Date: February 17, 1968. Place: King Edward’s Memorial (KEM) Hospital, Mumbai. Dramatis Personae: A 53-year Indian vascular and cardiothoracic surgeon. A 27-year old male farmer with a faulty heart. A 20-year old Maharashtrian woman who had sustained severe head injuries from a train accident. The occasion: The attempt at India’ first human heart transplant.
That fortuitous February day was rife with expectation. Nearly three months ago, on December 3, 1967, South African Dr Christiaan Barnard had performed the first human cardiac transplant and the world was astounded by this medical feat. Dr Prafulla Kumar Sen (December 7, 1915 – July 22, 1982), a vascular and cardiothoracic surgeon, had been preparing for this day. He had earlier experimented with transplants on mongrel dogs with no long-term survival rate and this was the first attempt at human heart transplantation. Dr Sen knew the odds were stacked against him but he was ready to yield the scalpel.
The patient, a farmer suffering from chronic progressive cardiomyopathy, had been in and out of the hospital for the past six months. When chosen as the recipient of the heart transplant, the farmer was made aware of the risks of cardiac transplantation and admitted to KEM Hospital’s surgical ward in January 1968. On February 16, 1968, a 20-year-old woman was brought to the hospital’s emergency room with severe head injuries from a train accident. Her blood group (O+) matched that of the patient-farmer and she was chosen as the donor.
As Dr Sen and his team donned the scrubs, the donor lay in the ‘donor room’ next to the main operation theatre where the patient was being readied for the epoch-making surgery. It took 4 minutes to excise the heart of the female donor and the transplant surgery took about two hours. Soon, the farmer’s heart resumed normal rhythm.
The heart did not beat for too long. Within three hours of the surgery, the farmer died of heart failure. But that one heartbeat of the farmer changed cardiac surgery in India. It was the country’s first human heart transplant and only the sixth in the world. Dr Sen became the fourth surgeon in the world to attempt this surgery; the other three surgeons being Dr Christiaan Barnard, Dr Norman Shumway and Dr Adrian Kantrowitzthe.
Also read: Kerala's first artificial heart implantation done successfully on a 61-year-old woman
The death of the patient barely three hours after a heart transplant did not deter Dr Sen. A few months later (September 13, 1968), he transplanted the heart of a road accident victim into a young patient. Once again, the surgery was successful but the patient did not live long. His heart ceased to function 14 hours after the procedure.
After Dr Sen’s second surgery, for 26 years, no human heart transplants were attempted in India, mainly because the country did not have proper laws concerning brain death and organ donation. In 1994, the Transplantation of Human Organs (THO) Act was passed by Indian Parliament which legalised calling brain-stem death and streamlined the procedure for cadaveric organ retrieval and transplantation. The same year, Dr P. Venugopal led the first successful heart transplant in India at the All India Institute of Medical Sciences, New Delhi.
In Transplant Buccaneers: P.K. Sen and India's First Heart Transplant, February 1968, authors David S. Jones and Kavita Sivaramakrishnan write: “On February 17, 1968, Bombay surgeon Prafulla Kumar Sen transplanted a human heart, becoming the fourth surgeon in the world to attempt the feat. Even though the patient survived just three hours, the feat won Sen worldwide acclaim. The ability of Sen's team to join the ranks of the world's surgical pioneers raises interesting questions. How was Sen able to transplant so quickly? He had to train a team of collaborators, import or reverse engineer technologies and techniques that had been developed largely in the United States, and begin conversations with Indian political authorities about the contested concept of brain death.”
According to the Global Burden of Disease study, nearly a quarter (24.8 %) of all deaths in India today are due to cardiovascular diseases (CVDs). As the case fatality due to CVD increases and the age of first myocardial infarction decreases (53 years in India, which is about 10 years earlier than their counterparts in developed countries), it is heartening to look back and remember Dr Sen and his can-do spirit.
Had he lived, Dr Prafulla Kumar Sen, a surgeon, poet, painter, would have turned 106 on December 7, 2021. Had he lived he would have witnessed the technological advancement in cardiac transplant surgery. A path that he paved 53 years ago in the operation theatre of Mumbai’s KEM Hospital on a historic day in February 1968.
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