Dr. ANAND RAMAMURTHY
Dr. Anand Ramamurthy
Senior Consultant Surgeon
MS, MNAMS, MRCS(Ed), DNB(SGE), PDF(LT)
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CONTACT INFO
Dr. Anand Ramamurthy is Senior Consultant and Director Training, Academics and Researchat The Centre for Liver Disease and Transplantation at Apollo Hospitals, Chennai. He is also an Adjunct Associate Professor (AHERF) in Surgical Gastroenterology and Liver Transplantation.
He completed his medical and surgical training from Maulana Azad Medical College, Delhi University, one of the leading institutions in India where he had a meritorious academic record.
He underwent specialty training in Surgical Gastroenterology from Sir Ganga Ram Hospital, Delhi where he worked with pioneers in the field of surgery for portal hypertension, pancreatitis and periampullary malignancies, ulcerative colitis and liver transplantation among others.
He subsequently joined the Liver Transplant program at Sir Ganga Ram Hospital as a Senior Clinical Fellow. He has an extensive experience of living related liver transplants and management of critical patients in liver transplant intensive care unit. He has been a part of numerous ‘firsts’ in the liver transplant program in India including the first dual lobe living donor liver transplant, combined liver-kidney transplant, the oldest and the youngest recipients among others. He then worked at King’s College Hospital, London where he gained experience in various aspects of deceased donor multiorgan retrieval and whole liver transplantation.
He is a member of several prestigious professional organizations including the Royal College of Surgeons of Edinburgh, Association of Surgeons of India, Indian Association of Surgical Gastroenterology, Indian Society of Organ Transplantation, Indian Medical Association, and National Academy of Medical Sciences, among others. He has several publications in peer-reviewed journals and textbooks.
Since it’s inception in 2008, the liver transplant program at Apollo Hospitals, Chennai has grown into the most prolific center in the country for cadaver liver transplantation as well as one of the few centers performing both deceased and living donor liver transplantation having performed over 250 liver transplants with 1-year graft and patient survival over 90%. Apart from transplant, numerous hepatobiliary pancreatic surgeries are also being performed such as pylorus preserving pancreatoduodenectomy for periampullary malignancy, liver resections in patients with cirrhosis and malignancy of the gall bladder among others.
The department of Surgical Gastroenterology at Apollo hospitals, Chennai is accredited by the National Board of Examinations to train 2 candidates every year for DNB (Surgical Gastroenterology). The Centre for Liver Disease and Transplantation also has a 1-year institutional fellowship for post- MCh/DNB (Surgical Gastroenterology) candidates to train in Hepatobiliary Surgery and Liver Transplantation.
Specialities
Liver Transplantation
Liver transplantation is another subspecialty that deals with liver failure either due to Cirrhosis and Chronic liver disease or Acute liver failure.
Hepato Biliary Pancreatic Surgery
Hepatobiliary pancreatic (HPB) surgery is a subspecialty of Surgical Gastroenterology that deals with the liver, bile ducts and pancreas.
KNOW YOUR DOCTOR
KNOW YOUR DOCTOR
- Domino Liver Transplant
- 200 Liver Transplants
- Three Liver Transplants
Requirement & Background : The demand for livers far outweighs the supply of deceased donor organs in our country as well as across the world. 30-40% of patients on the waiting list for a deceased donor transplant either succumb to complications of liver failure or become too sick to undergo a liver transplantation while waiting. Various strategies aimed at increasing the donor pool and reducing waitlist mortality have been explored across the world. One such innovation is domino liver transplantation, appropriately named, as two recipients undergo transplant from one deceased donor. This is possible because in certain rare congenital metabolic
The liver transplant team at The Centre for Liver Disease and Transplantation (CLDT), Apollo Hospitals, Chennai completed 200 liver transplants on 24th December 2012. It took half the time (1.5 years) to complete the second hundred transplants as compared the first 100 (3 years; 19/03/2008 to 21/04/2011). Our team performed 70 liver transplants in 2012, an increase of 30% from 2011 (55). We have performed the highest number of deceased donor liver transplants in the country (164) and are now the third largest centre overall. Our teamis now running the liver transplant programs at Apollo Hospitals Hyderabad and Bangalore.
Three Liver Transplants Performed in less than a Day at Apollo Hospital, Chennai
On July 11, 2013 the liver transplant team at Apollo Hospital, Chennai performed 3 liver transplants in less than 24 hours. Two were deceased donor liver transplants, 1 from a donor in Apollo Hospital, Chennai and 1 in Coimbatore allocated fromthe governmentpool. The third transplant was a scheduled pediatric living donor liver transplant for a sick 9-year old child with a part of left liver donated by his father. The situation presented a logistic challenge.Four teams of surgeons simultaneously retrieved livers from 2 donors (the Coimbatore donor involving transport by commercial aircraft) and transplanted them into 2 recipients with cirrhosis.
Deceased Donor Liver Transplantation at Apollo Hospital Chennai
Apollo Hospitals, Chennai, performed the first deceased donor multi-organ retrieval and the first liver transplant in the country on December 24, 1995. Five deceased donor liver transplants were performed between 1995 and 1997 but subsequently slackened. Meanwhile liver transplantation was on the way to becoming an established procedure for the treatment of end-stage liver disease in the country. Almost all the transplants being performed at that time were living donor liver transplants. In 2007, a new team comprising Dr. Anand Khakhar and Dr. Anand Ramamurthy joined Apollo Hospitals, Chennai with a mandate from the visionary Chairman of the Apollo Hospitals Group, Dr. Prathap C. Reddy to establish the first liver transplant program in Southern India.
We believed that the ideal system would be one where both, deceased as well as living donor liver transplants would be performed. It was clear from the beginning that existing systems in the west for organ donation could not be directly implemented and that it would require adaptation to the unique sociocultural economic and healthcare environment encountered here. A big difference here was that deceased donation was largely driven by the energy of the transplant programs.
A systematic approach to recognition and declaration of brain death, maintenance and optimization of potential donors, grief counseling and obtaining consent for solid organ donation was established.Declaration of brain death was encouraged and protocols for evaluation and maintenance were laid down in our ICU’s. The primary physician informed the family about brain death and the concept of organ donation was introduced. An intensivist(medical coordinator)would coordinate with the primary physician, relatives and 2 doctors from a government-approved panel for testing and certification and obtaining consent for brain death.A nurse coordinator was entrusted with the task of building a rapport and bereavement counseling of the next of kin as we observed that they were more likely to trust and respond to a caregiver than a social worker. We travelled across the state, addressing doctors regarding issues about brain death, organ donation and liver transplantation through forums like the Indian Medical Association, Association of Physicians of India among others. We also conducted meetings to increase public awareness through social and corporate organizations. A big revelation for us was that there were people who wanted to donate but was unaware of the procedure and the eligibility.
These efforts started showing results and in 2008, 2009 and 2010 the number of deceased donations were 13, 24 and 28 respectively. As the numbers of liver transplants started increasing the state government took cognizance and between September 2008 and February 2009 passed 8 Government Orders (GO) that laid down ground rules for declaration of brain death, retrieval, allocation and sharing of organs between centers. Scientific advisory sub-committees constituted of medical experts from the field were established to fine tune organ specific rules regarding recipient listing, organ allocation and other issues arising from time to time. The government also encouraged organ donation by recognizing and felicitating donor families. One such event, namely the decision of a doctor couple to donate the organs of their son in September 2008 was highlighted and contributed in a big way to encourage organ donation. The print media also played an important role in creating public awareness and acknowledging organ donation by articles highlighting deceased donations and transplantation. Contrary to popular belief deceased donation has cut across barriers of socioeconomic status. We have encountered exemplary donation by illiterate, daily wage labourers as well. Our youngest donor was 6 years old and the oldest used liver came from a 70-year-old donor.An interim analysis of potential donors at our hospital over a period of 4 months from May to September 2010, revealed a 44% conversion rate (15 out of 34 families). This reflects the maturity of the system and the commitment of our coordinators. Of significance is that only 4 (12%) families refused consent after counseling by the transplant coordinators.
These efforts started showing results and in 2008, 2009 and 2010 the number of deceased donations were 13, 24 and 28 respectively. As the numbers of liver transplants started increasing the state government took cognizance and between September 2008 and February 2009 passed 8 Government Orders (GO) that laid down ground rules for declaration of brain death, retrieval, allocation and sharing of organs between centers. Scientific advisory sub-committees constituted of medical experts from the field were established to fine tune organ specific rules regarding recipient listing, organ allocation and other issues arising from time to time. The government also encouraged organ donation by recognizing and felicitating donor families. One such event, namely the decision of a doctor couple to donate the organs of their son in September 2008 was highlighted and contributed in a big way to encourage organ donation. The print media also played an important role in creating public awareness and acknowledging organ donation by articles highlighting deceased donations and transplantation. Contrary to popular belief deceased donation has cut across barriers of socioeconomic status. We have encountered exemplary donation by illiterate, daily wage labourers as well. Our youngest donor was 6 years old and the oldest used liver came from a 70-year-old donor.An interim analysis of potential donors at our hospital over a period of 4 months from May to September 2010, revealed a 44% conversion rate (15 out of 34 families). This reflects the maturity of the system and the commitment of our coordinators. Of significance is that only 4 (12%) families refused consent after counseling by the transplant coordinators.
Our work speaks for itself. The numbers of deceased donors have increased over the years. We performed 200 DDLT’s till December 2012. The majority of them continue to be generated at ournetwork hospitals. Public awareness is increasing and will ensure that organ donations continue to increase. The future lies in creation of independent organ procurement organizations that, like in the west coordinate the identification, maintenance and distribution of organs.
