Dr. Avnish Seth - Leading from the front
Dr. Avnish Seth, MD, DM is Director, Gastroenterology & Hepatobiliary Sciences and Director, Fortis Organ Retrieval & Transplant (FORT) at Fortis Memorial Research Institute (FMRI), Gurugram. The quintessential ‘Officer and a Gentleman’ has been a driving force of the organ donation movement in India. He shared his experiences in an email interview with Dr. Sumana Navin.
Your professional journey started in the Army Medical Corps – how was that experience?
It has been my privilege to serve in the Army Medical Corps for 27 years. Wearing a uniform is a very special feeling. The camaraderie and brotherhood is unmatched and so is the professionalism. I got the opportunity to teach Medicine at my Alma Mater i.e. Armed Forces Medical College Pune, pursue Gastroenterology at PGIMER Chandigarh and also a fellowship in Liver Transplantation at UK. We started the first successful Deceased Donor Liver Transplantation program in North India at Army Hospital Research & Referral, New Delhi in 2007. It was an honour to receive the Vishisht Seva Medal from the President of India in 2008.
What was the genesis of the Armed Forces Organ Retrieval Transplantation Authority (AORTA)?
It was my stay in England for 6 months that made me realize that in India one went through school, college, MBBS, MD and DM without even a mention of brain death and deceased organ donation! On our return, everyone told us that organ donation does not happen in India and one should focus on living donor liver transplantation. We decided to give it a try and I asked my MD student to look for brain death prospectively as a thesis protocol. We got the paperwork in
Order and within 15 days we had our first multi-organ donation! I remember the wave of awe and positivity that swept through the hospital but we were not surprised. One had realized that the problem was not that the people of India were averse to organ donation but that we had not bothered to have systems in place. Buoyed by the success, I sought an appointment with the Director General of Armed Forces Medical Services and made a presentation. All the senior management was very supportive and the Armed Forces Organ Retrieval & Transplantation Authority (AORTA) was born.
Why did you move to the private sector and how did Fortis Organ Retrieval & Transplant (FORT) come about?
Unfortunately, the Armed Forces could not keep our team together at Army Hospital R&R despite us doing 30 deceased donor liver transplants in two years. I took premature retirement in 2009 and joined BL Kapur Super speciality Hospital where we were able to start a successful deceased donation program. In 2012 Fortis Healthcare Limited, which has the largest chain of hospitals in the country, accepted my proposal to set up Fortis Organ Retrieval & Transplant (FORT) and I joined Fortis Memorial Research Institute (FMRI) at Gurugram.
What was the Green Corridor drill that FORT initiated?
In August 2014 with the help of police officials from Delhi and Gurugram we carried out the first mock drill on establishing a green corridor for transportation of heart in North India. Within 5 months, on 2nd January 2015 we were able to successfully transport a heart from FMRI Gurugram to Fortis Escorts at New Delhi, a distance of 32 Km in 29 minutes! The police have been very cooperative and established as many as 44 Green Corridors in 2017 in the NCR at short notice.
You have been one of the driving forces of the deceased donation program in the Fortis group of hospitals. What has been the impact?
We focused on the 18 large Fortis hospitals that carry out organ transplantation, made an SOP on diagnosis of brain death and organ donation and held workshops. It is important to remember that organ donation does not happen on its own. Someone has to push the program constantly. As of date we have had 83 organ donors in 11 of our major hospitals across the country leading to retrieval and transplantation of 236 organs (139 kidneys, 66 livers, 28 hearts, 2 lungs and 1 pancreas). We have also established a Nursing driven process where relatives are counselled for Cornea Donation after each death in hospital.
The NDTV-Fortis campaign to promote organ donation has been garnering a lot of interest over the past few years. What are some of the significant achievements of the campaign?
At Fortis Healthcare organ donation is a priority. The visiting card of every Fortisian carries a message to promote organ donation. The Fortis-NDTV ‘More to Give’ campaign is in its season-III this year. We have had brand ambassadors like actors Irrfan Khan, Swara Bhaskar, Rajkummar Rao, and Former Indian Hockey Captain Sandeep Singh over the last three years. Our short film to promote organ donation won the Dadasaheb Phalke award in 2017 and was viewed by over 10 million people on Facebook. Our simultaneous Walkathon, covered live on NDTV, has expanded from 6 cities to 12 this year. We have been able to garner over 100,000 pledges so far. More To Give campaign was awarded the best CSR initiative in 2017. Does all this convert into more donations? The effect of what we do today will be seen over decades not years as it takes a generation to change the mindset of the nation. For me, the fact that six of our hospitals saw their first organ donation during the campaign is very significant.
Why do you think collaboration in training initiatives for organ donation and transplantation is important?
Organ donation is all about teamwork. We have to constantly support each other and not be afraid to learn. Spain is the leader in the field of organ donation and for the last five years we have invited experts from there to participate in national level meetings on organ donation hosted by us. The FORT- MOHAN Foundation partnership has grown stronger over the years and we have been conducting an annual training program on Transplant Coordination for the last five years, more recently under the aegis of NOTTO.
You have ‘walked the talk’ when it comes to organ donation…
We had the misfortune of losing my mother-in-law, Smt. Uma Chopra in 2014. Having worked in organ donation for over a decade I experienced first-hand the difficulties in the process. A large tertiary care hospital in South Delhi had no approvals for certification of brain death. My Father-in-law found it difficult to accept the concept of brain death as the heart was still beating and we had to show him a flat EEG for him to accept the loss.
We realized the importance of involving the younger generation as it was my daughter who convinced her Nana (grandfather) to donate organs. Today we are all happy that she is alive in five people! The other day, after one of my talks at NOTTO, a young lady came up to me and said ‘Sir, I just saw your presentation. Your mother’s liver is inside me!’ The sensation I felt when I shook her by the hand was overwhelming and cannot be described in words.
Your team has a first to its name in transplants in India – Stool transplant.
Yes, we performed the first stool transplant in the country on 14th November 2014 at FMRI and published the same. The research projects on stool transplant have expanded from Ulcerative Colitis to Irritable Bowel syndrome, Alcoholic Hepatitis, Metabolic syndrome and Parkinson’s.
What are the challenges and what is the way forward for the deceased organ donation programme in India?
Efforts at increasing organ donation have to focus simultaneously on legislation, increasing awareness and establishing best practices on the subject in all hospitals. Only 16 out of 26 states and Union Territories have adopted the amended Transplantation of Human Organs and Tissues Act of 2011. Prominent states like Punjab and West Bengal have virtually no organ donation. Organ donation cannot be viewed in isolation. It is a part of delivering quality health care. The Government needs to spend more on health, have better trauma care services, better critical care, more ventilators and more trained staff.
Other than being an ardent advocate of organ donation, what is your passion?
Cricket! I had the rare privilege of playing 20 Ranji Trophy Cricket matches from 1982 to 1986. Rubbing shoulders against the World Cup winning team members of 1983 was special. Scoring three centuries against them is a great memory!
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- Keywords: interview, driving force for organ donation, AORTA, Green Corridor drill, NDTV Fortis campaign