SCTIMST starts human valve bank

Thiruvananthapuram, July 16: The Sree Chitra Tirunal Medical Institute for Medical Sciences and Technology (SCTIMST), a pioneer in cardiology, has entered the realm of storing and preserving valves retrieved from dead bodies for live hearts, the first of its kind in the state.

The SCTIMST, which brought out the ''Chitra valve'', had set up a Homograft bank, a human valve bank, in collaboration with the Thiruvananthapuram Medical college.

''Homografts are considered to be more effective than artificial valves. The risk of blood clotting and infection is far less than the artificial ones and this prompts the surgeons to go for human valves. But in India, especially in Kerala, the availability and cost of the valves have become a major problem. It was at this juncture that we decided to go for a Homograft bank,'' SCTIMST Cardiac Surgeon and Project investigator Dr S Krishna Manohar told UNI.

''With the help of heart valve donation, two heart patients can be treated simultaneously, with the two valves derived from another human being who unfortunately lost his life,'' he said.

Though these human valves are available at only three medical colleges in the country, Dr Manohar said it costs around Rs 50,000 to Rs one lakh, which was not affordable for the common man. The SCTIMST ventured into the field so that it was available to all, he said, adding that the institute would not be charging any money for the valves, which were retrieved free of cost from the dead bodies.

''No money is spend for manufacturing this human valve. So we have decided to give it free of cost to heart surgeries conducted in the Institute and also at government medical colleges,'' he said and noted that this was a novel step in the field of heart surgery in Kerala and even in South India.

''But it is not that easy to start a bank with the infrastructure and facilities available here. The real component -- the human valve -- is needed. It is here that we have to be successful,'' Dr Manohar said, adding that strenuous efforts were needed for getting deposits in the bank.

''The valves are taken from dead bodies and this could be done only at the time of autopsy. And autopsy is conducted only in case of unnatural deaths. This is where the risk of getting the valve lies.

Even in normal deaths, no relative would allow to cut open the chest of the dead, which is considered to be something against the ethics. In unnatural cases, normally the relatives even try to avoid an autopsy if possible as it is considered to be against their beliefs,'' he said.

''There is also a social and psychological aspect to it. How can one ask a grieving relative to give the valve of the dead. Non one knows how he would react in such a condition.''

Noting that the attitude of the people would change in the coming years, he said in the initial stages, mass awareness programme could only change the attitude of the society and the people should be educated about the values of donating an organ. ''Years back, when people were asked to donate their eyes, there was some difficulty. Even in the case of kidney donation, the attitude of the people have now changed. So in the coming years, we can expect a more positive society,'' he said.

When asked about retrieving a valve from a person who had a natural death, Dr Manohar said it was impossible as no one would admit to cut open the chest of a dead.

When asked about the delay in coming up with such a 'bank' in a reputed institute like the SCTIMST, Administrative Medical Officer Dr Jawahar said the Institute had thought of setting up such a bank very long back. The delay was mainly due to legal and other procedures. We had to get sanction from the government and also approval from the ethical committees. But it was good that the bank materialised.

Elaborating on the Homograft Bank, Dr Manohar said the SCTIMST had signed an MoU with the Thiruvananthapuram Medical college, where about 20 autopsy were done a day. The forensic department of the medical college would detect the bodies from which the valve could be taken, as in normal cases the valve of persons who died due to poisoning, burns and other infections were not taken. After this, the SCTIMST team would collect the valve and get it to the Homograft bank for detailed investigation.

The valves which were found to be fit to be used is segregated according to different sizes and is preserved in a particular solution and stored in the cryo preservator. The valves should be collected within 24 hours of the death and it could be preserved for any time, he said.

With heart transplant assuming significance, Dr Manohar hoped the homograft bank was a prelude to the heart transplants in the state and said that this was a major aim of the institute.

Comparing with the artificial valves, both Dr Jawahar and Dr Manohar said the human valve was more successful as the risk of blood clotting and infection was far less after the surgery. But the only drawback was that the human valve was less durable than the artificial ones. The human valves would degenerate after 15 years and it should be replaced where as the artificial one would be there intact even after one's death.

On the possibility of getting homografts and also grafting a homograft valve into a heart, Dr Manohar said,''we have the technology and also the required expertise.'' Dr S Girish and Dr K Sreekumari of the Forensic Department, Medical college were also involved in the project.

UNI