India still decades away from animal organ transplants, says leading AIIMS cardiac surgeon | India News – Times of India

Chief Cardiothoracic and Vascular Surgeon, AIIMS New Delhi, Dr. Devgaurau Velayudam, Speaks Padma Rao Sundarji For the Times of Online, the recent pig-to-human heart transplant in the United States and the future of xenotransplantation in India.
Q: Earlier this month, doctors at a U.S. hospital transplanted a pig’s heart into a human for the first time in history. Opinions are divided between biotechnologists and surgeons. Some are suspicious, others are excited. How are you
A: I see it both ways. On the one hand, it is a real milestone in science. There is always a lack of human organs. So, this achievement of the Maryland Medical Team is a great advancement in terms of science and what it can achieve. Their method began with genetic engineering. They have genetically modified a pig. Simply put, they had to deal with ten pig genes. They removed four, made a change to prevent the pig’s heart from growing, and added six genes. They did this to reduce the human response and to prevent the pig’s heart from growing after the transplant. The only doubt that exists is that since this is just the beginning, no one is sure. Even in the case of a human-to-human heart transplant, which should ideally be taken by the recipient’s body, an immune response may occur. There may be either hyperacute rejection or chronic rejection over time. So even for such transfers, we need immunosuppression. It is only in the long run that we will know how the US transplant is working, how the patient has been taken to the pig’s heart, whether doctors will be able to deal with immunosuppression in his case, and so on.
Q: It’s been almost two weeks since the transplant and the patient is still alive, so what qualifies you as ‘long term’?
Answer: In case of transplantation, we consider the condition of survival of one year, five years or ten years. The ten-year survival rate is currently touching 90%. So we should look at that figure in the long run, even for a pig heart transplant. This means that currently, 90 out of 100 people who have a human heart transplant live at least ten years. In the case of the US patient, we want to see and wait at least a year. If he lived that long, it would be a big milestone. Then, we will be able to evaluate how similar or different it was with a human-to-human transplant, what immunosuppressants to use and in what doses, how they work, and so on. Many of these questions will be answered over time.
Q: Are other pig organs also considered suitable for genotransplantation?
A. The main advantage of using pigs is that they become adults in a short time. Also, the heart of a pig is like the heart of a man. A pig’s kidney was transplanted into humans, but since it was administered to a dead brain patient, it was a test to see if it worked. And it did.
Q: Are you thinking of animal organ transplantation or genotransplantation in India?
A: See, there is a lot of cost involved for R&D, because it involves genetic engineering. The US is blessed to have public and private funds. Of course, we also have our Department of Biotechnology (DBT) and other resources in India, which help us in the study of genetic engineering. DBT has cooperation with the United States. They allow fellowships, researchers in this field of genetic engineering and all other types of exchanges. Things can get better over time.
Question: What is the situation in India regarding availability of human organs? Is it too critical, or an improvement?
Answer: Human organ donation is much more rare in India than anywhere else in the world. According to global data, India may be in a better position than other countries, but human organ donation is not as frequent here as in Spain. Even within India, grants vary between North and South India. Probably due to the level of awareness created there, most of the grants happen in the south, where in the north, there is still a division. Maybe we need to cover the urgency and push for more awareness here in the North as well. Because no matter what is said or done, we are still decades away from genotransplantation. So we should make every effort to create awareness about organ donation.
Q You have indicated cost as a factor. But due to religious or moral problems, organ donation is less in India?
Answer: I think religious matters are secondary. We’ve been using porcine tissue valves and bovine pericardial valves – these made from pigs and cattle, respectively – for decades. So far, I have not seen any patient deny them. When it comes to life and death, I think people choose life over religion. ”
Q: U.S. physicians can get permission to use a pig’s heart almost immediately. In India, we have the Human Organ Transplant Act 1994, but it does not mention animal transplantation even in case of extreme emergency. Should India start enacting new legislation to meet the future of animal organ transplants?
A law will evolve over time, of course. Consider the case of vaccines. It would take us a decade to develop a vaccine. Now, we are making vaccines within a year and passing them in case of emergency. I’m sure things will evolve; I don’t think legislation will be a big problem.
Q: Still, there is no denying that public health is still in recession. The same is true of R&D: India has lost a lot to the “brain drain” incident. The epidemic has been a blessing in disguise because it made India realize those flaws. Can you comment on both aspects?
A: We have very good scientific and engineering institutes. Also, biomedical engineering is available as a course in many private institutions and government colleges. I think we’ll see a boom. People have now seen what it was like with vaccines, so the better the brain will be, the more people will join these courses. You hit the nail on the head about the epidemic. People understand the importance of spending money on health and infrastructure. Luckily, we had good private hospitals, so with their help we were able to overcome the first wave and at least the second wave of the epidemic. Wave 3 will also be well managed now. The government is deeply concerned about the health infrastructure. They have been concerned before, but the way the epidemic has spread has shown us how far behind we are in the Western world. But, please note: the Western world has also shown reluctance to manage epidemics, because it is, after all, an event once in 100 years. So any preparation of any country can fail. Yet, it has made us realize what is important in our lives and – health is paramount.
Q: In 1997, Assam-based cardiac surgeon Dhaniram Barua transplanted a pig’s heart into a human patient. The patient survived for seven days, but the doctor was sent to prison and later, his professional reputation was attacked. What do you think about that early replacement?
Answer: Dr. Barua may have been ahead of his time. Also, at that time there was no regulatory body to oversee such national transfers. Furthermore, the pig used by Dr. Barua was not itself genetically engineered, so his method was different. But please remember: very few people know that even in the United States, there is no law that allows genotransplantation. Organ transplants are not allowed anywhere in the world. U.S. doctors had to get Food and Drug Administration (FDA) approval on an emergency basis because the patient had no other choice. He was not a candidate for a human heart transplant. Maybe no donor was available. Maybe he was already in artificial support and wasting time. A committee of doctors had to be formed to prove that no other therapy like Ventricular Assist Device (VAD) could be used on him. That’s how they achieved this milestone.

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