Fifty years after the world first heart transplant surgery an expert team of medical professionals led by Cardiac Surgeon Dr Anil Abeywickrama performed Sri Lanka’s first heart transplant at the Kandy Teaching Hospital on July 7 this year. The groundbreaking surgery brought a new lease of life to the recipient while also bringing renewed hope to other patients suffering from heart failure with the surgery being declared a huge success.
It was in this background that a team of doctors geared up to perform the second heart transplant surgery in September. The recipient would be 19-year old Sachini Sewwandi Kaluperuma from Kaluwamodara, Aluthgama. The second child in a family of three children, Sachini had lost her older sister seven years ago due to an undiagnosed heart ailment. Without the necessary transplant surgery, Sachini who had been receiving treatment at the Kandy Teaching Hospital from March would have suffered a similar fate as the functioning of her heart was reduced to 10 percent. According to her father Mahesh Kumara, the doctors had recently declared that his daughter only had two months to live.
Therefore while the move to commence heart transplants in Sri Lanka brought hope to their family however unlike the first heart transplant, this surgery was embroiled in controversy and clashes since its inception. Nevertheless, Sachini received her new heart on September 27, but despite the initial success of the transplant surgery, she lost her life just three days after while recuperating in the ICU.
With the success rate of heart transplants the world over being around 85 percent the death of Sachini has now once again caused much debate with her parents casting their doubts as to if their daughter was given the proper post-surgery care in the ICU. Speaking to the Sunday Observer, her father voiced several of his concerns regarding how the post care was handled while also questioning if several other incidents leading up to the surgery had caused the death of his daughter.
A parent’s doubt
Mahesh Kumara appears to be cynical regarding the behaviour and post-surgery care provided by the Anesthetic and ICU medical professionals involved in his daughter’s surgery. The seed of this mistrust perhaps was sowed when efforts to conduct the transplant on September 20 were thwarted due to objections raised by the leading Anesthesiologist. Reported in the media as a tussle between medical experts according to hospital sources however the Anesthesiologists and ICU medical professionals had expressed their concerns in conducting the surgery without the necessary monitoring equipment despite the surgeons agreeing to conduct the surgery.
Speaking to the media at the time, Director of the Kandy Teaching Hospital Dr Saman Ratnayake said the monitoring equipment was needed due to an existing complication in the patient. In fact, the existing complication was present in her lungs sources said. ¨Therefore several doctors advised against proceeding with the surgery without the necessary equipment¨ he said.
However after a discussion between the Minister of Health and Indigenous Medicine Dr Rajitha Senaratne a second attempt was made at the transplant on September 27 after securing another matching organ.
According to Mahesh, it was after the surgery that things began to go downhill. ¨Dr Abeywickrama conducted the surgery successfully and my daughter was fine post surgery¨ he said adding that however, he was less than satisfied with the care given by the ICU doctors. ¨There was blood dripping from her arm and her breathing was fast paced but I was told it was normal when enquired” Mahesh said. According to him, he was also told by the leading Anesthesiologist that a special medication was needed for the treatment post surgery but they were unable to inform the parents of it because they were not aware of when exactly the surgery would take place. ¨She said it had to be brought six months before the surgery¨ he claims questioning why no mention of it was made before her death.
What has also upset him are what he says harsh words uttered to him by the same Doctor. ¨She said if the surgery is not successful do not try to make any statements to the media and even if I did that it will not affect her¨.
More doubts have also been created in the parents’ minds due to the failure of the hospital to hand over Sachinis medical records to her parents after her death. ¨When we went to get my daughter’s body released they had still not sent over her medical records¨ he said adding that they claimed to still be compiling it. According to Mahesh he still has not received them and therefore is planning to file a Human Rights Petition in this regard.
Cause of death
Yet another contention now appears to be the actual cause of death. According to her father, the post mortem has concluded that the cause of death is heart failure caused due to high blood pressure in her lungs.
¨This is what they told us but I am now hearing things to the contrary¨ he said adding that he has now been told it could have been due to her contracting septicemia.
Since the death of Sachini doctors involved in the surgery have maintained a stoic silence regarding the matter including leading Anesthesiologist Dr Jagathi Perera while Cardiac Surgeon Dr Anil Abeywickrama also remained uncontactable. When contacted Director of the Kandy Teaching Hospital Dr Saman Ratnayake said he is unable to comment and all queries regarding the issue should be directed to the Ministry of Health. However agreeing to speak under anonymity a Doctor from the Kandy Teaching Hospital claimed that there is evidence now to show that Sachini could have died due to contracting a bacteria during the post-op period. However, the exact cause of her death continues to be a mystery with Minister Senaratne this week ordering a probe into the death of Sachini to ensure it was not caused due to neglect.
Ministry investigation
In fact, it was Mahesh that had requested the Minister for an investigation into his daughter’s death. ¨This should not happen to another patient and that’s why I requested the Minister to look into this¨ he said adding that he is determined to find out if any wrongdoing or neglect led to the death of his child.
With no surgery being risk-free this investigation could possibly shed better light on the various circumstances surrounding the incident leading up to her death while also possibly implicating or absolving those whom now have serious allegations levelled against them. Announcing the investigation Dr Senaratne said having spoken to all parties involved he is confident that the death did not occur due to any purposeful action by anyone. Nevertheless, he declared that an investigation will be conducted to determine if any party had acted in a neglectful manner.
¨Serious action will be taken against anyone who is responsible¨ he said adding that if disagreements between parties resulted in this will also be looked at. According to the Minister initial investigations show that a bacteria may have entered her body while recuperating.
While the investigation launched is yet to conclude, the public have expressed their hopes that one failure would not lead to the halting of heart transplant surgeries, dashing the only hopes of many critically ill heart patients in Sri Lanka.