AFTER his wife phoned him to relay a message from the National Heart Institute (IJN) during a meeting, Albert Gunaratnam, told his staff in a light manner that he was going to "tukar jantung."
At that moment, most of his staff did not believe him. They had heard of the first heart transplant conducted successfully by IJN on R. Sathrugnan but were not convinced that the man in front of them would be going through the same experience.
In fact, Gunaratnam was the second heart transplant patient after Sathrugnan.
The phone call informed him that there was a donor who was brain dead after a road accident in Ipoh and the donor's family had consented to donate his heart and other organs.
Gunaratnam, who was on the IJN waiting list for about three weeks, was identified as the most suitable recipient of the heart.
On April 9, Gunaratnam arrived at the IJN at about 5pm. He was immediately put through all the necessary tests, including blood specimen test to make sure he was physically fit for the transplant.
To avoid being caught in the traffic jam, both teams were escorted by traffic outriders from IJN until they reached the toll gate of the PLUS highway.
From the highway exit in Ipoh, they were again escorted to the hospital.
Meanwhile, heart transplant coordinator Sister S. Ramayee and nurses at the intensive care unit of the Ipoh Hospital were kept busy with preparations for the major operation.
In fact, a total of four procurement teams were involved to harvest the heart, kidneys, corneas and bones of the victim.
Ramayee said that after sending Gunaratnam for check-ups, she was to stand by the phone to answer calls from Ipoh Hospital, from the assessment team and procurement team, from the Institute of Medical Research which was testing Gunaratnam's blood specimen, and from other transplant coordinators.
In between calls, Ramayee found time to comfort and reassure Gunaratnam's wife, Terry Nelson.
"I have to make sure things run smoothly. Time is very critical during that period," Ramayee said.
"Most of the co-ordination jobs were done through the phone and I have to arrange, organise and settle them," she said.
As soon as the assessment team had confirmed that the donor's heart was in good condition and suitable for Gunaratnam, he was wheeled into the operating theatre.
While the procurement team was on the way back to IJN, Gunaratnam was anaesthetised and a team of surgeons prepared him for the transplant.
The procurement team arrived at IJN at 3.25am on Friday to hand over the heart.
The transplant was completed at 6.25am and the whole process -- procuring the heart in Ipoh and implanting the heart into Gunaratnam's chest -- took only three hours and 25 minutes.
"We have to beat the clock ... a heart is only good for four to six hours after being removed from the body," said Ramayee.
She said this was called the "ischaemic time" for the heart. It starts when blood supply is disconnected from the donor's heart till it starts to work in the recipient's body.
As soon as the heart was removed from the donor's body in Ipoh, it was put into a preservative solution and placed in a box full of slushed ice and rushed to IJN.
"There must be teamwork to make a heart transplant successful," said Ramayee, adding that coordination from all parties including traffic police outriders, IJN drivers, lab technicians, pharmacists, physiotherapist, dietician and phone operators were essential to avoid mistakes or time-wasting."
As team coordination is essential to ensure a successful transplant, the IJN team had held practice runs using sheep since 1996.
She said the team used sheep's heart obtained from University Putra Malaysia (UPM) in Serdang and the procedure involved traffic outriders escorting the team back to IJN.
During the first practice run, the team was caught in a traffic jam with a sheep's heart while travelling from Serdang to IJN.
For the second test run, the organ was transported some 200km.
"With the good highway, we could rely on road travel," she said, adding that any distance ranging from 200km to 400km would involve transportation by helicopter.
With only a few organ donors in the country, time is of the essence for the transplant to be carried out smoothly and successfully.
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