Dr Rela Institute & Medical Centre, a leading multi-speciality quaternary care hospital in Chennai, and one of the largest liver transplant units in the country, saved the life of a Sri Lankan professor by mobilising a team of competent surgeons to perform a liver transplant surgery on him, amid strict lockdown restrictions - even as the original donor prospect, who was the patient’s wife, turned out to be medically unfit to donate her organ.

The patient, Mr Prasanga Namal Karunarathne, a 44 year old professor with the Ministry of Science, Technology and Research, Government of Sri Lanka, flew to Chennai with his wife, the donor prospect, his mother in law, and brother in law by a cargo flight on 4th July, when Covid lockdown was imposed in the state, and the rest of the country.

But during a routine CT scan showed the wife to have features of a low-grade tumor arising from the small intestine. This diagnosis made her unsuitable to be a donor. Luckily Mr Karunarathne’s brother-in-law came forward to be a living liver donor at the last moment. And the 9-hour long transplant surgery was done successfully on 24th September. Post-surgery, both the donor and the patient recovered well.

The hospital also performed a surgery on the professor’s wife to remove the low-grade tumor. As her condition is treated, all she needs now is long term follow up. The entire family is ready to return to Sri Lanka soon.

Addressing a press meet, Prof Mohamed Rela, Chairman and Managing Director of the hospital, explained that Mr Karunarathne was diagnosed with a rare autoimmune liver disease about three years ago. He was getting treatment at government hospitals in his country but when it became clear that liver transplantation was the only solution, he approached our specialists via email during early March this year. We looked into his condition thoroughly and advised him to go for liver transplantation immediately.

His wife was willing to donate part of her liver. The family was completing the documentation procedures to travel to India for the transplant in our hospital. Just then the pandemic broke out, and he had to postpone the trip. But his health was deteriorating, and he had to be hospitalized in Colombo several times to clear fluid accumulation in the abdomen.

The patient came for an online consultation with our doctors during May 2020, and we helped him and his family understand that it is life threatening to delay the transplant. Mr Karunarathne came to know that a cargo flight was departing to Chennai from Sri Lanka on 4th June. We helped the professor in getting the necessary approvals from the Ministry of Foreign Affairs, India, and Government of Sri Lanka and the patient boarded the flight with his wife, mother-in-law, and brother-in-law. The airline made a separate seating arrangement for four of them and finally they landed safely in Chennai on the same day.

We conducted all the tests on him for liver transplantation, but we were in for a rude shock when a CT scan done on his wife showed that she had a low grade tumor in her small intestine. The presence of the tumor made her unsuitable to be an organ donor. We performed a surgery on her and removed the tumor.

But the family was contemplating going back to their country without the planned liver transplantation, for want of a donor. It was then, Mr Karunarathne’s brother-in-law came forward to be the donor. Luckily, his liver matched. We obtained the approval of the government committee for the transplantation and performed the surgery successfully on 24th September. He and his donor made a very good and quick recovery. Six weeks post-surgery, the entire family is ready to return to Sri Lanka.”

In her comments on the diagnoses and surgical procedures, Dr. Gomathy Narasimhan, Vice-Chairman, Medical Advisory Board & Senior Consultant, HPB Surgery, Liver and Renal Transplant Surgeon, said that the Sri Lankan professor had developed an Autoimmune Hepatitis which affects the liver leading to liver cirrhosis and liver failure. His condition was irreversible with medical management other than a liver transplant. We used high-end live-donor liver transplantation procedure. The surgery took about 9 hours.

Dr Narasimhan added: “We operated on the patient’s wife as the CT scan showed features of a low grade tumor arising from the small intestine. Any unusual finding in a donor needs to be investigated further for safety of donor surgery. Hence for her own safety and treatment for the condition, we did a small bowel resection to remove a lesion in the small intestine. Now, the condition is treated for her and all she needs is long term follow up for the condition.”

Thanking the surgeons, the medical team, and the staff of Dr Rela Hospital, Mr Karunarathne said that he was completely heart broken, when he knew he could not travel to India, even when Dr Rela Institute was ready to give quick access to the treatment. I had a glimmer of hope only when I came to know of a cargo flight scheduled to depart to Chennai. The airline was kind enough to make exclusive seating arrangements for my family and myself. Dr Rela hospital helped me to clear travel documentation, and we could come to Chennai. I was still nervous as to how things would go in a different country, during Covid. But the moment I was received by the staff of Dr Rela Institute at the airport and till I am getting discharged now, I could feel that I was in safe hands. The perseverance, determination, and compassion of the team was extraordinary. I have a new lease of life. My wife is protected from a future emergency. I have no words to thank my brother in law, and the supportive mother in law for all their sacrifices and support. We all carry home with us the goodwill of my surgeons, medical team and the staff of the hospital, and the people of Tamil Nadu.”

Despite the expertise of the team, and well-equipped infrastructure to perform complex liver transplant surgeries, it was quite a challenge for the hospital to make things go well for the patient and his family. The challenges were related to obtaining government approvals for the liver transplant in a timely manner, and performing the 9-hour long, high-end surgery adhering to Covid protocols and guidelines, while managing the Covid restrictions on movements.

Photo Caption: Prof Mohamed Rela, Chairman and Managing Director of the hospital