Historic kidney transplant completed in seven hours –’new hope’ patient being monitored

Munesh Mangal and his mother at the Georgetown Public Hospital prior to the surgery on Friday. (Photo courtesy of the Ministry of Health)

By Iana Seales

Guyana’s first kidney transplant surgery was successfully completed in seven hours yesterday and patient Munesh Mangal was reportedly doing well, but will remain in the Intensive Care Unit (ICU) at the Georgetown Public Hospital for the next few days as doctors monitor his condition.

The possibility of Mangal rejecting his mother’s donated kidney is among immediate concerns though the compatibility tests done earlier were positive, and based on an early prognosis yesterday the 18-year-old’s body was responding well to his new kidney.

Just a few years ago, Mangal’s health had severely deteriorated after he was diagnosed with renal failure.
Mangal and his mother went in for surgery at 7.30 am and were out a little after 2 pm, which was earlier than expected. However, according to the doctors, the operation was well-coordinated and went as planned.

Minister of Health, Dr Leslie Ramsammy called the surgery “a new hope” for Mangal and “a bright promise” for all of Guyana, adding that someday in the not-too-distant future, the country will offer kidney transplant as a routine medical service.

Dr Rahul Jindal, lead attending surgeon, told reporters at a press briefing hours after the operation that Mangal would be closely monitored because he was susceptible to infections and other blood conditions. He would therefore likely spend another two to three days in the ICU, before being moved to the general ward.
His mother, Leelkumarie Mangal, who is also in the ICU, would be moved to the general ward today. In another three days, Leelkumarie could be released from hospital, Dr Jindal said. However, Mangal would remain for a minimum of five days.

Leelkumarie would be on medication for some time, but Mangal’s would likely be for the rest of his life.

Medical breakthrough: Dr Rahul Jindal, lead surgeon (right) and his team operate on Munesh Mangal yesterday, creating history in Guyana by completing the country’s first kidney transplant surgery. (Photo courtesy of GINA) “The surgery went as expected but we were able to complete it much earlier. The expertise and support was tremendous and the patient and his mother were trusting so everything just fell into place,” Dr Jindal said.

He said that post-op care was critical noting that the public hospital had all the facilities and expertise in place to provide the necessary care. Dr Jindal added that the patients would be well cared for while in hospital and after their release, since the hospital and the Ministry of Health had committed to this.

Though the focus was on Mangal and would be for some time, more kidney transplants are expected to be completed at the hospital in the coming months. Two patients suffering from renal failure who were seen by Dr Jindal and his team of US doctors on Friday were identified as possible candidates since according to the doctors, “they are in pretty bad shape”.
George Subraj, an overseas-based Guyanese who was instrumental in assisting Mangal with the surgery, has given a personal commitment to fund the medical team for at least another five kidney transplants.

Munesh Mangal and his mother at the Georgetown Public Hospital prior to the surgery on Friday. (Photo courtesy of the Ministry of Health)Subraj said while the need was there he would try to assist by bringing the best teams and working in collaboration with the Ministry of Health and the hospital.
“I saw an opportunity to help a young man who was ailing and I did. I am sure there are many others out there but it requires a certain amount of collaboration and funds as well,” Subraj added.

Two-fold surgery
Dr Jindal explained that Mangal’s mother was first rolled into the operating room and her kidney was removed in a procedure that took around three and a half hours. The kidney was then cleaned and readied to be inserted into the young man and this took roughly around the same time; in total, about seven to eight hours.
In another five days, Mangal’s new kidney should be functional but Dr Jindal reiterated that they would be looking at how his body responded to the kidney. He recalled visiting the young man at his home in Lusginan, being touched by his story and wanting to help.

According to the doctor, a team was quickly assembled since many persons just wanted to come and help. He noted that the doctors all volunteered their services and were eager to do so after hearing Mangal’s story.

“I remember that this lad and his mother were desperately trying to raise money for him to go India but it was George Subraj who showed a tremendous amount of concern and who wanted to help this family, he moved us to act,” the doctor stated.

The overseas medical team included the Indian-born Dr Jindal of Brookdale University Hospital; Dr Edward Falta, Transplant Surgeon of the Walter Reed Army Medical Centre (WRAMC), Washington; Dr Melenie Guerero, Pulmonary Care Physician; Laura Owens Transplant Coordinator, and Dr Arthur L. Womble attached to the Athens-Limestone Hospital, Athens, Alabama.
The local team included Dr Ravi Purohit, Surgeon;  Dr Ramsundar Doobay, Consultant, Internal Medicine; Dr Anita Florendo, Registrar, Internal Medicine; Dr Vivienne Amata, Anaesthesiologist; Dr Pheona Mohamed-Rambaran, Laboratory Director; Delon France, Medical Technologist, and Dr Wilson, Radiologist.
It is expected that within the coming years the local team will benefit from the expertise of Dr Jindal’s team and will eventually run with the programme.

Building capacity
Ramsammy said the surgery represented much for the country and was a tremendous step towards a stronger health care system.
Through an ongoing relationship with the US medical doctors and Guyanese in the diaspora, he said, Guyana will build capacity for kidney transplant and eventually offer it as routine service, making it a permanent part of the local health sector. But he cautioned that it will take time, the necessary funds and the right human resources.

“This is a huge success for us in Guyana and for the Caribbean region because we have taken this first step towards having a solid programme within our health care system. I remember when people called me mad when they heard I was going ahead with it and we are at this place today where this has actually happened,” Ramsammy said.

With around 10,000 new cases of diabetes a year in Guyana and a similar alarming number for hypertension, the minister said, a great demand was being placed on the health care system. He said dialysis still played a critical role in the lives of many persons and urged the private sector to keep assisting in this area.
Ramsammy commended the diaspora for the role it played in making the first kidney transplant a realization. He said the community has been assisting for years and continued to be active in many projects. He singled out Subraj for the work he has done.

Suffering for years
Mangal had suffered for years before being diagnosed with renal failure last October. In months that followed the young man started losing his sight and had to drop out of school as his health deteriorated. His mother gave up working as a vendor to care for him and as she described it, “things were difficult”.

He was on dialysis as the family tried to raise money for him to have a kidney transplant done in India but barely got anywhere with accumulating the funds. She was prepared since then to give one of her kidneys to her son. Since dialysis costs around $35,000 per treatment session and he required it three times a week, the mother said, they were forced to ask for help and a few corporate entities and kind persons assisted.

This operation is expected to grant Mangal a new lease on life and as his mother said, “remove a great burden off the family’s shoulders”.
It was in May that Ramsammy first announced that a kidney transplant surgery would be done in Guyana. Mangal had already been identified as the candidate and several tests were then carried out to determine whether his mother was a positive match for him.
Coordination of the project then kicked into full gear and over a period of time doctors did a careful scrutiny of Mangal and his mother.

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