Prof M Saleem Wani (SW), Head Department of Urology at Sher-e-Kashmir Institute of Medical Sciences Soura, needs no introduction. He has for long been the torch-bearer of Kidney Transplant program in J&K and an avid proponent of making Organ Transplants more accessible to those fighting for life due to an irreparable organ damage. His contribution was acknowledged last week at the Economic Times Conclave. He spoke to Greater Kashmir Correspondent ZehruNissa in an exclusive interview about Organ Transplants and the vision for J&K.
Tell us more about this feat?
SW: Economic Times has been conducting this conclave every year to acknowledge and honour the healthcare professionals who have excelled in their own fields. For me, it was a very humble moment when I was informed that I am one of the doctors in the list this year. It was an overwhelming experience to share this recognition with 20 leading urologists from across the country, many of whom have been my mentors and teachers. At another level, you feel a sense of pride that the efforts of doctors from Kashmir are being recognised. You see, every year many doctors from Kashmir bring laurels to the place; this in itself is a vindication of the quality medical care, education and research in Kashmir. This also reflects on the dedication and hard work of our doctors, who often function in challenging situations. I am sure that you will continue to see many doctors from Kashmir get recognition and acknowledgement at the national and the international levels.
The Press Statement by ET acknowledged your contribution towards starting and carrying forward Kidney Transplants in Kashmir?
SW: In Jammu and Kashmir, Kidney Transplant is carried out only at SKIMS Soura, as it is the only Government authorized center. Organ Transplants, including Kidney Transplants are done under strict laws – the Human Organ Transplant Act. The Act governs who can donate an organ, who can receive an organ and who will transplant an organ. At SKIMS, the Kidney Transplant was started in 1999-2000. In the past 21 years, we have done more than 400 transplants. We are a high volume Kidney Transplant Center with success rate at par with the best of the medical institutes of India. We cater to patients from across the regions of J&K. You will be surprised to know that we have transplanted the kidneys of some security personnel from other states as well.
However, there is much more we envisage and envision for the people of J&K and for the medical sciences here.
Are you referring to cadaver transplant?
SW: Absolutely. We are only doing live related kidney transplants here. However, we would like to start the cadaver or deceased donor based transplants. It is my endeavour to make this possible here.
What are the requirements for starting this type of organ transplant?
SW: The first thing that we need to do is create awareness, first of all among masses, about what brain stem death means. For example a person suffers a Road Traffic Accident and except for his breathing being supported by a ventilator, there is no life activity in him or her – brain stem is dead. If there is no ventilator, these patients would be in a vegetative state. We have so many people across ICUs of the country. These people can save lives and make lives better for so many people by donating their organs.
A person can donate two eyes, liver for two people, pancreas, kidneys, lungs and all the tissues. In a nutshell, a dying person can save the lives of at least seven people at times. This awareness needs to be created among medical professionals as well as people.
Many people would know this, but then there are inhibitions.
SW: We need to talk about these inhibitions to address them. The first questions would be – Is it permitted under law in India? Yes, it is. Then there would be the question of whether it is permitted under religions? Yes, it is permitted. There is no bar on organ transplants in Islam, or other religions.
In 2017, we had an update on cadaver transplant where we got all the religious heads to SKIMS Soura to discuss and deliberate upon the religious aspects of organ donation and receiving. We had religious heads from various religions. It was unanimously agreed that organ donation is an act that no religion is against. In fact, one person at that moment only pledged to donate his organs.
However, the program could not go ahead as we were hit by many unexpected situations in J&K that pushed the project behind, the pandemic being one of them.
Do we have infrastructure available in Kashmir, or SKIMS for the deceased donor based organ transplant?
SW: Of course we do. We need a Super Specialty Hospital with Urologists, Kidney Transplant Surgeons, Cardio-vascular Surgeons, Liver Transplant Surgeons, Pathology and other supportive back-up departments. All of this human resource is available with us at SKIMS.
We need to have a committee that is called the Brain-Death Certification Committee. This committee consists of a neurologist, an intensivist and a physician and these specialists certify that a certain person is brain-stem dead. None of these people can be part of the transplant team as per Human Organ Transplant Law.
Then comes the role of counselors to counsel the family about organ transplant. Once their consent is procured, the organ retrieval team takes the organs and a green corridor is provided to these organs. Transplant teams across hospitals of the region are alerted and the best match is provided to hundreds waiting for an organ to start afresh in life.
This is what we need to get running. It is happening in north India, in south India. There is a foundation in south India called Mohan Foundation that has done a wonderful job on making organ transplant stories a success in India.
How far have we progressed on making this possible?
SW: SKIMS needs to be upgraded, it is the need of the hour. I had given the concept Nephro-Uro Sciences where all the medical sciences related to kidneys and other cadaver transplants can be carried out. We had submitted a preliminary project report. We urged that the concept be approved and supported to make management of many life threatening diseases possible in the most advanced manner in J&K. However, not much has happened since 2017. I take this opportunity to request SKIMS administration and Government of J&K to help us realise this dream project which will mitigate the sufferings of lakhs of patients.
Only recently I received a call from Dr Vasanti Ramesh, the Director General of National Organ and Tissue Transplant Organisation (NOTTO). She urged that we revive the work on starting the Cadaver Organ Transplant in J&K. The urgency for this program is that there is a huge gap between organ donors and organ recipients.
There is a gross shortage of savior organs. There are more than 2 lakh people requiring kidney transplant in India, every year. Less than 5- 6 thousand are done.
How many people need a kidney transplant in J&K?
SW: The incidence of kidney diseases is very common in J&K and renal replacement therapies, including kidney transplant, are needed by thousands. The burden of disease affecting kidneys is the same as in other parts of India. There is a gross organ shortage and we are unable to cater to the need. We just do one kidney transplant a week, four in a month. That is not enough.
How is the scenario of dialysis in Kashmir?
SW: A lot of people need kidney transplants and a very high number need to get dialysis. Government has been doing a good job of training manpower and empowering hospitals and institutions to deliver hemo-dialysis and save lives of people. Dialysis facilities have multiplied, costs have reduced and patients are getting benefited. There are schemes that are incentivizing groups and organizations. However, I feel it is not going to address the problem at hand. We need to do more and dialysis needs to be more accessible in districts other than Srinagar. Dialysis is needed by the patient once or twice a week and it needs to be in the vicinity for ensuring adherence to the set regimen.
One good thing that has happened in J&K over the past couple of years is that we have new medical colleges in five districts other than the capital ones. These medical colleges can become major centers for kidney disease patients. Efforts to augment such facilities in these medical colleges need to multiply.
We also need a well-equipped private healthcare sector that can support the Public Healthcare sector.
Has the pandemic affected kidney diseases in Kashmir?
SW: The ongoing pandemic has thrown challenges for every aspect of healthcare, including for patients suffering with kidney disease. It is going to take a long time to recover from these effects. The CKD patients were one of the worst hit in the sense that our kidney transplant program was forced shut during most parts of the pandemic as has been across the Globe. It is because the patients are very susceptible to infections because of immune-suppressants. We have to be very careful about them.
We resumed in November last year and we created a bio-bubble where we segregated the donors and recipients for two weeks before the transplant was done – total quarantine and thankfully we did not have any COVID19 emergency. But we had to stop again in April this year when the second wave hit. Hopefully, in the next couple of weeks, we hope to start again. Similarly, we had to have separate protocols for people getting dialysis.
We need to conceptualise and upgrade our treatment protocols as COVID19 as a pandemic seems to be infiltrating every arena of healthcare. Many of the hospitalized patients have acute kidney injury, many have kidney failures; Then there are people with long COVID. We need to address all of these issues.
What is your message to people?
SW: Organ donations can save millions of lives across the world. Please come forward and save a life. All religions permit it. Take the pledge and take a step – donate.
How can we have healthy kidneys?
SW: First and foremost cause of kidney diseases is diabetes and hypertension. Follow the advice of your doctor to manage both these diseases. We live in the stone belt zone and stones in kidneys are very common here. Take care of your kidney stones and see a doctor for them. Do drink a lot of water and avoid high protein and high salt diets.