FEELING THE HEARTBEAT

The night of February 11–12th was an anxious one for the employees of the Republican Scientific Practical Centre (RSPC) for Cardiology. They managed to achieve something much spoken of in the media: Belarus’ first heart transplant operation. Moreover, it was achieved greatly ahead of schedule
The night of February 11–12th was an anxious one for the employees of the Republican Scientific Practical Centre (RSPC) for Cardiology. They managed to achieve something much spoken of in the media: Belarus’ first heart transplant operation. Moreover, it was achieved greatly ahead of schedule.

Back in 2007, the Ministry of Health foresaw the operation being undertaken by early 2010. Last April, the government resolved to encourage events forward and the first successful liver transplants were arranged, conducted by surgeons of the 9th Minsk Clinical Hospital (17 operations in all). Soon, heart transplants were being spoken of, but a suitable donor heart was needed; at least 100 Belarusians were on the waiting list, desperate for the chance of life. The Chief Heart Surgeon of Belarus, Yuri Ostrovsky, chose a 36 year old mother of two from Kletsk as the recipient; her youngest is just a tot…

Fifteen years ago, even Georgy Sidorenko, the legendary Belarusian cardiologist and academician, considered such operations impossible. When he was invited to Poland to observe patients who had undergone heart transplantation surgery, he was amazed: they were cheerful and active, moving about the corridors of the department! Even then, he felt hurt: why Poland, and not us?

Professor Ostrovsky noticed that neither Belarusian doctors nor the Health Ministry were ready to face such a challenge, “Though it is much easier for Belarus, as we learn from the experience of leqding countries.” It is a thorny path. The first attempt to carry out a heart transplant was made more than a century ago — upon a dog. It took 60 years before a human underwent the operation successfully. However, all efforts by heart surgeons came to nothing, with organs being rejected; gradually, interest died away.
By 1981, it seemed there was a breakthrough. “Within a year of their operation, 90 per cent of patients were still alive. Within 15 years, this fell to 40 per cent but one patient lived for 26 years after their transplant,” notes Prof. Ostrovsky. “Moreover, these patients had been given only a short life expectancy, according to doctors.”

“Only four Belarusians have ever succeeded in reaching the upper echelons of cardiosurgery,” notes the Director of RSPC “Cardiology”, Alexander Mrochek. With foreign clinics leading the way — although always elusive about their results — it seemed that trips abroad were the only answer for those needing the operation. Of 674 heart transplants in Germany in 2006, 5% were upon foreign patients. Unfortunately, demand ever exceeds the supply of donor hearts… Nevertheless, such transplants consume half the Ministry of Health budget for Belarusian citizens being treated abroad. It costs about 120,000 euros initially, plus 3,000 euros for each day of intensive care. Only two transplants can be afforded annually.

Of course, it’s cheaper to undertake the operations in Belarus. Taking into account special medicines, the cost is half that of western countries. Moreover, each transplant is undertaken with great seriousness; it’s no advertising trick or formality for the annual report. When the heart transplantation program commenced, heart surgeons foresaw ten operations a year, with corresponding estimated expenses: new equipment — $911,000, training — $120,000 and medicine — $420,000. The total was $1.4 million!

All in all, the doctors set 16 tasks — starting with the creation of a database and ending with resolving organisational questions (which, by the way, determine success). Liver transplants are technically difficult (taking 10–12 hours) but heart transplants require great organisation. Hearts last only three hours outside of body, whereas livers last more than 12 hours and kidneys can last thirty six hours.

RSPC “Cardiology” met its targets in record-breaking time — just 8 months. The first transplant could have been held in December but, several times, obstacles appeared: one donor heart was too big; and the family of another potential donor objected. Of course, such set backs are to be expected, no matter where one is in the world; this is why heart transplants are so precious…

Today, we can trace the stages of the operation hour by hour — from the moment when Anton Danilenko, the Chief of the Department for Donor Organ Transplants (named after N.Savchenko) of 4th City Clinical Hospital, received notice of a potential donor from 5th Hospital! A man had died in a road accident; their death would save another life — although their name remains confidential. At 1 p.m., RSPC haematology and transfusion specialists began taking blood samples. By 4.30 p.m., they knew that the heart was a match for five of the 26 patients on the waiting list. By 6 p.m., all were at the RSPC Cardiology Centre, but the candidates were finally narrowed down to two — both women, one from Brest, the other from Kletsk. At 10.30 p.m., after their last consultation, the doctors made a final choice. One team prepared the patient for the operation, another, at the far end of the city, prepared the heart. At normal temperature, cardiac muscle begins to deteriorate after 16 minutes, so doctors use a special solution, container and temperature conditions of 0 to 4 degrees centigrade to keep their valuable cargo viable during transportation. The heart was accompanied by State Automobile Inspectorate cars, with lights flashing. At 1.30 a.m., it arrived and, by 7.00 a.m., the operation was pronounced a success!

The event could not be kept secret although, according to the rules, surgeons are required to withhold comment for 48 hours after an operation. On February 12th, rumours were already circulating the city; perhaps superstitiously, people declined to name the operation precisely. One day later, Alexander Mrochek and Yuri Ostrovsky officially confirmed that the medical ‘Rubicon’ had been crossed. The patient felt good, their health rates were normal and they were stable. Even her husband and children were allowed to visit — indescribable joy!

However, the doctors emphasise that, although the first and most difficult stage is over, the most important is yet to come. The heart needs to adapt to its new body; if it fails, it will be rejected. To help the patient, her environment is being monitored closely, to ensure the risk of infection is kept to the minimum. Who knows how large Prof. Ostrovsky’s team is; some say 20 but it seems that at least 30 people are already involved. The idea is to award every team member with a special service medal but, of course, they’ll remember this wonderful achievement for the rest of their lives regardless. It was teamwork that won the day, and brought their shared dream to life.

Liudmila Gabasova
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