IndiaMedToday July 2019

JULY 2019, VOLUME 3 ISSUE 7 `200 INDIA MED TODAY

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INTERIVEW

DR. SUBRAMANIA IYER, HOD, PLASTIC & RECONSTRUCTIVE SURGERY, AMRITA HOSPITAL

NORTH-SOUTH DIVIDE IN ORGAN TRANSPLANT

JULY 2019

Organ Transplantation Gaining Momentum In Northern India, But Southern India Is The Hub For Organ And Tissue Transplantation

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JULY 2019 EDITORIAL

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Stop Beating Around the Bush! Stop Violence at Hospitals THE MEDICAL community captured the mind space of our nation, once again, when a junior doctor was grievously injured by a patient’s relative in Kolkata. The attack on a junior doctor sparked the agitation, which became a cry for help. And when the State government started to play hard ball with the agitating doctors reluctant to address their concerns and negotiate, the agitation turned into a mass movement and spread to other parts of the country.The situation was only controlled by the wisdom of apt communication. The State government’s assurance and cajoling dissipated the mass nationwide agitation.

Vengeance attacks on doctors by agitated relatives of patients are not new.

There have been a number of reports in the media and elsewhere. IMA says that 3/4th of all doctors face acts of violence during their life-time. In most cases, the violence is retaliation for the death of a patient but is fuelled by mob mentality and a bad public image of the healthcare system where the doctor is the proponent of greed and suffering. But the problem invariably points towards systemic glitches that have incapacitated optimal healthcare delivery to patients, like infrastructural and manpower constraints.

The government is reminded of the same and requested to focus on addressing the deficiencies afflicting the healthcare system as a whole.

The current Union Health Minister Harsh Vardhan has written to State governments highlighting the need for stringent action against anyone who assaults doctors. He asked States that do not have a law to protect doctors against violence to enact one, and circulated a 2017 draft of a law that envisaged imprisonment besides recovery of compensation from perpetrators for loss or damage to property. In fact, states have enacted laws to protect healthcare personnel from violence, but these laws are not strict and there is no data to show if anyone has ever been prosecuted under these laws.

Most of us still believe that being a doctor is a calling. Not everyone can become a healer, that it requires a lot of hard work and sacrifice to become a clinician. It is a responsibility and commitment to a lifetime of serving and learning. Ofcourse, there is gratitude and adoration but it comes along with stress, loneliness and self-deprivation. And yet doctors prevail.

Doctors are champions; they face challenges everyday with every new patient. Sometimes they are defeated by death. However, that can never be an excuse for instigating violence. As much as the doctor needs to learn to communicate, the patent’s attendants also need to learn to channel grief and anger.

Clearly, as a society we are incapable of teaching ourselves self-control. The political silence on incidences of violence have become deafening. The social media cushions and provides a platform to spread hatred and cheer for wrongful acts. As a society we are divided by religion and cause, but does that justify violence. An act of violence is an act of violence, which cannot be justified by rage, anger, grief, religion or cause.

So stop beating around the bush, and call a spade a spade. Stop violence.

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CONTENTS

22

OPINION

Facebook Linkedin

UPFRONT

27

When Hostility Replaces Civility

PULSE

COVER STORY

North-South Divide in Organ Transplant

BioprintingThe Future of Transplant Medicine

30

Organ transplantation is gaining momentum in northern India, but Southis hub for organ and tissue transplantation

04 Editorial 07 Letters 08 News roundup 40 Q&A 42 Event listing MARKET CONNECT 39 Mindray promises Better healthcare for all INNOVATE

Personalised Bioink for 3D Printing

TAU Scientists Print First 3D Heart Using Patient’s Own Cells and Materials

37

APPROACH

Can Kidney Exchange Transplant rescue patients on waitlist Incompatible donors can be exchanged to enable compatible transplant, reducing waiting time

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INTERVIEW

34

“Hand donations and transplant is a fairly new concept but it is successful”

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Our foremost request to the government is to accord due recognition to the emergency medical services (EMS) industry and recognise it as an independent sector within the healthcare industry.

90% of the EMS space is controlled by the government and we believe, the sector is in urgent need of impetus in the form of budgetary allocation of funds so that even the remotest parts of the country have access to timely quality medical care. There is a severe demand supply gap when it comes to the availability of ambulances in India with the ratio of ambulances per capita pegged at 1:146249.

We need to move to a ratio of 1:60000, and this can only happen if the government incentivises the industry in the form of subsidies.

The government should also invest in setting up skill centres for training paramedics and emergency medical technicians.While the government is already taking steps to improve road connectivity, we believe the government should look at increasing the accessibility of emergency medical services through station ambulance services on national highways and medical units on trains.With regard to taxation, we believe health services should be zero rated under the GST instead of a complete exemption so that cost of inputs can be reduced by claiming refunds of the taxes paid on these inputs.

s Mahatma Gandhi said “we all need to be the change we wish the world to be”. We individually must be at the forefront of any pollution initiative.

We cannot litter in streets and parks and then say they are dirty. It is hypocrisy to complain of dirty roads and building and then spit out pan all over; or drive polluting cars and complain about the air. Stopping pollution starts with us stopping to pollute.

Dr Aviral Roy, Critical Care Consultant, Medica Superspecialty Hospital

The major bulk of cancer in India is attributable to oral cancers due to high prevalence of smokeless tobacco. Smokeless tobacco consists of chewable tobacco, snuff which is as harmful as smoking tobacco. It consists of more than 28 carcinogens that get absorbed through lining mucosa of oral cavity.

Dr Samskruthi P Murthy, Consultant Head and Neck Oncologist, BGS Gleneagles Global Hospital

Manish Sacheti, CFO, Ziqitza Heathcare

Worldwide, over 1.8 million new Lung Cancer cases are registered annually. Lung cancer occurs mostly in adults over 60 years of age and history of long-term tobacco smoking hugely increases the person’s risk of developing lung cancer. Other risk factors include exposure to pollution, asbestos, metals, second hand smoke, Chronic bronchitis, etc. However, thanks to the advances in molecular genetics, it is becoming more accepted that the identification of genomic alterations in lung cancer can have great impact in the choices ofdrugs and in our understanding of patient specific drug sensitivity/resistance profile. This has led to significantly higher therapy successes in lung cancer patients. Advanced molecular testing is now an integral part of lung cancer diagnosis and management.

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INTERVIEW IAN YOUNGMAN, UK

HOW BIG DATA CAN SOLVE THE BLOOD CRISIS ARTIFICIAL INTELLIGENCE IN RADIOLOGY SYMPOSIUM

NEW INNOVATION FOR BLOOD TESTING

HOLY GRAIL OF

ADVANCEMENT IN BRAIN TUMOR TREATMENT

CANCER DIAGNOSTICS

SPECIAL FEATURE DEEPAK PAWAR, FICCI DALIP KUMAR CHOPRA

TOP 10 INTERVENTIONS POSITIVELY AFFECTING CANCER CARE PATIENT ENGAGEMENT

India’s Next Crown Jewel

PHILANTHROPY CAN WIDEN THE REACH OF CANCER CARE

Mandate for

Blood Bank

DECEMBER 2018

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NEWS ROUNDUP OUTCOME BASED SCORECARD FOR CLINICIANS, INSTITUTES IN INDIA HealthCare Global Enterprises Ltd. (HCG), the largest provider of cancer care in India, has said that it will collaborate with Dr Jayanta Bhattacharya, MD, PhD, Director, Center on Demography and Economics of Health and Aging, Stanford University, to create algorithms for scoring clinicians and institutes based on patient outcomes. This will help HCG manage its resources wisely and incentivize meaningful use of resources and good clinical outcomes.

At present there is no way to measure the performance of a clinician or an institute in India. There has been growing discontent among the patients regarding care provided at hospitals and the number of medical negligence cases are on the rise. A standard transparent performance score will not only bring back the trust in doctor-patient relationship but it will also promote ethical

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practice and quality of care, said Dr BS Ajaikumar, Chairman and CEO, HCG. The idea is to measure performance of clinician and institutes and benchmark it with global performance of institutes of repute.

Once this is done, the data will be used to improve the existing performance based on the scores. The study will be done both prospectively and retrospectively involving all HCG centers and modalities. The wealth of data resting with HCG that includes predictive analysis, outcomes and even a patient’s response to a particular form of treatment would help to analyse and measure pointers that will offer the best course of treatment for a patient. By means of creating a scorecard for doctors & hospitals, patients will be able to review where HCG stands in comparison with global standards in treating a particular form of cancer, based on its own data and outcome measures. The pilot project will look at some of the endpoints like morbidity, mortality, length-of-stay, hospital acquired infections, hospital re-admission and re-surgery. The

study will be published for further learning.

Dr Ajaikumar stressed on the need for generating Indian data to guide policy making.

Performance based payment systems will guide the government to analyze schemes like Ayushman Bharat and scientifically calculate treatment costs.

Another area of interest for the study group is to look at precision medicine and genomics. The study will validate the use and protocols for precision medicine in India.

Dr Bhattacharya, has been working with the US Federal government to help implement the Medicare Access and CHIP Reauthorization Act (MACRA) 2015. He has served as the lead Clinical Investigator for a large Acumen Project to assist the Center for Medicare and Medicaid Services to develop a new way to assess the performance of doctors in terms of the appropriateness of medical expenditures.

The measures developed in this project will be used in the Medicare Incentive Payment Program (MIPS), which is part of the medicare MACR Act, 2015.

(Left to Right): Mr. Venki Muthanna, CEO, LM Excellence;Prof. KurienIssac, Senior Professor & Dean IPRCE, IIST;Dr. Alexander Thomas, President, AHPI; Dr. Y V N Krishna Murthy,Senior Professor and Registrar, IIST;Prof. Anurag Kumar, Director, IISc; Mr. V Rajarajan, Registrar, IISc; Dr. Sandeep Bhalla, Director, Training, PHFI; Dr. AnuradhaMonga, Program Manager, PHFI;Dr. V C Shanmuganandan, Advisor, AHPI;Prof. Chiranjib, Professor ,Department of Computer Science and Automation, IISc

AHPI, PHFI, IISC, IIST TO DEVELOP CERTIFICATE PROGRAM IN HEALTHCARE TECHNOLOGY Association of Health Care Providers (India) (AHPI), Public Health Foundation of India [PHFI] Indian Institute of Science, Bangalore (IISc) and Indian Institute of Space Science and Technology, Trivandrum (IIST),signed an MOU at IISc,Bengaluru and commitment towards developing and implementing Certificate Program in Healthcare Technology.

Certificate Course in Healthcare Technology (CCHT) will be developed and implemented with a blended learning model. The Course will be specially tailored for both clinical and managerial healthcare professionals, with the primary objective to enhance their knowledge, skill and core competencies in healthcare technology. Module development by the technical and academic partners is the way ahead and to be taken up in subsequent months.

SAHAJANAND GROUP INVESTS IN AI STARTUP INFINNIUM Infinnium LLC, Virginia based software company that develops solutions to improve information management and business decision-making through effective use of the latest artificial intelligence technology, announced today a multimillion-dollar seed investment in the company.

The investment was made by the Sahajanand Group, a technology conglomerate which has historically built successful enterprises based on emerging technologies.

The Sahajanand Group of Companies, headquartered in India, is focused on developing pioneering smart technologies to bring groundbreaking solutions to the world’s most pressing challenges. The investment in Infinnium recognizes the potential for AI and other data technologies to address growing challenges in data privacy, data protection and regulatory compliance.

Company leaders at Infinnium plan to use

the funding to support the final development efforts and market introduction of its 4iG Suite of solutions. The 4iG product suite leverages AI technology to provide visibility across an organization’s data repositories, offering insights into both structured and unstructured data. The 4iG framework allows corporations, law firms and other organizations to identify analyze and govern information assets in support of business decision-making, data security and regulatory compliance.

ObscurePI, a key module of the 4iG Suite, focuses on identification and management of personally identifiable information – a key component of HIPAA, GDPR, CCPA, SarbanesOxley, FISMA and other data privacy and compliance regulations.

NATHEALTH PARTNERS WITH WELL TECH Apex healthcare industry body NATHEALTH announced its collaboration with global healthfocused innovation platform Well Technologies Ltd to support healthcare startups with access

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NEWS ROUNDUP to capital & market, industry partnership, mentorship and technology development assistance. NATHEALTH, in association with Well Tech, plans to infuse seed investment of upto $ 1.5 Million.

Under the agreement, syndicate investment from Well Tech’s capital partners as well as support due diligence of startups would go long way to create a new ecosystem. Startups would get industry support from NATHEALTH members in technology, product development, innovation and global market access. The joint initiative would also support in designing the scale plan for other markets and facilitating new partnerships. The initiative aims to cater to early and growth stage start-ups and is looking to scale up across diverse categories within the domain.

FRENCH COMPANIES TO VISIT DELHI, MUMBAI WITH TECHNOLOGIES AND SOLUTIONS FOR INDIAN HOSPITALS Business France, the Trade & Investment Commission of France in India is welcoming a French Healthcare delegation of six French companies to India from July 1-4. The delegation will be meeting representatives from Indian hospitals. This delegation that will consist of six French companies will be in India to understand the trends of the health sector and its working and will give them a chance to meet their prospective commercial partners. In addition, the companies will also attend an informative session on the Indian health sector (provided by professionals) at the premises of the French Embassy in New Delhi. Following this, the companies will then attend personalized B2B meetings.

Government initiatives such as national health coverage for the poorest, called as the ‘Ayushman Bharat’ and the dynamism of the private sector make India a country of opportunity, in which it becomes crucial to deliver health care.

With the last visit of the French President, Emmanuel Macron to India, it is clear that

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France is focusing on technology in healthcare and wants to further develop strong partnerships with India. “India is becoming the most preferred healthcare destination. The country is renowned for its skilled doctors and world-class hospitals. France is known for its innovative, high-quality biomedical research and its excellence in treatment and patient care. This meet in July will be a good platform for Indian and French healthcare players to interact and share their knowledge,” says BrinderRault, Head of Healthcare and Lifestyle sector for India at Business France.

NATIONAL CONFERENCE ON COMMUNITY HEALTH & NUTRITION CONCLUDES The 2nd National Conference on Community Health and Nutrition wasorganized by the Department of Community Medicine, Ramaiah Medical College incollaboration with Indian Association for Parenteral and Enteral Nutrition (IAPEN),Bangalore Regional Centre at the college premises on Friday.

Community Health & Nutrition Conference

The conference was an enlightening session about the current nutritional status ofour country. With speakers from across industries, from professors to scientists, thelearning was extensive and scientific.

The conference focused upon the current nutrition awareness and acceptance levelsby the community based on long term studies.

It was also interesting to understandvarious national and international policies that have been existing and have beenworking towards combating malnutrition in the country.

PRISTYN CARE EXPANDS ITS HEALTHCARE DELIVERY NETWORK IN 6 NEW CITIES

Gurgaon based Healthcare Delivery start-up Pristyn Care, expands its footprints in 6 tier 2 cities, after getting an overwhelming response in Delhi NCR, Bangalore, and Hyderabad.

The accelerated expansion of Pristyn Care is the result of a diversified business model in tier 2 cities. Built into that expansion are

elements that will be very beneficial for the local community. The compelling factor for the expansion was the need for advanced treatments and quality of care in tier 2 cities.

The company is establishing associations with existing hospitals in new cities, unlike building their own clinics as they did in tier 1 cities.

After getting financial backing from Sequoia India, Pristyn Care gained momentum and executed expansion plan in a very short span of time. They penetrated 6 tier 2 cities that are Lucknow, Kanpur, Chandigarh, Gwalior, Ludhiana, and Agra within a month of conceptualization.

According to Harsimarbir Singh, Cofounder Pristyn Care,has cracked the intricate code of asset-light model in the healthcare services sector after building the same in the National capital region. The company wanted to bring innovation in healthcare and provide seamless surgical experience. They plan to launch over 30 cities by 2020. The business model of Pristyn Care is enabling them to grow faster and expand their reach at a quick yet manageable rate.

IMA DEMANDS COUNSELING CENTERS AND HELPLINES IN ALL MEDICAL COLLEGES AND TEACHING HOSPITALS

Indian Medical Association (IMA) have initiated a program to tackle the burden of burnout and rising rates of mental health challenges among medical students Residents and clinicians.

This initiative has been aptly named Doctors 4 Doctors (D4D).Dr. Santanu Sen, National President, Indian Medical Association (IMA) said, Through this initiative, we will focus upon preventing burn out, address mental health challenges, reduce the incidents of suicide among Residents and clinicians. We will achieve this by creating awareness of the issue and using tools for emotional well-being. We will provide training for self- help and offer D-4-D Free Help Lines to those in need.” IMA demands counseling centers and 24 x 7 Help Line in all medical colleges and teaching institutions.

As the umbrella organisation and the largest association of doctors, the IMA believes that doctors must care for all doctors, especially given the global picture of higher risk of depression and suicide among medical professionals. Globally, the risk is 2.5 times higher among medical students and doctors, with those in the age group of 24 to 37 years being the most vulnerable segment. A study among clinicians in India has revealed that 45% of the respondents scored high on emotional exhaustion with 87% of the doctors scoring low on “personal accomplishments”.

The specialities under highest stress and risk of burn out or suicide are Emergency Medicine, Obstetrics &Gynaecology, Psychiatry,

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NEWS ROUNDUP Intensivists (ICU Doctors) and Anaesthetists.

Dr.NilimaKadambi, Chairperson, IMA National Committee for Emotional Health and Wellbeing of Medical Students and Doctors in Indiasaid, “Realising the seriousness of the situation, the IMA had launched a unique initiative, Doctors-4-Doctors (D-4-D) with the aim of tackling the rising rates of mental health challenges and suicides among Medical Students, Residents and clinicians. The D4D will tackle physician burnout and mental health at a system level through changes in policy and training. It will offer a Sustainable Support System to bring about emotional wellbeing, robust resilience and coping capabilities among the medical students, Residents and clinicians.”

IMA D-4-D Team has already held Awareness and Self-Help Work-Shops for Medicos about Emotional Well-being and Burn-Out in Bengaluru, Pune, Delhi, Surat and Cochin and soon will organise in Mumbai, Delhi and in other cities.

IMA is also working on strengthening

and implementation of legislation to protect Resident doctors and clinicians against violence, better living and working conditions for junior doctors and residents with proper HR guidelines for duty hours and rest periods and strict documentation, reporting and action against campus ragging, bullying, sexual harassment to unrealistic expectations from all. The D4D initiative will also offer timely assistance and support with easily accessible professional counselling.”

IMA D-4-D Team has already held Awareness and Self-Help Work-Shops for Medicos about Emotional Well-being and Burn-Out in Bengaluru, Pune, Delhi, Surat and Cochin and soon organise in Mumbai, Delhi and other cities.

IMA is also working on strengthening and implementation of legislation to protect Resident doctors and clinicians against violence, better living and working conditions for junior doctors and residents with proper HR guidelines for duty hours and rest periods and strict documentation, reporting and action

Governor of Karnataka Shri Vajubhai Vala inaugurating Aster RV Hospital

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against campus ragging, bullying, sexual harassment and social discrimination.

ASTER DM HEALTHCARE TAKES OVER RV HOSPITAL BANGALORE Aster DM Healthcare, one of the largest integrated healthcare service network in the GCC and the third largest healthcare company in India, is expanding its footprint by commissioning its second multi-specialty quaternary care hospital in Bangalore called Aster RV Hospital. The hospital has been formally inaugurated bythe Honourable Governor of Karnataka Shri Vajubhai Vala; in the presence of Sowmya Reddy, MLA, J.P. Nagar Constituency; Dr Azad Moopen, Founder Chairman and Managing Director of Aster DM Healthcare and Dr. PandurangaSetty, President of RV Group of Institutions.

The 250 bedded Aster RV Hospital is introducing specialty services through its Centers of Excellence in Cardiac-Sciences,

Neuro-Sciences, Gastro-Sciences, General and Laparoscopic surgery, Integrated Liver Care, Organ Transplant, Urology and Nephrology, Orthopedics, Urology & Nephrology & General Medicine; with added features like Bi Plane Cath Lab, Da Vinci Robotic System for robotic surgeries, Intra-Operative MRI Machine, Integrated Liver Care and 53 critical care beds across ICU, CCU & TICU. Spread across 1.5 lakh sqft of built up area, the quaternary care hospital has 39 out-patient consultation rooms, 9 operating theatres and offers other specialties like ENT, General Medicine, Endocrinology, Plastic Surgery, Dermatology, Radiology among others, supported by a team of highly qualified doctors, medical professionals and nurses.

ONCO.COM PROVIDES FREE CANCER CONSULTATION FOR CHILDREN

Onco.com, online cancer care platform, is now providing free cancer consultations for all children below the age of 14 who are suffering from cancer. Said Rashie Jain, Cofounder & CEO, Onco.com, “Not many people relate cancer to young kids, but the reality is that childhood cancers account for 3-5 per cent of all cancer cases in India. The country hosts a fifth of all childhood cancer patients in the world. As many as 50,000 children get affected by cancer every year in the country, a number growing by 1.5 per cent annually.

We believe that no child should ever die of cancer, especially when it can be treated with a high degree of success. We at Onco.com have decided to provide free cancer consultations for all children below the age of 14 years.”

Dr.AmitJotwani, Cofounder of Onco.com and Chief of Medical Services said, “Childhood cancers have better chances of cure as they are more responsive to treatment. In developed nations, the cure rate for childhood cancer is 80%. This plunges to just 40% in developing nations like India. The results also vary within the country, with metro cities and states with better healthcare facilities having much better cure rates. The incidence of childhood

cancers in India is quite low compared to the total number of adult patients. Because of this, the infrastructure for treatment of childhood cancer patients is lacking in the country, even though they require more intensive care and monitoring than adult patients. There are not enough centers providing specialized treatment of childhood cancers. This adversely affects the quality of childhood cancer care, eventually leading to poorer cure rates.”

AMITABH BACHCHAN LAUNCHES SEE NOW CAMPAIGN TO HELP END AVOIDABLE BLINDNESS

Amitabh Bachchan is the face of a new campaign in Uttar Pradesh that is expected to reach tens of millions of Indians with a simple ask: go and get your vision checked. A new SEE NOW campaign will deploy creative content across five key districts - Unnao, Lucknow, Raebareli, LakhimpurKheri and Sitapur - via radio, television, print, social media, Whatsapp and SMS to provide information on eye health issues, local services and how to access them.

The social impacts of vision loss are extreme, almost half of all drivers having impaired vision, creating a public safety issue; women account for 67 per cent of vision problems, but are 40 per cent less likely to access services; vision impairment is the second highest risk factor for learning difficulties in children; and poor vision accounts for $37 billion in lost annual productivity.

The campaign is funded by The Fred Hollows Foundation and in part by Essilor Vision Foundation, and is working in partnership with Sightsavers India and Vision2020 India among others. Through partnership with Sightsavers and Essilor 2.5 NVG, the campaign has also profiled “eye heroes” who work to restore vision and fit glasses. The campaign includes an interactive call centre to allow people in those districts to find out where their nearest Sightsavers eye camp or Eye Mitra Optician is located. If none are located in the vicinity, it will register the location to request for an eye camp in the

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NEWS ROUNDUP future. People in the campaign areas can put in a missed call to 9266 021 666 to hear a recorded message from Bachchan and find out where their nearest eye health service is located.

RADIANT LIFE CARE BUYS 49.7 PER CENT IN MAX HEALTHCARE FROM LIFE HEALTHCARE

Radiant Life Care Private Limited, a leading Indian hospital management company promoted by AbhaySoi and backed by KKR, has completed the previously announced acquisition of a 49.7% stake in Max Healthcare Institute Limited from South Africa-based hospital operator Life Healthcare. AbhaySoi will now lead Max Healthcare as Chairman of its Board and Executive Council.

As part of the transaction, Max India’s promoters have received an advance of INR361 crore (US$52.2 million) from KKR in exchange for a 4.99% stake in the merged entity. Max India’s promoters have used the funds for deleveraging purposes.

Radiant funded this acquisition with an investment from KKR’s Asian Fund III. The process of combining Radiant Life Care and Max Healthcare and the eventual listing of Max Healthcare is underway, and is likely to be completed in 6 to 8 months, subject to receipt of the requisite approvals.

Coordinator of AiMeD. “Exports have gone up a record 29%, 2840 Cr ₹ from 9908 Cr ₹ in 2017-18 to 12749 Cr ₹ in 2017-19 but the 2840 Cr ₹ gain is not enough to neutralize the 7450 Cr ₹ import increase. We are however happy to contribute another 4610 Cr ₹ to the negative trade imbalance of India.We are being globally competitive but not in our own market.” Said Mr. Rajiv Nath We estimated the market size at the retail and institutional level to be over 15 Billion $ with Domestic products now at less than 20% market share.

There is an urgent need for the Govt. to expedite steps to end the 80-90% import dependence forced upon us and an ever increasing import bill of over Rs 38,837 Crore, expedite steps for patients’ protection, stronger quality & Safety regulations, price controls to make medical devices and quality treatment accessible and affordable and ethical indigenous manufacturing viable .

DR LALPATHLABS TO ACQUIRE NEW COMPANY Dr LalPathLabs buys a new company Diagnostic chain Dr LalPathLabs said its board has approved the acquisition of a 70 per cent stake in a new company to be incorporated

BAD NEWS FOR INDIAN MEDICAL DEVICE INDUSTRY: IMPORT UP BY RECORD 24%

MSME dominated medical domestic manufacturing takes a hit post GST as imports become 11% cheaper and shoot up 24%.

Imports of medical devices are up by record 24 % at 7450 Cr Rs from Rs31386 Cr in 2017-2018 to 38,837 Cr Rs in 2018-2019.

As the market is barely growing at 10-12%, overall the data of 24% increase in imports indicates further erosion of 10-30% Domestic market share to 10 to 20% market share stated a visibly upset Mr. Rajiv Nath, Forum

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Myval-PCR

by Vinita Kothari and SushilaDalal for a cash consideration not exceeding Rs50 crore. Dr LalPathLabs has routed the acquisition through its wholly owned subsidiary PathLabs Unifiers Pvt Ltd with the objective of strengthening its business presence in Madhya Pradesh, it said in a regulatory filing. The new company will be engaged in healthcare/diagnostic services in Madhya Pradesh and adjoining areas and shall house the business of Central Lab, Indore, and proprietorship concern M/s Vinita Kothari, it added.

MERIL’S MYVAL-THV SYSTEM RECEIVES CE APPROVAL Meril has recently received the CE approval for its indigenously researched and manufactured TAVR technology, Myval-THV system. This coveted approval catapults Meril Life Sciences to the select list of Global Medtech organizations that market and distribute TAVR to European Union and other international geographies.

The Myval is a balloon-expandable tri-leaflet, bovine pericardium THV. The valve sports a novel hybrid honey-comb scaffold design which on crimping results in a distinct alternating dark-light banding pattern visible under fluoro. This unique

pattern intuitively helps in precise placement of the valve and ensures its orthotopic deployment. Myval is recommended to be pre-crimped on its dedicated hi-flex Navigator THV delivery system which comes with a counter opposing stopper system ensuring precise, low profile & snug valve crimping. The Myval-THV System comes with an OTW balloon Mammoth for pre-dilatation purpose. The kit also includes Python a low profile, lubricious, expandable 14Fr which allows for percutaneous access of all sizes of the crimped Myval – THV (20mm – 29mm diameters).

J MITRA AND CO AWARDED TUV SUD CERTIFICATION J Mitra& Co., India’s leading In-vitro Diagnostic Company, has bagged the TUV SUD Certification, which automatically pushes them in the global big league. TUV SUD is the gold standard in certification for the healthcare industry.

TUV SUD certification was awarded to J Mitra& Co., for ‘Design & development, Manufacturing, Distribution & Marketing of RAPID, ELISA, Confirmatory, Blood Grouping and Fluorescence immunoassay based In-vitro Diagnostic Reagent Test Kits’.

Earlier, in March, the company was also awarded the ICMED 13485 Certification.

Indian Certification for Medical Devices (ICMED) Certification is India’s First indigenous quality assurance system.

J Mitra& Co. already has ISO 9001:2015, WHO-GMP and CE certifications in line with its exceptional high-quality standards and exports to more than 45 countries worldwide.

Speaking on the occasion, JatinMahajan, Managing Director, J Mitra& Co. said, “These certifications are a great testimony to the quality standards adopted by J Mitra& Co. India is no longer a developing country, but in fact in many cases like this, it equates and surpasses the norms laid down in many of the developed countries. India is well-established in the global manufacturing and healthcare map”.

MANIPAL EDUCATION AND MEDICAL GROUP APPOINTS SUBRAT MOHANTY AS GROUP PRESIDENT Manipal Education & Medical Group (MEMG), a privately held conglomerate with focus on education, healthcare and research, has announced the appointment of Subrat Mohanty as its Group President.

Mohanty shall spearhead business performance and strategy across the Group’s interests in education, healthcare and health insurance. He has extensive prior experience in scaling up businesses, understanding digital trends and transforming traditional enterprises, thereby infusing new age tools and practices.

“On behalf of MEMG, I welcome Mr Subrat Mohanty on board to lead some of our key initiatives. His understanding of scaling business, recognizing trends at an early stage, comprehensive grasp of the customers’ needs, and transformative leadership are critical in driving the next phase of growth for the company,” said S Vaitheeswaran, MD & CEO, MEMG.

Subrat Mohanty

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NEWS ROUNDUP NIGHTINGALES HOME HEALTH SERVICES APPOINTS PIYUSH BHARGAV AS THEIR CHIEF OPERATING OFFICER Nightingales Home Health Services, an enterprise of Medwell Ventures and a pioneer in specialty home healthcare in India, named Piyush Bhargav as their Chief Operating Officer today. He will be assisting in bringing in new technologies which, in turn will help the company provide better services to consumers and enter into newer geographies.

Announcing the appointment, Ferzaan Engineer, Co-Founder &Jt Chairman said, “We are excited to see what Piyush has in store for us with his new role. He will have a significant role to play in achieving our goal of evolving into a digitally perceptive and agile home health service provider. We wish him the best for his new role.”

With over two decades of experience in Marketing and Product Management, Piyush is an ecommerce veteran. He joined eBay’s core team back in 2003, where his primary focuses involved Brand Management, Internet Marketing, Ad sales and Cross Border Trade among others. He was the first Indian employee in eBay to get awarded a diploma

Piyush Bhargav

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from Global Marketing College in San Jose, US and also was the employee of the year. Prior to his current stint, he was the Vice President at Reliance Retail where he was responsible for the newly launched Reliance B2B fashion business and also handled the role of Vice President - Digital at Ajio.com, which is one of the largest Indian fashion e-tailers. His earlier stints also include founding homeshop18. com and handling the Marketing and Product Management portfolio at Quikr.com.

ASSISTED REPRODUCTIVE TECHNOLOGIES CONCLAVE IN VIJAYWADA Oasis Centre For Reproductive Medicine, which is one of the pioneers in reproductive medicine is conducting their 3rd Annual ART conclave, with a focus to disseminate information on the latest Advancements in artificial reproductive technologies and their usage for better outcomes.

Infertility treatments are set of procedures which help an infertile couple to conceive a child. Nearly 10 to 15per cent of married couples in India come under the shadow of infertility issues that translate to 27.5 million couples and out of which only one per cent of the couple come forward to get them treated.

This is primarily because of the low awareness levels and the myth that the success rate in IVF/ Fertility treatment is very low.

Having talked about the issue, we also need to understand that IVF Technology is now 40 years old since the first test tube baby was born on July 24th 1978 in UK and since then there have been so many advanced technologies which are helping the clinicians to give the better success rates.

Talking about the objective of conducting the Artificial Reproductive Techinques Conclave in association with VOGS(Vijayawada obs and gynaec society) and Chapter of ISAR – AP (Indian society For Assisted Reproduction) at Vijayawada on 16th July 2019, at Hotel Gateway, Vijaywada. Dr Durga G Rao, CoFounder and Medical Director of Oasis Centre for Reproductive Medicine stated that “The entire objective of conducting this ART conclave is to have conversation around

the latest advancements around fertility treatment, and to train clinicians from across the state by the way of interactive session on the next gen treatment options which helps us achieve the success rates as high as 70per cent, we have seen some of the late latest technologies like PGT -A and PGD have come to stay for a while now, but we are talking about next gen diagnostics tools like PGT – A on and AI platform. This technology uses mathematical algorithm and machine learning technology and analyses the growing data set of more than 10,000 samples and removes human subjectivity and human error element and bring power of the big data to the clinicians transfer decision.

Adding more she said “At the end of it we need the participants to get empowered with knowledge and recent updates on fertility treatment aspects so that they can start treating more of infertile couples also as it is being done in association with VOGS the clinicians will be awarded 2 credit points for attending this conclave” Talking on the occasion Dr Krishna Chaitanya – Scientific Head and Clinical Embryologist of Oasis Centre for Reproductive Medicinesaid that “ We are glad to share with you today that Oasis has launched their dedicated arm of treating Male fertility called Androlife, In India the general notion or myth is that infertility clinics are meant only for treating women, the entire male infertility gamut is just ignored. According to Journal of Reproductive Sciences “Male factor” infertility is seen as an alteration in sperm concentration and/or motility and/or morphology in at least one sample of two sperm analyzes, collected 1 and 4 weeks apart, in India, nearly 50per cent of infertility is related to the reproductive anomalies or disorders in the male. Hence it is important that the male infertility is evaluated completely when a couple come forward for fertility treatment. We, at Oasis pride ourselves about the impeccable standards we maintain in our IVF lab which is an advanced lab. The lab is crucial for the treatments offered at our centre and we ensure that the highest level of quality is maintained here.

Our lab is one of the very few labs in India that has proper Total Quality Management

in place which optimizes the results of the Assisted Reproductive Techniques.We are first in AP to provide advanced services like PGS/ PGD /IVM/ mTESE/ Vitrification/ Fertility preservation”.

its India manufacturing plants, Sikkim is the fourth one after Mumbai, Daman and Baddi.

Also, the first ever diagnostics manufacturing facility in Northeast, the expanded facility will significantly enhance Transasia’s capacity to cater to the growing Indian and overseas market demands. Spread over 2 acres, thestate of the art facility can produce 6000+ instruments monthly including the complete range of semi-automated analyzers.

Announcing the new facility, Suresh Vazirani, Chairman & Managing Director, Transasia Bio-Medicals Ltd., said, “Sikkim

DR ANIL K. D’CRUZ JOINS APOLLO HOSPITALS GROUP AS DIRECTOR ONCOLOGY

Apollo Hospitals announced recently that renowned senior Oncologist, Dr. Anil K. D’Cruz has joined the group as Director, Oncology – Apollo Hospitals, Mumbai, Chennai and Delhi.

A well-recognized global leader, clinician, researcher and teacher in Head and Neck Oncology, Dr. Anil K. D’Cruz brings with him over 33 years of experience in the field of cancer. Dr. D’Cruz will drive Apollo Hospitals’ efforts in the fight against cancer, focussing on providing and overseeing care and treatment for patients suffering from cancer of the head and neck, oral and laryngeal cancer as well as cancer affecting the thyroid, parathyroid and salivary glands. Dr. D’Cruz has undergone special training for head and neck surgery at the Sloan Kettering Cancer Centre, New York, Laser Surgery at Vanderbilt University, USA and speech rehabilitation at Indianapolis, USA. Awarded the Honorary FRCS from the Royal College of Surgeons, London, Dr. D’Cruz is the first Indian to hold the prestigious post of President Elect (2018-2020) and President (2020-2022) of the Union International for Cancer Control, Geneva, Switzerland which is the largest cancer organisation globally committed to the cause of cancer control.

Prior to joining Apollo Hospitals, Dr.D’Cruz was Director of at Tata Memorial Hospital and Chief of Head Neck Services. He has held leadership positions and is on the board of numerous professional organisations, universities, research organisations and cancer institutions across the country and abroad. His landmark contribution on the management was neck nodes in oral cancer was awarded the prestigious plenary at the American Society of Clinical Oncology in 2015.

Dr Anil D’Cruz

TRANSASIA BIOMEDICALS IN 50 CRORE EXPANSION OF ITS SIKKIM MANUFACTURING PLANT Transasia Bio-Medicals Ltd., India’s leading invitro diagnostics company, announced a Rs. 50 crore investment in the expansion of its manufacturing facility in Sikkim. The largest of

is fast becoming a major hub for healthcare manufacturing with 14 major players already there. Transasia’s new facility will further reinforce this besides providing employment to local youth who otherwise would need to move out of the state for such quality opportunities. With this addition of capacity, we are well placed to deliver to the demand arising from continued growth posted by the company both in Indian and overseas markets.”

Limited access to quality medical infrastructure, including skilled manpower and technologies have been the pain points of over 70% of Indians who live in smaller towns and rural areas. Transasia addresses this through its competitive pricing, which makes diagnostics affordable besides having a sales & service network present nationwide.

Transasia’s Sikkim manufacturing plant

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APPROACH

Can Kidney Exchange Transplant rescue patients on waitlist Incompatible donors can be exchanged to enable compatible transplant, reducing waiting time

Dr Satish Chander Chhabra, MD, DM, DNB (Nephrology), Senior Director, Dept. of Nephrology, Max Super Speciality Hospital, Patparganj

Dr Manik Chhabra, Attending Consultant, Dept. of Nephrology, Max Super Speciality Hospital, Patparganj

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RECENTLY, KIDNEY transplant became the proponent of Hindu, Muslim unity, when a Hindu couple from Bihar and a Muslim couple from Kashmir helped save each other’s lives by exchanging organs for transplant.

The 46-year-old Sujeet Kumar’s kidney was found to be a good match for 53-year-old Abdul Aziz. While, Aziz’s 50-year-old wife Shazia proved the right match for Sujeet Kumar’s 42-year-old wife Manjula Devi. Both families underwent surgeries for a paired kidney exchange at a private hospital in Mohali in December 2018. Six-months post-transplant both sets of couples are doing well. This isone of the many cases of kidney exchange transplant done in India. A new trend that may well be able to rescue patients stranded on waitlists.

Kidney the Essential Organ A pair of bean shaped organs kidneys, filter waste from blood. When kidney fails to filter blood, the waste accumulates in the body and leads to death. Dialysis is an option for such patients, where the blood is filtered with the help of machines. However, this requires frequent visits to dialysis centers and takes long hours, which limits the quality-of-life of the patients.

Another option for such patients is kidney transplant. Today kidney transplant protocols are so robust that it is available at many hospitals and has become a common and safe transplant procedures of cadaver (brain dead peo-

ple). Contrary to this not many patients can opt for kidney transplant as there is a long waitlist for patients to receive donated organs. Organ donation is still not very prevalent in India and the wait for a matched donor can be anywhere between 2-5 years.

Living donor A living donor, is a healthy person, related to the patient who is willing to donate one of their kidney to the patient. According toThe Transplantation of Human Organ Act, only first-degree near relatives can donate kidney, but the amendment brought in 2014, has provisions for kidney exchange donation.

Receiving kidney from one’s relatives sounds easy but for the fact that all members of the family may not be ABO compatible or tissue compatible. Until a few years ago, incompatible donor-recipient pair had no option but to wait for a matched deceased organ to be available, which meant a long and painful wait time. This is exactly why kidney exchange is gaining momentum where an incompatible pair of donor recipient is matched to another pair and they exchange the donated organs.

Kidney-Paired Donation in India According to a report by the Indian CKD registry, 2010, 61% of end-stage renal disease (ESRD) patients were not on any form of renal replacement therapy (RRT), while 32% were

on hemodialysis, 5% on peritoneal dialysis and only 2% were being worked up for kidney transplantation.

Today, there is large disparity between supply and demand of the transplant organs across the world, including India. Also, there are regional variations in deceased donor transplantation with majority happening in southern states of India and very few in northern states. Although outcomes of living donor transplantations are better than deceased donor transplants, there are very few living voluntary related donors who come forward for the noble cause. In the recent years, a lot of efforts are being made to increase the supply of quality organs to the waiting transplant recipients. Kidney exchange program or paired kidney donation is one such process for increasing supply of organs to patients waiting for transplant. Kidney exchange transplant enables two incompatible donor-recipient pairs to receive more compatible kidneys. In this process, a living kidney donor who is otherwise incompatible

with the recipient, exchanges kidneys with another donor –recipient pair. Kidney exchange can be performed at any transplant center that is doing kidney transplantation without the need of extra facilities as required for ABOiKT and transplant with desensitization protocol.

Despite its benefits, Kidney paired donation is underutilised in India. This could be attributed to lack of national database about incompatible pairs, lack of awareness/ counselling about kidney paired donation and administrative challenges. For example, if the pair involved in donation are from different states the state authorities from both the states have to approve of the donation, this process may increase the waiting time. But the recent amendments in the Transplantation of Human Organs Act 2014, could change this. Now, hospital committees could approve the process if donors are from different states. However, there are other challenges that still need to be sorted to take kidney exchange mainstream.

Recently, Kidney transplant became the proponent of Hindu, Muslim unity, when a Hindu couple from Bihar and a Muslim couple from Kashmir helped save each other’s lives by exchanging organs for transplant

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APPROACH Kidney Exchange Chains In fact, experts believe that kidney exchange offers a lifesaving alternative to waiting for an organ from the deceased-donor waiting list. Recently, chains---byproduct of exchange transplants initiated by a humble kidney donor---have shown marked success in practice, yet remain poorly understood.

Chain exchange happens when the kidney exchange is not reciprocal but non-direct. A non-directed donor ismatched to a recipient who has a willing, but incompatible living donor, in turn the incompatible donor agrees to give their kidney to the first compatible patient on the deceased donor waiting list.

However, this needs to be studied more to analyse the efficacy of the chain and for its wider implementation.

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Types of kidney exchange Simultaneous anonymous 2-way kidney exchange  3-way, 4-way, n-way exchange  Compatible pair  Non-simultaneous kidney exchange  Non-simultaneous extended altruistic donor and domino  Kidney exchange + desensitization therapy  Kidney exchange + ABO incompatible transplant  Acceptable mismatch transplant  Use of A2 donor to O patients  Living donor-deceased donor list exchange  National kidney exchange  International kidney exchange  Global kidney exchange 

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COVER STORY

NORTH-SOUTH DIVIDE IN ORGAN TRANSPLANT

Organ transplantation is gaining momentum in northern India, but Southis hub for organ and tissue transplantation

Author: Dr Sandeep Attawar, programme Director and Chair – Cardiac Science Thoracic Organ Transplant, Gleneagles Global Health City

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O

rgan transplantation is a high end surgical intervention, resurrecting people and offering them a second chance to lead a dignified life. This kind of “LAZARUS “phenomenon solely thrives on the single act of extreme altruism (organ donation). The nobility of organ donation forms the core of a successful organ and tissue transplantation programs.

The number of transplants done annually has been gradually rising in India. As per Mohan Foundation report, currently around 5,000 kidneys, 1000 livers and around 15 hearts are transplanted annually in India.

However, this is not enough, because even today one person dies of kidney failure every 5-minutes, which amount toroughly 290 deaths per day due to kidney failure. And

there are more statistics to show the gap between the organs donated and lives saved.

Organ Donation Rate–0.26 per million in India is very poor as compared to some of the better performing countries such as America’s 26, Spain’s 35.3, and Croatia’s 36.5 per million respectively. There is a need of roughly 200,000 kidneys, 50,000 hearts and 50,000 livers for transplantation each year in India.

The North-South Divide With the intent to regulate the removal,storage andt ransplantation of human organs for the rapeutic purposes and for prevention of commercial dealings in human organs, Transplantation of Human Organs Act, was passedi n1994 in India. Since then a number of amendments have been made to the act to make it more robust and to facilitate organ donation. Yet, very few states have been able to establish a working system to facilitate organ donation and transplant.

The organ donation and transplant programs are well established in the southern states. In the northern states the pace at which organ transplant programs have developed has been alarmingly slow. While southern states like Tamil Nadu were having successful heart transplants from 1995 onwards, the process was not established in Northern states till late 2011. In fact a successful heart transplant was done in Mumbai only in 2015, 47 years after the pioneering treatment was attempted for the first time by Late Dr P K Sen at KEM Hospital in 1968.

The Southern states of India, led by Tamil Nadu, Karnataka, Kerala, Andhra Pradesh and Telangana have structured , almost perfect, well-oiled machinery to run tissue and organ transplantation in fairly successful numbers. It is heart warming that other states including Gujarat, Maharashtra, and more recently Rajasthan are picking up the trend and emulating high standards in their

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COVER STORY transplant programs from southern states.

The co-ordinated system invariably attracts the best of the skilled medical fraternity to southern states, thereby producing good and positive outcomes, which in turn stabilises the program well.

The pioneers and leadership in tissue and organ transplantation originated from Tamil Nadu. The key to the success of the state’s program is the strong alliance forged between Government and private health sectors, non-governmental organisations (NGO’s) and the state’s health ministry. The political willingness to bank on the nobility of organ donation has been the propelling force driving organ donation and transplant in these states.

These southern states have also worked onsteps like transparent, smooth allocation and sharing of organs to deserving patients, training coordinators across the state hospitals to counsel the grieving relatives to make them aware of the system which are all exemplary.

The role of media has been commendable, their wide support for organ donation brings a greater visibility to the issue and helps break the barriers like stigma and scepticism surrounding organ donation.

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Tamil Nadu leads the Way Mohan foundation was responsible in launching its pilot project of organ sharing in 1999. The Initiative for Organ Sharing was formed first in Tamil Nadu in January 2000 with Apollo Hospitals, Sri Ramachandra Hospital, Sundaram Medical Foundation, Madras Medical Mission Hospital and Christian Medical College Hospital, Vellore.

The state government of Tamil nadu immediately embraced the philosophy.

Only five hospitals were involved at that time. But with an attitude of salvaging all retrieved organs, this partnership helped 681 patients in getting organs between the years 2001 to 2008.

In the later years, five hospitals became 55 hospitals and in the year 2012 number of donors in India were 196, out of which almost fifty percent were generated from Tamil nadu, which was seven times the national average (1.15 donor per million population).

Chennai city alone had a donation rate of 14 per million population, comparable to organ donation rates in Netherlands, Poland and Denmark.

The Hitendran Effect The single largest catalyst in promulgating the transplant program in Tamil Nadu was the Hithendran effect, when a doctor couple though grieving on their son Hithendran’s untimely demise, still consented to donate his organs. This act of kindness was highlighted by the media and this in turn swelled up the donation rates. The state government through various self-regulatory acts (G.O’s) made sure that the transplant program is transparent and seamless.

Other States Follow Suite This bolt of successsoon triggered a series of positive emulations from other states leading to a dawn of new era in organ transplantation.

The very successful, Jeevandan programme in Andhra Pradesh, Zonal Coordination Committee of Karnataka for Transplantation, in Karnataka and Maharashtra developed the Zonal Transplant Coordination Center in Mumbai and Nagpur, are some of the examples. The Kerala government, in 2012, set up Mrithasanjeevani and the Kerala Network for Organ Sharing and the programme has been moving forward

the pioneer in organ donation and transplant but also being the role model for the rest of the country. Tamil Nadu has received the award for highest donor generation for four consecutive years. (2015, 16, 17, 18) It also holds the Guinness record for a very large awareness meet (3500 members), setting up such high standards have helped drive the program more intensely. It’s almost midyear 2019, the organs transplanted in Kerala are 28, the organs donated in Andhra Pradesh are 225, and the organs used in Tamil Nadu exceed 417. This is clearly an indicator of the success of transplant program in Tamil Nadu.

In the foreseeable future this trend will continue. Let us see why?

Transtan

Image courtesy MOHAN foundation

successfully. The western state of Gujarat has also been working to implement organ transplant network consistently.

In addition, Mohan Foundation has been helping Delhi-NCR and Chandigarh develop similar networks and the results are encouraging. The most recent initiative in this area has been taken by the Government of Rajasthan with the setting up of the Rajasthan Network for Organ Sharing in December 2014. Now though other states have picked up, only ten states and certain union territories have generated organ donors. This trend has to change.

Why Tamil Nadu Will Stay Aheadin Organ Transplantation From ancient time, Tamil Nadu has been known for its literature, architecture, religious diversity and traditional wealth, but now it had attained the distinction of not only being

Transplant Authority of Tamil Nadu TRANSTAN was formed in 2014. Its functions are streamlining all procedures related to cadaver and living organ transplantation; helping hospitals identify brain stem death and maintain, distributing organs in a transparent manner; maintaining online waitlist registry; transmitting soft skills related to donor maintenance; helping hospitals in medical legal procedures; liaising with Police in providing Green Corridor for transporting organs; compile a state and regional database; liaising with neighbouring States in organ sharing; liaising with the Govt of India on issues related to transplants.

The CTP (cadaver transplant program), ROTTO (regional organ and tissue transplantation organisation) and SOTTO (state organ and tissue transplantation organisation) comes under the umbrella of TRANSTAN, thereby coordinating all activities effortlessly. Most importantly, TRANSTAN stands tall, in taking fast decisions and in prompt responses to allocating and sharing of organs.

Better Medical Expertise

Another core factor of success lies at the hands of the medical expertise that is available in Tamil Nadu, more specifically in Chennai. The transplant services in Chennai hospitals have learnt to apply pure

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COVER STORY

science; self-drive themselves to perfection, establishing a team style of working contrary to single surgeon concepts, and also have a democratic ambience amongst the team which eventually improves the outcomes of the transplanted patients.

The primary instinct of transplant teams to salvage every possible organ donated has led to increased organ utilisation rates, which is also an important reason why Tamil Nadu (Chennai) has more organs transplanted.

In addition, post-operative care extended by intensivists, pulmonologists, dedicated intensive care, ward staff and physician assistants is the key to good long term outcomes. This in turn propels Chennai into a transplantation hub for heart and lung failure patients.

Uplifting Tier 2 Cities

Only in Tamil Nadu, six second tier cities such as Madurai, Coimbatore, Trichy, Vellore, Salem and Thirunelvei has been generating donors regularly. This is because of the widespread,

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regular awareness activities, so much so, that most grieving relatives on their own raise queries about donating their deceased relative’s organs. This spontaneous and willing act of nobility if banked rightly and ethically will take the program to much greater heights.

Coordinated Efforts

The coordination between government and private sectors in Tamil Nadu is commendable. The role of fourth estate in allaying fears and eradicating the stigma and scepticism surrounding organ donation, is also strengthening the program.

The reasons behind this are a multitude of factors the foremost being, the good will of organ donation has been ambassador using all the popular faces that includes a long list of actors, politicians, sports person. Hence it is deep rooted even in the rural areas of Tamil Nadu. The coordinators are well trained to counsel the grieving relatives as well as to initiate and execute the chain of events following the consent for donation.

The Road Ahead With neighbouring states excelling in their own and rivalling positively with good numbers of organ donors, Southern India will soon be the undisputed leader of organ and tissue transplantation, with good long term outcomes. We will also be the center of learning and research on organ and tissue transplantation, helping other states set-up good networks.

It is our responsibility to spread awareness about this gift of life and to appreciate the fact that organ transplantation is not just a surgical procedure; it is an act of transforming lives. And it is also in our responsibility, that whenever the noble act of organ donation happens, no organ should be waste, for only in this scenario lies the uniqueness of the dead resurrecting the living.

Together, let’s make a healthier India and pledge organs, promote organ donation and save lives.

When Hostility Replaces Civility Dr Sunil Chandy, DM. M Phil, CMC Vellore

THE ASSAULT on a junior doctor in Kolkota, two weeks ago, is more than just another episode in the long saga of violence against doctors in India. Though unusual in its aggression, it reflects a growing mob sentiment against a profession that is set apart to care for others. Whatever their faults and failures may be, the doctor-fraternity is a crucial lifesustaining pillar of the society.

This incident too shall pass after the noise in the media dies down. In all likelihood, the offenders will get away after a name sake enquiry which will find them -not guilty.

Meanwhile, the doctor with the fractured skull will nurse his wounds at his own cost and move on with life. He will however, for the rest of his life, question whether it was for a dented skull that he pursued a career in Medicine; and so will many other junior doctors across India, whose confidence has been dented in the knowledge that it could happen to any one of them. The nation wide medico strike isan expression of their collective anger against the assault. The show of solidarity by members of the medical community through demonstrations is on expected lines. It is all over and the whole episode may now be just another portrait in the hall of shame.

But there arelarger issues that are of concern. This incident throws light on a deeper aspectof our social behaviorwhich must prompt thinkers to engage in conversation. There must beserious discussion on these mattersby the medical fraternity, media, regulatory agencies and the health ministry. The discussions must lead to the framing of preventive and prohibitory policies against assault on professionals. This

must be done quickly before the perceived apathy of action converts to larger deficits in the already strained healthcare services in India.It is not good to have healthcare be delivered by a demoralized workforce.

Crisis in Healthcare It is no secret that healthcare in India facesserious manpower shortage. The nation is short by about three hundred thousand doctors.

Although the deficitis pan-nation, it is felt maximally where doctors are needed most -the rural outback. Remote villageswhere most illhealth abounds are isolated and insecure for doctors to live unprotected.

Hospitals in cities offer more physical security, but doctors are cowered downby the pressure of work and clinical demands. Deficits of sleep and food go unattended. The demand of clinical work results in doctors working 10-15 hours a day. All this is compounded under the constraints of physical fatigue, accommodation, salary, leave and other compensations.

The rapidly declining culture of mentorship where a senior doctor accompanies, teaches and protects the junior adds to their insecurity.

Violent episodes like theseare serious disincentives for doctors to stay motivated, committed and comfortable at their workplace.

On the other hand, the government is on a commendable mission to increase the number of doctors with the hope that quantitative increase will solve the reeling healthcare problem in India. That surely is a good start. But they mustalso pay equal attention to qualitative issues like safety and security toensure their permanence.

The current attrition of healthcare

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OPINION

Whatever their faults and failures may be, the doctor-fraternity is a crucial life-sustaining pillar of the society

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professionalsfrom the system is a serious multifactorial problem which remains understated and unattended. Young doctors are leaving the country, changing into easier and more lucrative career streams or just stopping practice, unable to cope with the rigors of multiple exams and demanding work schedules. To add to this, the perceived threat to life will amplify this trend. A hostile work environment such as the current case will only alienate medical personnel further from giving their best to patient care. The escalating culture of violence against the doctors must therefore be curbed on a war footing to minimize further attrition.

Decline of Civility For every event that gets reported, there are a few that do not. Videos of assault captured on cellphones and forwarded on social media are just the tip of the iceberg. The identity of the assailants and the attitude of the onlookers suggest that there is a general decline of civility in our country. Aggression seems to be the new currency of expediency as showcased by public figures who endorse and support

such acts publicly for their five minutes of fame to be feature in televised debates. This macho attitude is trickling downwards into the public mind as the new mantraof public behavior, which the larger population thinks is acceptable. Anotherserious problem exists in our social behavior -amix of aggression and apathy. Aggression, when it comes to ourselves and what we want, andapathy when it comes to others and what they need. Airport counters, hospitals androad-travel are common scenarios where aggression and rage are displayed. On the contrary, it is apathy when we nonchalantly drive past the scene of a road accident.

The Kolkota episode is a display of aggression by the offenders and apathy by the public.Timely intervention by the public, police and press in a spirit of empathy, not enquiry, would have mitigated the near fatal hit. The profession has been brought down in stature by the sporadic sting operation reports by the media.Although anecdotal, these media salvoshave smeared the entire profession with the stain of non-professionalism. This is most unfortunate.The media would do well to resist the urge to sensationalise medical tragedies

in bringing out facts. The perception that doctors are money minded to the extent of being negligent is the reason for the bias that triggers attack on them. There is a human side to the doctors’ life which rarely gets captured. A thousand stories of compassionate care and miracles of healing can be heard in the corridors of every hospital. Stories of indomitable courage, sacrifice and empathy lie embedded in the medical records of every hospital. They need to be heard, told and retold a thousand times for the public to understand what it takes to be a doctor. This may be part of the public sensitisation that the media can do effectively. The publicmust be made to understand the finiteness of health and life and the limitations of a doctor.

Physician Behavior This incident may be a clarion call that should draw the attention of the medical community to rediscover the forgotten art of communication and compassionate care. Sickness and death are extremely emotive situations that can make a patient and his relatives irrational. This must be understood and responded to with caution.

Doctors must relearn the art of practicing real world medicine which is vastly different from what is taught inmedical colleges.

Day-to-day practice is nuanced with a thousand subtleties that must be factored in the care of the sickest people.

The knee jerk reactions to this episode have been aplenty. Some have suggested that doctors be armed with guns. Others have recommended that martial arts be introduced in the medical curriculum. One person has floated a GIF showing an Alsatian dog as an escort in the consulting chamber. These may have been made in jest, but it does convey a sense of cynicism within the doctor community. The brotherhood of doctors including the IMA must respond with a plan of action that will be a deterrent for the future episodes of violence on doctors. It is possible that such incidents will recur, but the response will hopefully be prompt and definite.

We have only heard of the phrase ‘cutting the hand that feeds you’. This episode actualises the phrase by ‘cutting the hand that serves you’.

One can only pray that this be the last time such an event has taken place.

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PULSE

Bioprinting- The Future of Transplant Medicine Divya Ramaswamy

As per the latest NHS statistics, in the UK one needs to wait about 944 days for kidney transplantation despite a significant decrease from the previous wait-time of 1,153 days.

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NOTHING CAN be more afflicting for patients and their families than waiting to receive an organ to save their lives. As per the latest NHS statistics, in the UK one needs to wait about 944 days for kidney transplantation despite a significant decrease from the previous wait-time of 1,153 days. Also, a huge disparity has been reported in the supply and demand, with just 2,456 organ donors compared to 6,388 patients requesting transplants, as of the year 2016⁄17.

To add to this complexity, there are other factors to be met such as the immunocompatibility, Rh Status and if the patients are prone to any Infections, or if there are any undiagnosed medical conditions like HIV, Hepatitis B or Cancer.

Recent advancements in medicine could tackle these issues via technologies such as additive manufacturing aka 3D printing, using which organs can be bioprinted. Bioprinting has not only the potential to tackle the- current issues of wait-list but also to be the next big thing in healthcare. Although the artificial making of human skin, tissue, and internal organs might seem very futuristic, a lot of it is already being researched around the world, providing a wide range of new treatment possibilities. Not only does bioprinting offers hope in making the long wait-times for organs a thing of the past, but also in making transplantation of organs done as quick as a matter of a few hours and without any risk of rejection from the body.

It was in 1983 when (full name)Charles W. Hull’s discovery of stereolithography (a type of printing that relied on a laser beam and computer-aided software to print objects in 3 dimensions) paved the way towards bioprinting.

The process of stereolithography slowly evolved alongside medicine and medical researchers further developed the technology to make organ-

building a reality. Later, in 1999, the researchers at the Wake Forest Institute for Regenerative Medicine, 3-D printed a synthetic scaffold of a human bladder and then coated it with the patients’ cells and successfully developed functioning human organs.

Bioprinting technology has now entered medicine via 3D printed prosthetics, surgical instruments, and bio-ink as a way of printing vital organs, bones, and cartilage. Bioprinting is just 3D printing using biological materials to create a three-dimensional organ by building successive layers of biomaterials. Organs are produced from a digital 3D file such as a CAD drawing or an MRI. This offers great flexibility compared to the implants that are made as standard size because it allows making changes to the implant easily without having to set up additional equipment or tools. Medical devices with highly complex internal structures can also be created to match a patient’s anatomy. To match the exact size, specifications, and requirements of each individual patient, bioprinted organs are created from the very cells of the body that they have to re-enter.

Such possibilities have sparked a huge interest in 3D printing of orthopedic, cranial implants, surgical instrument, and dental restorations too.

Timeline of Bioprinting Technology 1986- Charles Hull discovered 3D printing 1996- Discovery of the self-organizing and selfassembling capacity of cells to form new combined structures.

1998- First human stem cell lines were developed 2000- First trials with a synthetic scaffold for Urinary bladder augmentation 2003- Thomas Boland modified an inkjet printer to accommodate & distribute cells in scaffolds 2004- Dr. Gabor Forgacs develops new technol-

ogy to engineer 3D-tissue using just cells 2009- Invetech&Organovo developed the world’s first commercial bioprinter- NovoGen MMX 2009-10- The first human blood vessels were printed 2010 to present- Additional advancements have enabled 3D printing of bones, ears, exoskeletons, windpipes, blood vessels, vascular networks, tissues, and other organs While most organs are in their early stages of development, bioprinting has already proved to be successful, especially in the area of skin and bone.

Breakthroughs In The Field Of Bioprinting: Skin Constructs That Accelerate Wound Healing

The researchers at the Wake Forest School of Medicine have designed a skin bioprinter that allows skin cells to be printed directly on the wound. “The unique aspect of this technology is

the mobility of the system and the ability to provide on-site management of extensive wounds by scanning and measuring them in order to deposit the cells directly where they are needed to create skin,” said Sean Murphy, PhD, a WFIRM assistant professor who was lead author of the paper published in Nature’s Scientific Reports journal.

The cells are mixed into a hydrogel and placed into the bioprinter. Integrated imaging technology involving a device that scans the wound, feeds the data into the software to tell the print heads which cells to deliver exactly where in the wound layer by layer. The bioprinter deposits the cells directly into the wound, replicating the layered skin structure, and accelerating the formation of normal skin structure and function.

One Step Closer To Making A Human Kidney

In recent years, researchers have created miniorgans known as organoids in the culture dish Image courtesy :Organovo Holdings, Inc

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PULSE that contain many of the cell types and complex microarchitectures found in human organs, such as the kidney, liver, intestine, and even the brain.

However, most organoids grown in vitro lack the vasculature required to provide oxygen and nutrients, remove metabolic waste, and facilitate communication between different cell types that drives their maturation into truly functional tissue building blocks.For kidney organoids, this shortcoming prevents researchers from emulating key kidney functions in vitro, including blood filtration, reabsorption, and urine production. Creating robustly vascularized kidney organoids could enable better modeling of kidney diseases, enhance renal drug toxicity testing and, ultimately, lead to new building blocks for renal replacement therapies.

Now, a research team at the Wyss Institute for Biologically Inspired Engineering at Harvard University, Harvard’s John A. Paulson School of Engineering and Applied Sciences (SEAS), Brigham and Women’s Hospital, and the Harvard Stem Cell Institute led by Jennifer Lewis and Ryuji Morizane has developed a powerful new

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approach as part of the Institute’s new 3D Organ Engineering Initiative. By exposing stem cell-derived organoids to fluidic shear stress, they were able to significantly expand organoid-derived vascular networks, and improve the maturation of kidney compartments in comparison to previous static culture methods. The work is published in Nature Methods.

Therapeutic Implants for Liver Disease

San Diego-based bioprinting organization- ‘Organovo’ has already demonstrated 3D printing of human liver tissue patches. The company is modeling non-alcoholic fatty liver disease using its 3D bioprinted human liver tissues. The company demonstrate a progressive accumulation of fat over time, creating a window of disease progression onto which candidate drugs targeted at fat accumulation and disposition can be applied.

These new data provide strong support for the application of the NAFLD model to high-value drug profiling, including the possible creation of patient or population-specific model variants.

Organovo’s 3D bioprinted human liver tis-

sues function for at least four weeks and are comprised of a complex multicellular architecture that more closely emulates human biology and disease. The Company’s tissue systems have the potential to facilitate breakthrough translational research from target discovery to high-value drug profiling, enabling better understanding of disease processes, discovery of novel therapeutics, biomarkers, and the safety assessment of drugs in a disease-relevant background.

Working, Beating Hearts soon to be printed out

Apart from being one of the most promising bioprinted organs for transplantation, hearts are also the easiest to recreate since it doesn’t involve complex biochemical reactions but only a primary function being pumping of blood. Researchers at the Tel Aviv University (TAU) have bioprinted the world’s first ever 3D vascularized heart using a patient’s own cells and other biological materials. They used a simple approach and bioprinted a thick, vascularized and perfusable cardiac patches to perfectly match the patient’s anatomical properties. This research has demonstrated the potential of the approach for engineering personalized tissues and organ replacement in the near future. Though their bioprinted heart is small at this stage, they believe that larger human hearts can be created using the same technology. They are planning on culturing the bioprinted hearts in the laboratory and are trying to develop the organ further, especially with respect to its functionality.

3D- Printed Artificial Corneas to Replace Donor Transplants

With millions of people throughout the world suffering from corneal blindness, there is an enormous requirement of corneal transplants.

The scientists at Newcastle University have for the first time bioprinted human corneas using stem cells from a healthy donor cornea. They used a simple low-cost 3D bioprinter and the bio-ink was successfully extruded in concentric circles to form the shape of a human cornea. It took less than 10 minutes to print.. They used a unique gel combination of collagen and alginate to keep the stem cells alive whilst developing a material that is rigid enough to be squeezed out

of a 3D printer’s nozzle. The bioprinted corneas are undergoing further testing and have the hope that they will be used for transplantations in the near future.

3D Printed Bones to Accelerate Healing Of Fractures

A team of researchers at the University of Glasgow has developed ‘nanokicking’ technique that can grow 3D samples of mineralized bone.

In a paper in the journal Nature Biomedical Engineering, the researchers describe how they have used measurement technology, based on the sophisticated laser interferometer systems built for gravitational wave detection of astrophysical objects, to turn mesenchymal cells taken from human donors into bone cells in three dimensions. These 3D living bone grafts, when implanted into patients in the future, will be able to repair or replace damaged sections of bone.

Bioprinting technology has now entered medicine via 3D printed prosthetics, surgical instruments, and bio-ink as a way of printing vital organs, bones, and cartilage

Bioprinted Cartilages to Revolutionize Joint Care

Experts at the Australian biofabrication center ‘BioFAB3D” have developed a handheld printing device called ‘BioPen’ to make cartilages. The device is filled with stem cells obtained from an individual’s fat to create and surgically implant custom scaffolds into failing joints. It has been tested only on sheep but is hoped the BioPen can help accelerate functional human cartilage soon.

In spite of its versatility and enormous benefits offered by bioprinting, it still has a number of challenges including higher shear stresses, lower resolutions, and limitations with respect to material selection. And while certain parts of the human body are highly complex than the rest, each of them has its own specialized needs and problems that have to be addressed. Furthermore, working through all these complexities need integration and input on several advanced technologies from various fields other than medicine such as physics, cell biology, material science, and engineering.

However, despite all the above-mentioned complexities, bioprinting is developing at a massive rate making advances daily. Although we are not quite there yet, there is no doubt that there will soon be a successful clinical translation of bioprinting.

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INTERVIEW

“Hand donations and transplant is a fairly new concept but it is successful” Amrita Institute of Medical Sciences, Kochi conducted Asia’s first upperarm doublehand-transplant on a 19-year-old female student last year

SHREYA SIDDANAGOWDA, a 19-yearold chemical engineering student of Manipal Institute of Technology who lost both her hands in a road mishap. In September 2016, while returning by road from Pune to her college near Mangalore, the bus she was travelling in overturned at Honnavar (80 kms from Manipal), crushing her hands. She was rushed to the Kasturba Medical College in Manipal, where both her arms had to be amputated at the elbow. Shreya was devastated, losing her hands at such a young age. Four months later, Shreya began to use prosthetic limbs, but was unhappy with them as it did not allow her to do most of the daily chores. Her uncertain wait for a hand donor finally ended in August 2017.

A 20-year-old BCom final year student of Ernakulam’s Rajagiri College, Sachin met with an unfortunate accident. He was declared brain-dead after suffering fatal head injury in a motorcycle accident. His parents readily agreed to donate his hands and other organs for transplant. Dr. Subramania Iyer, HOD, Plastic & Reconstructive Surgery, Amrita Hospital, led a team of 20 surgeons and a 16-member anesthetic team in a surgery that lasted 13 hours. M Neelam Kachhap speaks to Dr Iyer to find out more about the hand transplant.

Why are hand transplants so rare?

Globally about 150 patients have undergone

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hand transplants. In India, nine patients have undergone bilateral hand transplants. Hand transplant are very complex and need a large team to carry it out.Also getting a donor is not very easy. These are the main impediments why the number of transplants is still low.

Tell us about your journey when you and team first thought of starting hand transplant program and till you did your first case?

We had a lot of preparations to do. We had to equip ourselves technically. This we achieved by going through the published literature, having several team meetings as well as practicing on cadavers. We had to get the team organised by getting together different specialists like plastic and micro surgeons, orthopedic surgeons, immunologists, rehabilitation specialists, transplant nurses and coordinators. Next was the legal hurdle, we had to get legal sanction from the government. This was granted after two inspections by the authorities. And finally we had to publicise the program well so that we would be able to get the most suitable recipients as well as increase the awareness of the public to increase the chances of getting a donor.

Could you tell us about your team who were part of hand transplant surgery?

We had a team of six plastic surgery consultants assisted by about 10 junior surgeons. Dr Mohit Sharma and Iled these teams. The orthopaedic team consisted of five surgeons and the nephrology team who lent us support for immunosuppression protocols and management was led by Dr George. In addition, Dr Ravisankaran led the rehabilitation team, Dr Malini Eapen the pathology services and Mr Prasad led the coordinators.

In terms of complexity, please explain how hand transplant is different from other organ transplants?

Hands have complex anatomy and several structures inside it. For example the hand at the area of wrist has 6-8 blood vessels 4-5 nerves, 20-24 tendons and two bones. All these have

to be connected and so that the hand function properly. Additionally, the preparation of the recipient and donor takes much more time than the other organs.

surgery and one or two orthopaedic teams ready at the same time. Ischemia time is a great factor which determines the final outcome. So everything has to be done in a time efficient and quick manner.

What are the challenges while doing hand transplant surgery?

The main challenge is to get the suitable donor.

Hand donation is much less common than solid organ donation. It is not heard off in many places.

In fact, when hands are donated the mutilation that occurs on the body due to the donation is quite evident. So we have to mask it by attaching prosthetic hands. We show the prosthetic hands to the potential donor families and reassure them that the deformity will be masked to a great extent.

But still many are reluctant. Then other challenge is to have at least five surgical teams, two for donor retrieval and preparation and two for recipient

What are the organ retrieval and transportation protocols? Are they different from other organ retrievals?

One of the important factor to be kept in mind is the coordination with the other organ retrieval teams. Among the transplant retrieval teams itself many are not aware how the hands are retrieved. Sequence of the retrieval optimising the viability of vital organs as well as the hands have to be worked out with the other teams. This was possible in all our five transplant cases.

What we do is to prepare the hands for

Hand transplant recipient Shreya with her parents, Dr. Subramania Iyer and team of doctor

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INTERVIEW muscles of the recipient are intact. Also the more distal you go the better chances of nerve recovery so the elbow, the process is difficult and the results are slightly poorer.

Could you tell us about the training programs for hand transplant surgery in India?

We have been acting as the nodal centre for centers that want to start transplant programs.

We have had several teams visiting us and spending time interacting with all our team members. Also we have prepared a protocol and SOP which has been used by all other centres to get approval from the authorities. This protocol has been made withconsidering the Indian conditions and hence found to be quite useful by all the other teams.

Dr. Subramania Iyer, led a team of 20 surgeons and a 16-member anesthetic team in a surgery that lasted 13 hours retrieval initially under tourniquet so that the blood loss and hence hemodynamic instability is avoided and then proceed with the removal after the aorta is cross clamped. The limb is perfused in cold solutions and kept wrapped in subnormal temperature for transport.

The cases you have done so far were they perfect HLA matched?

Donor matching isdone as for kidney donor match; ABO blood group compatibility is adhered to. More important is doing the

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lymphocyte cross match. Initially we were using CDC matching but we have additionally started to use the luminex assay platform too.

The HLA match was never perfect in our cases.

How important is the institutional support and an enabling environment as you need multidisciplinary approach to hand transplant?

The only reason for our success was the institutional capability for the transplants. We were leaders in solid organ transplants and this helped a lot in assembling the supporting team. The transplant coordinators play an important role in getting willing donor families. We had a very good team of coordinators with us in the institution.

How different are wrist transplants from elbow transplant?

Wrist transplants are technically easier as the structures are more distinct in this area.

Though technically wrists take more time to join together, the results are better as the

Is your team working towards full face transplant? By when do you think it could happen?

We are geared up for full face transplant. We had done our cadaver training sessions and are planning to apply for the permission. We are looking for a very suitable recipient who wouldnot be benefited from routine reconstructive methods but will benefit from face transplant. A burn or trauma victim with poor nasal and oral function and looking to benefit in getting the eye function restored will be the ideal candidate. A major consideration here is the reaction of the donor’s family. We are still worried about how the society will take the concept of face donation when the request is made.

What else is next on the cards?

We have five candidates waiting for transplants.

All have lost both of their upper limbs. In fact one lady is also a double leg amputee.

Our main constraint has been the general lack of organ donations in the state. We are trying to improve it by spreading the positive message of benefits of hand transplantation among general public as well as transplant coordinators. I feel it is still a long way to go.

We want to initiate a programme for donation of hands after cardiac death also. Necessary permissions are being sought from the government for this.

INNOVATE

Personalised Bioink for 3D Printing TAU Scientists Print First 3D Heart Using Patient’s Own Cells and Materials

IN A major medical break through, Tel Aviv University (TAU) researchers have printed the world’s first 3D vascularised engineered heart using a patient’s own cells and biological materials.

“This is the first time anyone anywhere has successfully engineered and printed an entire heart replete with cells, blood vessels, ventricles

Fig 1: Concept schematic. An omentum tissue is extracted from the patient and while the cells are separated from the matrix, the latter is processed into a personalized thermoresponsive hydrogel. The cells are reprogrammed to become pluripotent and are then differentiated to cardiomyocytes and endothelial cells, followed by encapsulation within the hydrogel to generate the bioinks used for printing. The bioinks are then printed to engineer vascularized patches and complex cellularized structures. The resulting autologous engineered tissue can be transplanted back into the patient, to repair or replace injured/diseased organs with low risk of rejection.

and chambers,” says Prof. Tal Dvir of TAU’s School of Molecular Cell Biology and Biotechnology, Department of Materials Science and Engineering, Center for Nanoscience and Nanotechnology and Sagol Center for Regenerative Biotechnology, who led the research for the study.

Until now, scientists in regenerative medicine — a field positioned at the crossroads of biology and technology — have been successful in printing only simple tissues without blood vessels. Heart disease is the leading cause of death among both men and women globaly. Heart transplantation is currently the only treatment available to patients with end-stage heart failure.

Given the dire shortage of heart donors, the need to develop new approaches to regenerate the diseased heart is urgent.

“This heart is made from human cells and patient-specific biological materials. In our process these materials serve as the bioinks, substances made of sugars and proteins that can be used for 3D printing of complex tissue models,” Prof. Dvir says. “People have managed to 3D-print the structure of a heart in the past, but not with cells or with blood vessels. Our results demonstrate the potential of our approach for engineering personalized tissue and organ replacement in the future.”

Research for the study was conducted jointly

by Prof. Dvir, Dr. AssafShapira of TAU’s Faculty of Life Sciences and Nadav Moor, a doctoral student in Prof. Dvir’s lab. “At this stage, our 3D heart is small, the size of a rabbit’s heart,” explains Prof.

Dvir. “But larger human hearts require the same technology.”

For the research, a biopsy of fatty tissue was

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INNOVATE

Fig 2: Printing thick vascularized tissues. a) A top view of a lumen entrance (CD31; green) in a thick cardiac tissue (actinin; pink). b) A model of a tripod blood vessel within a thick engineered cardiac tissue (coordinates in mm), and c) the corresponding lumens in each indicated section of the printed structure. d) Tissue perfusion visualized from dual viewpoints. e–k) A printed small‐scaled, cellularized, human heart. e) The human heart CAD model. f,g) A printed heart within a support bath. h) After extraction, the left and right ventricles were injected with red and blue dyes, respectively, in order to demonstrate hollow chambers and the septum in‐between them. i) 3D confocal image of the printed heart (CMs in pink, ECs in orange). j,k) Cross‐sections of the heart immunostained against sarcomericactinin (green). Scale bars: (a,c,h, i,j) = 1 mm, (g) = 0.5 cm, (k) = 50 µm.

This is the first time anyone anywhere has successfully engineered and printed an entire heart replete with cells, blood vessels, ventricles and chambers

taken from patients. The cellular and a-cellular materials of the tissue were then separated.

While the cells were reprogrammed to become pluripotent stem cells, the extracellular matrix (ECM), a three-dimensional network of extracellular macromolecules such as collagen and glycoproteins, were processed into a personalized hydrogel that served as the printing “ink.” After being mixed with the hydrogel, the cells were efficiently differentiated to cardiac or endothelial cells to create patient-specific, immune-compatible cardiac patches with blood vessels and, subsequently, an entire heart.

According to Prof. Dvir, the use of “native” patient-specific materials is crucial to successfully engineering tissues and organs.

“The biocompatibility of engineered materials is crucial to eliminating the risk of implant rejection, which jeopardizes the success of such treatments,” Prof. Dvir says. “Ideally, the biomaterial should possess the same biochemical, mechanical and topographical properties of the patient’s own tissues. Here, we can report a simple approach to 3D-printed thick, vascularized and perfusable cardiac tissues that completely match the immunological, cellular, biochemical and anatomical properties of the patient.”

The researchers are now planning on culturing the printed hearts in the lab and “teaching them to behave” like hearts, Prof. Dvir says. They then plan to transplant the 3D-printed heart in animal models. “We need to develop the printed heart further,” he concludes. “The cells need to form a pumping ability; they can currently contract, but we need them to work together. Our hope is that we will succeed and prove our method’s efficacy and usefulness. Maybe, in ten years, there will be organ printers in the finest hospitals around the world, and these procedures will be conducted routinely.”

References  Nadav Noor, AssafShapira, ReuvenEdri, Idan Gal, Lior Wertheim, Tal Dvir. 3D Printing of Personalized Thick and Perfusable Cardiac Patches and Hearts. Advanced Science, 2019; 1900344 DOI: 10.1002/ advs.201900344

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38

MARKET CONNECT

Mindray promises Better healthcare for all

DEAN ZHANG

Managing Director, Mindray India

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ith the vision of “Better healthcare for all”,

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Exchanges on medical knowledge and technologies,

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In India we have always taken extra initiatives to provide latest high-quality, innovative and cost-effective products and a very good service team and very good professional clinical support team. We are so glad that increasingly Indian hospitals have accepted us over past two decades – and also, very importantly, that they are very happy about the product, service and support. This gives us a lot of confidence. We walk very closely with the end-user and customer and medical professionals. We also have now many very good reference installations in university hospitals and city-level top hospitals and diagnostics centers all over India.

Mindray being a complete healthcare solutions provider will continue delivering the products and services that meet customer needs. We believe that every life is equal and deserves the right to receive quality healthcare service. We will continue striving harder toward our aim of providing healthcare within reach.

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Q&A

ASK THE EXPERT

Running a private medical practice in India comes with the risk of lawsuits and property damage. As a medical professional, you are probably well aware of the devastating effects of legal cases and security threats that await doctors who face the blunt of an angry patient. We encourage you to share your queries and concerns regarding legalities of practicing medicine in India to learn more about legal framework, legal cases and the experience of fellow doctors

Prof ( Dr ) R K Sharma, President, Indian Association of Medico-Legal Experts , New Delhi will answer questions from our readers. Please send in your queries to editor@indiamedtoday.com

Q: Do doctors charge a lot in India, is it correct?

Ans: The following is fee structure of doctors of allopathy in India • In tier 3 cities - Rs 100 per consultation including medicines • In tier 2 cities- Rs 300 per consultation that may include medicines in some cases • In tier 1 cities – Rs 400 per consultation • In metropolitan cities- MBBS doctor charge Rs 500 per consultation • Specialist charges - Rs 1200-2000 per consultation • Maximum charge - Rs 3500-3500 per visit I have yet to come across any doctor who charges Rs 10,000 per consultation. While I know a lot of High court / Supreme Court lawyers who charge Rs 10000 / per consultation. Do we doctors charge a lot? Average doctor earns more than average lawyer but a good lawyer earns 10 times more than a good doctor.

Q:

What is my medico-legal liability for

patients admitted under my care in a private hospital, if I resign from the hospital.

Dr TanuSatija

Ans: You can only be relieved of your duties in case of resignation when • You discharge your patients and they leave hospital.

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July 2019

• Care of your patient is transferred to other doctor who takes over before your relieving order is signed.

Only after you get relieving order, your medico-legal liability stands finished but you still remain liable for earlier care provided by you Q: I

nursing home too. Your insurance is not applicable for claims against nursing home.

Recommended is atleast 1-2 crores. You should ask your son also to take separate insurance as he may work in other places too but if he is working on salary basis in your nursing home, he need not take separate insurance as he would be covered in nursing home insurance.

am running a small nursing home as

Q: Is it essential to keep record of OPD pre-

am having Professional Insurance for my-

scriptions? Should we give new prescrip-

self .I am an Orthopedic Surgeon with M.S.

tion everytime when patient comes for

ortho. Now my son also an orthopedic sur-

follow up?

geon has joined me in my practice and is

Ans: It is not essential legally to keep record of OPD prescriptions, there is no need also to issue new prescription when patient comes for follow up. You can write on same prescription paper again. But it is always better to keep records. It can be easily done if you issue it from computer. Doctors should be tech friendly now.

do I get him an insurance in individual capacity or get my nursing home insured. If I get the nursing home insured do I need to get myself insured separately?

Ans: You should take insurance for your

If I have changed my state medical

council number of all my degrees from one state to another state with NOC from the previous sate and now practicing in a the new state ,can the medical council of the previous state call me up for PE committee on any incident involving me many years back during my stay in the previous state ?

Does it fall under their jurisdiction to ask a

a single proprietor of the nursing home. I

being given a salary for his services. Now

Q:

doctor to come and face quarries?

Ans: Yes, previous medical council can call you on any incident when you were working in that state. Please remember that there is no time limit fixed for filing complaint against doctors in medical council.

Disclaimer: This material has been prepared for informational purposes only, and is not intended to replace, and should not be conveyed or constitute legal advice. You should consult professional lawyer and legal advisors before engaging in any legal matter.

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EVENTS

EVENTS

CAHOTECH 2019 Date: 27-28Sep, 2019 Location: IIT Madras, Research Park City: Chennai Organizer: Consortium of Accredited

healthcare Organizations (CAHO) Click: http://cahotech.com Contact: Organizing Secretary, J Adel,

99444 37572

C

AHOTECH is one of the most primed events that brings together all stakeholders – hospitals, healthcare and technology startups.Cahotech 2019 -4th International Annual Healthcare Technology

MEDICALL 2019 Date: July 26-28, 2019 Organiser: Medexpert Business Consultants Pvt. City: chennai Contact: Mr.KSundararajan, 91-7305789789 Click: info@medicall.in

M

ADVANTAGE HEALTHCARE-INDIA 2019 Noida(NCR) India

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July 2019

he medical value travel industry has emerged as one of the fastest growing segment of tourism industry despite the global economic downturn. According to the FICCI – IMS Report, India is one of the key MVT destinations in Asia with over 500,000 foreign patients seeking treatment. MVT can be a 9 billion USD opportunity by 2020 through adequate focus and effective execution. The objective of this summit is to promote India as a Premier Global Healthcare Destination and to enable streamlined medical services exports from India. This underlying objective is a unique conglomeration of the ‘5 – Ts’ - talent, tradition, technology, tourism and trade.

The event will host three days exhibition with B2B meetings and hospital inspection. Along with Proposed Health Minister’s round table meeting followed by Networking Dinner hosted by Hon’ble Health Minister. There will also a proposed Tourism Minister’s round table meeting followed by Networking Dinner hosted by Hon’ble Tourism Minister. Along with networking dinner on last day hosted by FICCI.

INTERNATIONAL CONFERENCE ON HEALTH IN SDGS Date: 18-21 August, 2019

T

he SDGs have been built upon the success of the Millennium Development Goals agreed upon in 2000. The SDGs have been adopted in 2015 to follow up on MDGs and determine the direction and the role of various other sectors in health. SDGs are a universal call to action to focus on People, Planet, Prosperity, Peace and Partnership. SDGs differ from MDGs and are designed to finish the unfinished agenda of MDGs and to get a statistical zero on hunger, poverty, preventable child death and other targets. The health goal is on ‘health and wellbeing for all at all ages’. It addresses the health needs of the population from womb to tomb. The social determinants of health are central to promoting well-being for all at all ages and thus dealing with health and wellbeing. The SDGs have put emphasis on social determinants of health by taking care of environmental (7 goals), poverty and inequality (4 goals) and peace (5 goals), which all contribute to health.

IIHMR Delhi is organizing an International Conference on Health in SDGs - “Health for all and all for Health” from August 18- 21, 2019. The conference will provide a common platform for the participants from different Countries to discuss the challenges in achieving SDGs and to formulate action plans for their respective countries.

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JUNE 2019

Date: Nov 13-15, 2019 Noida; Venue: India Expo Centre and Mart, Greater

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Organiser: IIHMR Delhi Contact: akkhokhar@iihmr.org Venue: Indian Habitat Centre, Lodhi Road

INDIA MED TODAY

edicall is India’s largest B2B trade fair for medical devices and hospital supplies. Approx. 750 exhibitors and 15,000 trade visitors from over 20 countries, among them physicians, but also biomedical engineers, sales people, decision makers, consultants and hospital owners, are represented at this important industry event. In addition to the presentation of the best and the latest medical and medical-technical equipment, software, supplies and other devices the market has to offer the fair mainly serves as a platform to exchange knowledge and experiences among renowned industry experts. Various conferences and innovation awards in different categories complement the event.

Event, promises to bring some of the best incubation centers like IITM Research Park, HTIC, SINE (IIT Mumbai), Health Pod, Start-up Podium, The Chennai Angels, TiE Global etc and their startups, the most respected healthcare leaders and the industry’s most sought after investors on board. It is primed to be event of the year with discussions on disruptive and adaptable technologies in healthcare.

The event boasts of stalwart speakers, contemporary topics and provides an opportunity for professional upgradation, paper presentation, master classes, liaison and networking.

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