The Hindu : Develop transplant programme: Donald Ross

Online edition of India's National Newspaper
Sunday, Mar 14, 2004

Tamil Nadu

Tamil Nadu

Develop transplant programme: Donald Ross

By Ramya Kannan

CHENNAI, MARCH 13. The worldwide shortage of human organs and tissues is increasing, says Donald Ross, renowned cardiac surgeon and pioneer of the Ross Procedure, also known as `autograft.'

In Chennai recently, Mr. Ross stressed the need to develop a substantial organ transplant programme in the country, particularly for preserving heart valves and human tissue.

"We have not been able to harvest as many cadavers as we want to. We probably will never be able to do that," Mr. Ross, who is a Fellow of the Royal Society of Medicine, London, said. But it was essential for nations to spread awareness of organ and tissue donation, he stressed. "People who die must donate their organs and their families must consent to this."

The British Heart Valve Bank, with which he was associated, has sent a large number of heart valves to countries across the world, including India. "But each country has to evolve its own organ donation programme."

However, awareness generation must be matched by training of surgeons and paramedical staff in the science of removing and preserving organs. "If frozen, the organs can be stored for ever and ever."

Mr. Ross, who was in the forefront of the burgeoning speciality of open heart surgery in the 50's, is probably best known for his work on the aortic valve and a procedure called the `autograft' — which uses a living heart valve to replace a diseased aortic valve.

"Basically, we were trained to believe in tissues replacing diseased parts of the body. We believe that there is no way we can make anything in a laboratory or workshop that can simulate nature," Mr. Ross said. Working as he was in an age "where they had not yet opened the heart," it was only after the heart and lung machine was invented that the `homograft' — replacement of the heart valve with a cadaveric implant — became possible. It was followed by the `autograft.'

Aided by the conviction that biological tissue was the best replacement of heart valve, Mr. Ross and his team, through trial and error, chanced upon using a cadaver valve. "We took a frozen cadaveric valve, thawed it and used it to replace the aortic valve. To our surprise, it worked. And, it went on working."

Then the team decided that using living valves would provide even better results. The alternative was to replace the aortic valve with a similar valve. "Fortunately the pulmonary valve, on the right side of the heart, is not so essential. We could use it, provided it could stand the strain. This was the basis of the `autograft' operation," Mr. Ross explained. It turned out that the pulmonary valve could indeed stand the strain, and worked effortlessly inside the human heart.

The second patient on whom the valve transplant operation was performed, 37 years ago, is still living, while the first patient died 30 years after the procedure was done — of cancer.

"Given the large number of rheumatic heart patients in India, it is very relevant that we can treat people with a living valve that does not require constant medical attention," Mr. Ross said. According to statistics, 30 per cent of all heart operations in the country are on rheumatic conditions.

"Autograft is permanent," he said, "But, prevention is the best," he added, making a case for launching a massive preventive health programme in the country. "It is the real answer to rheumatic heart disease. Why, even heart disease in general."

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