First Small Bowel Transplant Patient Of Mumbai Embarks On A New Journey

Bengaluru June, 2022: Global Hospital, a centre for multi organ transplantation conducted the first ever small bowel transplant in Mumbai on Anirban Samanta, a 46 year old patient from Kolkata. Dr. Gaurav Chaubal with his team of doctors performed this complex surgery. Small bowel transplant, a complex and rare surgery has been conducted approximately 12-18 times in India. More than 50% of these surgeries were conducted in Maharashtra alone and this is the first surgery conducted in Mumbai.

Mr. Anirban Samanta had diffuse severe abdominal pain in April 2022, which was diagnosed as Superior Mesenteric Artery Thrombosis leading to Bowel Gangrene for which he was treated at a local hospital. He underwent resection anastomosis and jejunostomy on 17th April 2022. He was on parenteral nutrition since then and was listed with ZTCC in May 2022. An alert was received on 18th May 2022, and the team went for retrieval after receiving a negative report on the CDC cross match.

Dr. Gaurav Chaubal, Director – liver, pancreas, intestine transplant programme and HPB surgery at Global Hospital, Parel, said, “The donation of the Small Bowel is important to treat people who suffer bowel failures caused by twisting of the bowel, birth defects, or when a part of the bowel tissue dies. Dr. Chaubal added, “Early last month, Anirban was listed with the Zonal Transplant Coordination Center (ZTCC), Mumbai, for an organ transplant as this was the only treatment available for him given the challenges he faced. The patient has shown phenomenal progress post- surgery and has fully recovered. I urge people to come forward and donate organs for those who are in need, this might give them a new hope to live their lives.” Dr. Chaubal has successfully conducted over 600 complex surgeries like Living donor Intestine Transplants, Liver Transplants, Simultaneous Kidney Pancreas transplant, Simultaneous Liver Kidney Transplants and complex HepatoPancreaticoBiliary surgeries.

Small bowel transplant may be considered for people with bowel failure who develop complications from total parenteral nutrition (TPN – where a person requires all their nutrition to be given through a drip into a vein because their bowel is unable to absorb nutrients from any food they eat). Bowel failure means a person’s bowel is not able to absorb enough nutrients from food. It’s most often caused by either short bowel syndrome or a non-functioning bowel. Intestinal transplants are very complex and rare across the world and very few doctors have specialisation in such transplants. Small bowel is a complex organ and transplants are prone to rejection. Dr Gaurav is trained to do such surgeries and has the largest series of small bowel transplants in western India including Living donor small bowel transplants. Such rare and complex case studies have helped us set new benchmarks not only in India but internationally too.

Mr. Anirban Samanta said, “When I was in Kolkata the doctors there lost all the hope that I would even survive more than two months and then later when we got to know about Dr Gaurav Chaubal who specialises in such cases and we came down to Mumbai to meet him and we got hope that I might survive through this. And my surgery was successful. Me and my family feel blessed and grateful that the transplant was successful, considering that just a few dozen small bowel transplants have been performed in the country so far. We would like to thank the donor family for taking the magnanimous decision of donating organs in time of grief for them.

Dr. Vivek Talaulikar, CEO, Global Hospital, Parel, lauded the entire team for taking up challenging and complex cases and delivering excellent clinical outcomes. He mentioned “The success of the Intestine Transplant is a proud moment for the hospital as with the discharge of this patient, Global Hospital, Parel, Mumbai, is the only private hospital in India to have to its credit multi-organ transplants like Kidney, Liver, Heart, Lung, Pancreas, Hand and Small bowel. Global Hospital, Parel, Mumbai, has always been on the forefront of Transplant care in western India with multiple firsts to its name with regards to Liver, Kidney, Heart, Hand and now small bowel Transplant. It is a matter of pride for the hospital that the transplant surgeon Dr. Gaurav Chaubal who performed Mumbai’s first small bowel transplant also started the living donor intestine program and performed the first transplant on a paediatric patient in Singapore.”

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As we celebrate the World Food Safety Day, our heart should go for the193 million people who face acute food insecurity in 53 countries and territories according to the Global Report on Food Crises, GRFC 2022 released recently by the United Nations. These numbers are in themselves alarmingly high and point towards the need for a greater analysis of the drivers of food insecurity and inspire us to consider global actions for an integrated response to food security, economic inclusion, employment creation and actions to mitigate climate change. Although the report highlights the countries facing acute food insecurity for some years like Yemen, Somalia, Ethiopia. Sudan, and Nigeria, food insecurity is in fact looming large on the vast humanity. Food insecurity is partly due to repeated draught and adverse weather conditions and because of instability of governmental support and ongoing conflicts and war. Further, even in the countries that are otherwise comfortable on food production, the glaring economic disparity poses a serious threat to food insecurity. If anything, Russia’s continued aggression against Ukraine is going to make the situation even worse as Russia and Ukraine are among the largest producers of wheat and other cereals. In 2021, the two countries accounted for major shares of global exports of wheat (33 percent), barley (27 percent),maize (17 percent), sunflower seeds (24 percent) and sunflower oil(73 percent) as per the IFPRI report of February 2022. What Russian leadership has not understood that the post Covid-19 world required a dialogue rather than a war to resolve the conflicts of interest, if any, with neighbour. The old tactics of waging a conventional war to win over another nation’s territory would not work in a hyper-connected world in which the capabilities and moves of each nation are clearly visible to one and all. As Sam Pitroda beautifully put in in his best seller Resign the World- A Global Call to Action, “The future is not only about national pride, business, market, religion, or race, with the bogey of an enemy at the border; it is about climate change and human development. Now is the time to move from violence and military options to non-violence and the imperatives of peace”. With Russia still at war with Ukraine, the food insecurity and the global economic instability may further be impacted, even become the worst. Agriculture Development is Key to Food Security There could be no denying that agricultural sector is one of the most powerful vehicle for economic development and a valid means to end extreme poverty, create employment in the rural areas, boost economic inclusion, and feed a projected 9.7 billion world population by 2050.But nations around the world are deeply engaged in boosting economic growth using an urban centric growth strategy for the last several decades. Even in a country like India, that achieved international acclaim for its Green Revolution of the 1970s, the focused attention of economic development, especially after the globalization of national economy in July 1991 has largely rested on increased urbanization. The cities and mega towns began to be regarded as powerhouses of accelerated economic growth that was powered by IT and IT enabled high-tech automated industries and the service sector. Agriculture and the development of rural areas received a low priority, in otherwise a highly agri-based society of India. Increased urbanization besides causing exodus of rural population to the urban cities and mega towns, deprived the rural areas of both the capital as well as the talent to create a vibrant rural sector of economy. We need to pay a focused attention to the development of agriculture sector and the rural India by going rural with a high-tech mind and scientific solutions to boost agriculture productivity without eroding soil fertility and achieving substantial water conservation in cultivation of a variety of agriculture crops.  Further, alongside with increased production, we need to foster a new era of food processing and allied agriculture industries in rural areas to design and develop tomorrow 'smart village clusters as the new power houses of economic prosperity and sustainable development. Establishment of a chain of high-tech food testing laboratory is also urgently required to prevent food adulteration. Currently there is a real shortage of testing facilities, though the FSS standards are being tightened. A balanced approach to urbanization and high-tech village cluster development will suit the goal of accelerated economic development of a populous country like India. This is also the way to protecting the interest of people and the planet. Urgent Actions Needed to Stop Food Wastage and boost Food Processing Industry According to data provided by the United Nations Food and Agriculture Organization (FAO), India’s total food production across all categories such as fruits, vegetables, grains, and horticultural items accounts to a total of 308.65 million tons. After China, India ranks as the second largest producer of fruits and vegetables. Unfortunately, this large amount of food production is also associated with large amounts of food wastage. The FAO report indicates that as much as 40% of all food produced in India is wasted every year. Out of the 40% of food wasted, 18% accounts for Fruit and Vegetable production which is caused by lack of proper storage and dismal food processing industry. This is where immediate actions are required to overnight boost the storage capacity and provide an accelerated growth of high-tech food processing industry in the rural areas that now have excellent roads as well as cyber connectivity. However, the trouble in India is that we do not acknowledge the severity of the problem and tend to put it on backburner with the hope that the situation shall improve by itself, but the hope alone is not enough. It needs to be matched by strategic actions, implemented with conviction and with a sense of urgency. It is also disturbing to note that almost one third of food produced globally is either lost or wasted. As such addressing food loss and waste is critical to improving food and nutrition security, as well as helping to meet climate goals and reduce stress on the environment. A major attempt for series of systemic reforms in agriculture, including tackling food waste was however, made by the Government of India through the Agriculture Laws that were so viciously opposed by the famers unions and were ultimately withdrawn. A serious attempt to reviving the agenda for systemic reforms in the agriculture sector is urgently needed to safeguard the interest of the farmers as well as the people of India. Food is not just to fetch Hunger but for a Healthy Life  Our current food systems also threaten the health of people and the planet and generate unsustainable levels of pollution and waste. Reliance on meat for food is causing a serious concern both for the health of the people as well as that of the environment. The IPCC report 2021states that “non animal sourced food, including meat, poultry, and seafood alone account for reducing 8gigatons of CO 2  per year”. That itself amounts to just over 20% reduction in worldwide carbon dioxide emissions that are currently estimated at 38 gigatons per year. Naturally, it makes a great environmental protection sense to shift away from the meat based non vegetarian diets. Studies led by Dr Keren Papier, from the Nuffield Department of Population Health at the University of Oxford in 2021 have shown that excessive consumption of red as well as processed meat leads to an increased likelihood of developing colorectal cancer. The Oxford study also concluded that those individuals who consume excessive amounts of meat are more likely to adopt unhealthy habits such as smoking and alcoholism and are also more likely to develop diseases, compared to those who consume little or no amounts of meat. It goes without saying that we humans are designed to be vegetarians. Our teeth and jaw are the testimony of our vegetarian design. Our metabolism is also more akin to a plant based vegetarian diet. But unfortunately, in India, under the disguise of modernity there appears to be a mad rush towards non vegetarian diet and alcoholism while people in the western developed countries are shifting away from meat eating and alcohols. Let the celebration of World Food Safety Day inspire us to turn towards healthy food and protect the interest of both the people and the planet. Anugyan is a 12th grader at an International School in the US, and Professor Pritam B Sharma is an eminent academician, former professor of IIT Delhi, founder Vice-Chancellor of DTU and RGPV, past president of Association of Indian Universities, AIU. Previous post Food Security and Inclusive Sustainable Development will go Together- Anugyan and Prof Pritam B Sharma
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