, big spleen, etc. Parents usually think that even if the child is unwell they can go on for years without treatment. That is a mistake: they don't like to tell the outside world that their child is sick. As long as their child is coping well with the environment, they are ok with it. Parents shouldn't postpone a transplant that is needed.

Q: Tamilnadu leads in cadaver transplants. Is it being fully utilised?

A: I think so. We need more: we shouldn't say we have enough. We are  leading in the country. Still we are only doing donor rate of 1.5 per million  population. USA, the UK and Europe will do something like 14 -15 per million population. We need to catch up as it is almost 10 times higher than ours. But  we are doing well. Our Health Minister, Dr Vijaya Baskar, recently got an award in Delhi for performing well with cadaver transplants.The average of rest of India will be like 0.1- 0.2 per million population. We are 10 times higher than them, but the world is 10 times higher than us. But this has not stopped  advancements in liver transplants in India.

Q: How do parents accept donating the organs of their children?

A: That requires a special level of understanding and education for the  parents. Parents will know that the parts of their child is living in other  children. I think that is a huge comfort factor after losing their child. 

Q: Are youngsters these days into donating organs?

A: The present generation is donating much better. They are well-educated and informed. Our problem lies with the older population. Because they are still fixed in their ideas. The younger people always want to donate. They want to change the world.



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