Prof. Nithya Krishnan is Consultant Transplant Nephrologist, Lead Renal Transplant Services (Clinical & Research),University Hospitals Coventry & Warwickshire (UHCW) NHS Trust, U.K and Visiting Professor, Faculty of Health and Life Sciences, Coventry University, U.K. She delivered the Swamy Narayan Memorial Oration on ‘Women in Transplantation’ at the 10th Annual Transplant Coordinators’ Conference in October 2017 at Indore, India. It was an impassioned presentation by an accomplished ‘Woman in Transplantation.’ Excerpts from an interview –

Q. How has your professional journey been from India to UK?

A lot of gain and a significant amount of pain. As you know, there is no gain without pain. The journey had been a roller-coaster ride with its ups and downs. I have now been in the UK for 21 years. There is no substitute for hard work and being able to persevere and endure keeping the cause in mind is what keeps one going. Of course, the cause needs to be genuine and one needs to be truthful.

Q. Teaching and collaboration seem to be close to your heart – tell us more about your work as Course Director of the Advanced Renal Transplantation interactive webinar and future plans for this.

The aim of this project, the advanced course in Renal Transplantation, administered by The Transplantation Society (TTS) was to provide first-class exemplary teaching by the world experts to all those interested in advancing their knowledge in renal transplantation globally. This curriculum was administered through 18 online webinars and is CME accredited. Those who completed the entire series were awarded the TTS Certificate in Advanced Renal Transplantation. The expenditure involved in the actual delivery process was borne by the TTS. The world experts in their fields delivered the lectures free of charge, as they were members of the TTS. The lectures will be available for all members for a two-year period on the TTS website (tts.org).

The course was launched in 2015 and has had more than 1000 viewings making it the most successful course run by TTS. I am thankful for the expertise of Prof. Medhat Askar, Prof. of Immunology, Baylor University, USA in refining the course modules, as well as the expert faculty – Dr. Francis Delmonico, USA, Dr. Dominique Martin, Australia, Prof. Howard Cable, Prof. Stanley Jordan, USA, Prof. Peter Friend from Oxford, UK, Prof. Rutger, UK to name a few.

I propose to consolidate the learning experience of the trainees worldwide by structuring a programme that enables them to secure a higher degree in Transplantation. This project would ensure access to evidence-based practices in various transplant related disciplines to those interested in advancing their knowledge in transplantation at a subsidized rate. This would enable the participants to practice state-of-the-art medicine, as currently there are huge disparities worldwide. As the TTS is the main international organisation for transplantation and has about 6400 members worldwide, courses like these would be far-reaching and enhance ethical state-of-the-art transplantation globally.

Q. What is the International Transplant Fellowship programme that you are running?

I have introduced an International Transplant Fellowship programme for visiting fellows in transplantation in our unit. The fellows, both surgeons and physicians, would visit our centre for a one-year period. They would not only get hands-on experience in the day-to-day management of renal transplant recipients and donors, but also get to spend a considerable amount of time doing research. Our centre is an active research unit with many publications in peer reviewed journals.

The programme is new. We have had two graduates of the programme, one surgical fellow and one nephrology fellow. The training and hands-on experience in the day-to-day management of these complex patients has certainly helped them a lot. The programme has become very popular and therefore we have now increased it to four posts and are going to advertise in February 2018. A panel from UHCW will select the candidates.

Q. There is a Mentor-mentee partnership between UHCW and Jawarhalal Institute of Medical Sciences, Imphal – what is your vision and the way forward for this?

I am originally from Chennai and did my undergraduate medical degree from Madras Medical College. Having been involved in a lot of social service activities, mainly through the Chinmaya Organisation of Rural Development (CORD) in India, I have the urge to do more. I am passionate about improving ethical transplantation worldwide. I firmly believe that access to state-of-the-art treatment should be made available to every human being. This can only be facilitated by empowerment and advancement of local hospitals, which forms the basis of the ISN-TTS sister unit scheme. The mentor-mentee unit partnerships are fundamental and integral in improving health care outcomes throughout the world.

The sister unit programme concurs with my vision and thus provides a platform to reach out and promote the best health care available today to the disadvantaged areas. Currently there is no deceased donor transplantation happening in this state which has a population of 2.6 million people or in the neighbouring five states, which has a total population of 37 million. The nearest transplant centre is 945 km away in Kolkata. For an average patient residing in those states, it is a huge financial burden to even travel to Kolkata, let alone the costs of the treatment and medications. If we successfully establish a transplant centre in the underdeveloped North-Eastern part of India, this will provide kidney transplant service free of charge to a population of 39 million, closer to their home. This is a golden opportunity and thus we will endeavour to make this partnership a huge success. The idea was mooted by Dr. Georgi Abraham, Consultant Nephrologist, Madras Medical Mission. Dr. Sholay Meitie, Nodal officer of SOTTO, Manipur, will be going to UK to undergo training and take back best practices to Manipur.

A year of fellowship would mutually benefit the mentor and the mentee unit in establishing a world class service in patient care and raising the research profile at both the centres. The mentor unit would aim to train transplant coordinators, nurses and other support workers in the mentee unit so that a complete transplant team is established at the sister unit in the developing country. Some members of the mentor unit would be visiting the centre on a regular basis to appreciate the local needs and help in setting up the service accordingly. Similarly, some members of the mentee unit will visit so that they would be able to experience and learn the state-of-the-art practice in different aspects of kidney transplantation. Thus, the mentor unit would provide support to the partner centre in research, education and patient care and thus improve the transplant service holistically.

Q. What research projects/studies are you currently working on?

Live donors and outcomes, Nutrition on dialysis and its impact post transplantation, Non-adherence in young adults post renal transplantation, Management of recurrent diseases post transplantation, Antibody incompatible transplantation and Cardiovascular assessment and fitness of potential recipients.

With regard to non-adherence in young adults post transplantation, we are looking at Serious games using the KJ Ho method (a creative thinking and problem solving methodology invented by a Japanese anthropologist) for the first time in UK. In this method everyone’s opinion counts. One keeps going back to the baseline; this is refined and after coming to a concrete conclusion, the appropriate games are designed.

Q. What does India need to do to scale up its organ donation and transplantation programme? What about prevention of Chronic Kidney Disease (CKD)?

It is encouraging to note that the Government of India and the state governments are invested in promoting organ donation and deceased donor transplantation. MOHAN Foundation has been doing a phenomenal job in the field for the past 20 years and continues to do so. Of course, we should concentrate on the four pillars of prevention of CKD – Education, Awareness, Healthy Lifestyle and Early Intervention given that Asians have a genetic predisposition for diabetes mellitus and hypertension.

Q. Any other thoughts that have impacted you and your work in a positive manner.

My dad’s preaching to me – ‘Work like a bull and live like a Prince’ and my Guru’s teachings – ‘Producing more than what we consume and giving more than what we take’ are the two mantras which have had and continue to have a positive impact on my work. Remembering that ‘This too shall pass’ has stood me in good stead!

                                                                                      Interviewed by Dr. Sumana Navin