Heart transplantation in Kazakhstan: hundred people need but not everyone gets
According to experts, due to a deficit of heart donors, the cardiac centre of Astana takes to alternative solutions - the implantation of artificial organs.
The National Scientific Cardiosurgical Centre (NSCC) in Astana is the only one in the country where unique donor organ transplantation and artificial heart implantation are performed. First Deputy Chairman of the Board of NSCCs, Doctor of Medical Sciences Mahabbat Bekbosynova told in an interview with BNews.kz about the origin of new technologies in cardiac surgery and how they help patients to prolong and improve their life.
- This refers to new technologies in cardiosurgery. Tell me, please, what is being implemented now in Kazakhstan? Are there technologies in your center that are not available anywhere else in the world?
- The main program of our centre is surgical treatment of the terminal stage of heart failure. The terminal stage is when a patient can no longer walk, has no opportunity for self-care, is constantly on intravenous drug introduction, without any quality of life. So new technologies are born from the needs of our patients. According to statistics, about 15 million people in Europe today suffer from heart failure, the terminal stage of heart failure is about 500 thousand. Half a million people in the world need heart transplantation. Heart transplantation is now a quite problem not only in Kazakhstan, but all over the world, because the number of donors decreases. High-tech technology is replacing heart transplantation.
- How many people does need heart transplantation?
- Around one hundred persons are in our list. Herewith annually 30-40 our patients slip away. We have 10 patients per 1 million people who need heart transplantation. Taking into account the fact that the population of Kazakhstan is 18 million people, 180 patients are obtained. In our centre six patients are waiting for the transplantations, unfortunately we have no donors. This year we carried out eight surgeries. Our annual demand is 180-200 hart transplantations. However, we do not cover then whole volume. And I suppose 300 people are needed heart transplantations minimum. The one side of the problem is a luck of donors and the moral ethic from the other side (talking about heart transplantation means we expect that someone will die and give his heart to another person)
- What is the alternative to transplantation?
- High technology is now replacing heart transplantation. I mean the artificial left ventricle. We have implement this program for 7 years, since the opening of our clinic. In the world it has existed for 50 years, but this practical mass application of an artificial left ventricle has been occurring for the last 20 years. Today, the Register of the Society for International Heart and Lung Transplantation has about 15,000 patients. He performed implantation of artificial devices: an artificial left ventricle, support for two ventricles, Total Artificial Heart operation - the heart is completely withdrawn and mechanical is placed. (2% of 15 thousand patients).
- How many of such patients are in Kazakhstan?
- To date our clinic carried three Total Artificial Heart surgeries within international trial CARMAT. CARMAT the designer and developer of the world's most advanced total artificial heart project, aiming to provide a therapeutic alternative for people suffering from end-stage biventricular heart failure. We have operated three patients with an artificial heart, in Prague - already 7 patients and 6 patients in France. Our country stands out by the fact that we are the only clinic in the world today, which made these patients, two out of three, heart transplantation. Patients who could not wait for their donor for medical, vital indications were implanted completely mechanical heart: the first patient - in 8 months, the second patient - in 5 months. This is what Kazakhstan is currently singling out in the world cardiac surgery, because nowhere in the world such operations are carried out yet.
- Does Kazakhstan make children cardiac transplantation?
- We have a program of heart failure for children, there is a department of pediatric cardiology, pediatric cardiosurgery. We are preparing children for a heart transplant operation, five children were operated in India and returned to us for further monitoring. There is no a law on child donation, therefore, children do not undergo heart transplantation in Kazakhstan. Teenagers aged 15 and 17 years are among the 68 transplants we have completed in the six years since the start of the program. They underwent a heart transplant in the country, because they transplanted the heart of an adult with a small weight. And these patients are observed in the senior group.
Besides, implantation of an artificial left ventricle for children have been carried in our centre. Zhizel from Taraz city six month lived with artificial left ventricle. Then she was operated in India. Another girl is 12 years old also has recently undergone artificial left ventricle implantation recently. It was the second time she was hospitalized in our centre. Being in the terminal stage, she was sent in the intensive care department. This new technology - the implantation of an artificial ventricle - is the chance for her t live. She would have already died without it, the situation was critical. Today she sent home and put on a waiting list and will wait for her donor to have her heart transplant performed. These are new technologies that today allow patients to live, wait for their donor and improve their quality of life.
- How many years can patients live with an artificial heart?
- For some patients it is lifelong (destination) therapy. It depends on contraindications to heart transplantation for one reason or another. For such patients it is the only way out.
Our program of no exception. Mostly they are elderly people over 65 years of age. They are implanted with an artificial left ventricle, which allows them to live 5-8 years. There are patients in the world who have lived with this device for 10-15 years, our centre experienced this program within eight years and we have no such data yet.
- How long does the adaptation last following the transplantation and artificial left ventricle implantation?
- It depends on a lot of factors. In average it is about two weeks. Then we observe our patients within a year. The main sequela is a rejection or some complications associated with immunosuppressive therapy.
- Are foreign people among the patients of your centre?
- It is some kind of medicine tourism. The number of foreign patients is quite less. Recently, representatives of medicine from Israel came to us and they said that our level of medical care is the same as in other countries, but the prices are much lower. Citizens from CIS, US, Japan, Koreans and German citizens who came to Kazakhstan may apply to our center for medical care. Which is not the case for non-emergency appeal. In my opinion, it is Kazakhstan’s perspective – to promote centre and healthcare in general. It should be noted the centre has JCI Certificate (approved twice).
- What is necessary for attraction of foreign patients?
Our marketing department promotes our centre in Moscow, Uzbekistan, Tajikistan, Kyrgyzstan. Besides the right logistics should be as well. The services responsible for the flight, hotels – in other words tourism. The development of the tourism has an impact on medicine development. First it is the confidence in our country. There can be no trust in the clinic unless there is trust in the country.